title: Pancreatic head cancer with distant duodenal metastasis: a case report with rare endoscopic presentations.
abstract: Metastasis to the duodenum from a primary cancer is rare, but direct extension from pancreatic cancer is much more common. Here, we present a case of multiple duodenal metastases of pancreatic head cancer in a 77-year-old woman with upper gastrointestinal bleeding. An upper gastrointestinal endoscopic examination revealed multiple elevated reddish nodules on a normal mucosa background that extended from the superior duodenal angle to the duodenal second portion. Echo-guided fine needle aspiration biopsies of the pancreatic head tumor and endoscopic biopsies of the reddish duodenal nodules proved the diagnosis of adenocarcinoma. When such endoscopic morphology is found, especially when the locations are distant from the papillae, metastasis should be considered and multiple biopsies are mandatory.
authors.affiliation: Division of Hepato-Gastroenterology, Department of Internal Medicine, Chang Gang Memorial Hospital-Kaohsiung Medical Center, Chang Gang University, College of Medicine, Kaohsiung, Taiwan.
authors.forename: Wei-Chen
authors.initials: WC
authors.lastname: Tai
authors.forename: Chi-Sin
authors.initials: CS
authors.lastname: Changchien
authors.forename: Tsung-Hui
authors.initials: TH
authors.lastname: Hu
authors.forename: Chao-Cheng
authors.initials: CC
authors.lastname: Huang
authors.forename: Seng-Kee
authors.initials: SK
authors.lastname: Chuah
authors.forename: Chuan-Mo
authors.initials: CM
authors.lastname: Lee
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000473:pathology*; D000368:Aged; D044963:Biopsy, Fine-Needle; D004379:Duodenal Neoplasms / Q000175:diagnosis / Q000556:secondary*; D016145:Endoscopy, Digestive System; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D009362:Neoplasm Metastasis; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery