A case of Bone Marrow Carcinomatosis after Surgery for Primary Duodenal Cancer

Abstract

A 73-year-old woman presented with upper abdominal pain. Upper gastrointestinal endoscopy findings indicated a semicircular type 2 tumor in the second portion of the duodenum. A diagnosis of signet ring cell carcinoma was made on biopsy, and she was referred to our hospital. Based on these examination findings, the patient was considered a suitable surgical candidate and a subtotal stomach-preserving pancreaticoduodenectomy was performed. Postoperative pathological examination findings indicated signet ring cell carcinoma > mucinous carcinoma > poorly differentiated adenocarcinoma. A six-month postoperative follow-up computed tomography scan showed no signs of recurrence ; however, at approximately seven months postoperatively, she experienced a loss of appetite along with neck, back, lower back, and bilateral thigh pain, and she re-visited our department. Blood test results indicated an abnormally high lactate dehydrogenase level (2350 U/L). A bone marrow puncture biopsy revealed proliferation of cancer cells, mainly poorly differentiated adenocarcinoma, and she was diagnosed with myelocarcinomatosis of duodenal cancer. 5-Fluorouracil, leucovorin, and oxaliplatin (mFOLFOX6) was administered, which was effective, with observable improvement in her activities of daily living ; however, the cancer subsequently worsened and she died. Given myeloid carcinomatosis of duodenal cancer is extremely rare, we report this case and discuss the relevant literature.