Modern Medicine | 2016, Vol. 23, No. 3 247 Adenocarcinoma of Duodenum - Case Report Amelia Genunche-Dumitrescu 1,2 , Daniela Badea 1,4 , Mihail Badea 1,3 , Paul Mitruţ 1,2 , Vlad Pădureanu 1,2 , Aurelian Adrian Badea 1 1 University of Medicine and Pharmacy, Craiova, Romania 2 1 st Medical Clinic, Clinical Hospital of Emergency Craiova, Ro- mania 3 Clinic of Hematology, „Filantropia” Hospital, Craiova, Romania 4 Clinic Laboratory, Clinical Hospital of Emergency Craiova, Ro- mania Corresponding author: Amelia Genunche-Dumitrescu 35 Infratirii Street, bl. G, Craiova. E-mail: amelia_genunche@yahoo.com Abstract We present the case of a 45 years old man who was admitted with epigastric pain, asthenia, nausea and weight loss. The endoscopic exam revealed a duodenal tumoral mass and the following biopsy revealed adenocarcinoma. Ultrasonography identified liver metastases witch made the surgical intervention imposible. The patient folowed chimioterapeutic treatment. Keywords: upper gastrointestinal endoscopy, endoscopic biopsy, duodenal carcinoma. Rezumat Prezentăm cazul unui pacient, de sex masculin, în vărstă de 45 de ani internat în spital pentru dureri epigastrice, astenie fizică, vărsături și scădere ponderală marcată. Endoscopia a evidenţiat tumoră duodenală, iar examenul bioptic prezenţa adenocarcinomului. Ecografia abdominală a descris prezenţa metastazelor hepatice. Intervenţia chirurgicală nu a fost posibilă, datorită metastazelor hepatice multiple, iar pacientul a urmat tratament chimiote- rapeutic. Cuvinte cheie: endoscopia digestiva superioara, biopsia endoscopică, carcinom duodenal. CASE REPORTS BACKGROUND Primary duodenal carcinoma represent 35-45% of all tumors in the small bowel but he has a small share in all gastro-intestinal tumors (0.35%) 1,2 . e most frequent type of tumor in the duodenum is the adenocarcino- ma, but can observed other types of tumours such as lymphomas, carcinoid tumors, gastrinomas, leiomyo- sarcomas and stromal tumors 3 . e localization of the primary duodenal adenocarcinomas is in the first and second level of the duodenum, and 20% and 10% re- main in the next two levels. Early detection of the carcinoma has low frequency. Patients with Gardner syndrome or family history of polyposis may have a higher risk of developing duo- denal cancer. Patients who have duodenal polyps also have an increased risk, regardless of family history 5 . Clinical picture of patients with early duodenal can- cer consist of epigastric pain, vomiting, nausea, weight loss and upper gastrointestinal bleeding. At first pre- sentation many patients with duodenal cancer had le- sions, frequently in an advanced stage. e metastasis appear in liver, lymph nodes and lungs. e duodenal carcinoma was diagnosed by upper gastrointestinal endoscopy and was confirmed by his- tological examination. Barium examination show an irregular structure of the duodenum in most cases. EUS determine the size and depth of infiltration and also assesses regional lymph nodes. e ultrasono- graphy can diagnose and assess the vascularity of larger lesions, but the smaller tumours (<2 cm) may not be detected. e imagistic methods, the tomography and magnetic resonance (CT, MRI), showed the tumor in- vasion and localization. e complex treatment of cancer involves specific therapeutic measures. ese must be taken in order to increase the resistance of the organism to the malign