PMC9878825_01
(A) Endoscopic findings of the duodenum reveal a type 2 tumor on the descending part. (B, C) Abdominal computed tomography shows multiple liver metastases (long arrow) and lymph nodes (arrowhead). (D) After EUS-guided puncture, contrast agent was injected into the common bile duct for cholangiogram. (E) Choledochoduodenostomy was accomplished with a fully covered metallic stent through the duodenal bulb.
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Urayasu Ichikawa Medical Center. The patient had a medical history of diabetes mellitus and bronchial asthma. Upper gastrointestinal endoscopy revealed Borrmann type 2 duodenal carcinoma in the descending part of the duodenum ( Figure 1A ). Computed tomography (CT) revealed multiple lymph nodes, liver metastases, and lung metastases ( Figures 1B, C ). Guide wire was inserted through the duodenal bulb into the common bile duct and a metallic biliary stent (fully covered metallic stent 6cm) was placed using EUS-CDS ( Figures 1D, E ).
(A) Hematoxylin and eosin-stained biopsy specimen of the primary tumor. (B) Immunohistochemistry analysis showing strong ALK-positive staining.
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Immunohistochemistry analysis showed strong ALK expression in over 80% of tumor cells ( Figure 2 ).
(A) Course of tumor markers (carcinoembryonic antigen [CEA] and carbohydrate antigen 19-9 [CA 19-9]) while receiving treatment with FOLFOX and alectinib. (B) Abdominal computed tomography showing multiple liver metastases pre-FOLFOX therapy, increased tumor volume 4 weeks after the FOLFOX therapy, and reduction of liver metastases 6 weeks after alectinib. the second follow-up CT imaging showed continuing response for liver metastases.
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Figure 3 ). Furthermore, the patient's serum carcinoembryonic antigen and carbohydrate antigen 19-9 levels markedly decreased.