Tracking Down Duodenopancreatic Malignancy

Background Malignant tumours of the duodenumare rare and often difficult to diagnose. Due to thesmall clinical experience with duodenal malignanciestheir prognosis is unknown and resection is thetreatment of choice.Case report Adding to a small series of incidentaltumours, we report the case of a 65-year-old patientwith primary extranodal (MALT-) lymphoma of theduodenum infiltrating the pancreatic head. Thepatient was admitted because of anaemia andepigastric discomfort with a history of Helicobacter-pylori associated gastric ulceration. Physicalexamination and bloodchemical values were otherwisenormal. Endoscopy revealed duodenal ulcerationbut the biopsies taken from the ulceration didnot give any evidence of malignancy or residualHelicobacter pylori infection. But MRT showed acircular intramural tumour of the duodenum. Onlaparotomy a large duodenal tumour adherent to thepancreatic head was found and a Whipple procedurewas performed.Conclusion Apart from describing the case of arare lymphoproliferative disorder of the duodenum,this report illustrates the diagnostic difficulties withuncommon neoplasm''s of the duodenopancreaticregion and the value of MRT prior to resection of aduodenopancreatic mass.