In the second part of the duodenum there is a carcinoma some 5.0 cm. broad completely
surrounding the lumen and showing extensive ulceration. Proximal to the lesion there is irregular
thickening of the mucosa without ulceration. The common bile duct is thickened and dilated, and
is obviously obstructed by tumour.
This man presented at the age of 74 with crescendo angina. Investigation showed an
iron-deficiency anaemia; he was transfused and the angina disappeared. Further investigation
showed blood in the faeces; endoscopy established the presence of this tumour. In the meantime
he became jaundiced (with an obstructive pattern). The distal portion of the stomach and the greater
part of the duodenum was removed, together with the pancreas which showed tumour infiltration
in the head. The histology of the lesion is that of an adenocarcinoma of the duodenum.