DUODENUM - Carcinoma

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.