Year 2021 / Volume 113 / Number 9
Letter
Duodenal lymphangiectasias — The first sign of pancreatic adenocarcinoma

684

DOI: 10.17235/reed.2021.7823/2021

Filipe Taveira, José Paulo Magalhães, Daniel Brito,

Abstract
A 41-year-old caucasian female, with past medical history of pituitary adenoma medicated with cabergoline, presented with worsening dyspepsia and unintentional weight loss of 5%. Physical exam and laboratory results were unremarkable for pathological findings. Esophagogastroduodenoscopy revealed an oedematous and exuberant lymphangiectasia appearance in the duodenum, with no ulceration or suspected infiltration component. However, duodenal biopsies revealed infiltration by poorly differentiated carcinoma. In the meantime, infection and inflammatory/autoimmune causes were ruled out. A CT scan was performed revealing a thickened and enlarged pancreas with ill-defined limits and several intra-abdominal adenopathies, raising suspicion of pancreatic lymphoproliferative disease. EUS with FNB was performed with biopsy of the pancreas and one of the larger adenopathy. EUS also revealed an enlarged, non-nodular pancreas and a thickened duodenal wall. Mild ascites was detected. Both EUS-biopsies were concordant on the diagnosis of carcinoma with gastric or pancreatic-biliary origin, highly aggressive (Ki67 > 80 %). Therefore, the diagnosis of pancreatic adenocarcinoma was assumed (cT4N1Mx). The patient is currently on palliative chemotherapy and remains paucisymptomatic.
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References
1. Vignes S, Carcelain G. Increased surface receptor Fas (CD95) levels on CD4+ lymphocytes in patients with primary intestinal lymphangiectasia. Scand J Gastroenterol 2009;44:252-6. DOI: 10.1080/00365520802321220
2. Freeman HJ, Nimmo M. Intestinal lymphangiectasia in adults. World J Gastrointest Oncol 2011;3:19-23. DOI: 10.4251/wjgo.v3.i2.19
3. Bhat M, Laneuville P, Marliss EB, et al. Secondary intestinal lymphangiectasia due to multiple myeloma. Gastrointest Endosc 2011;74:718-20. DOI: 10.1016/j.gie.2010.09.019
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Taveira F, Magalhães J, Brito D. Duodenal lymphangiectasias — The first sign of pancreatic adenocarcinoma. 7823/2021


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Publication history

Received: 24/01/2021

Accepted: 26/01/2021

Online First: 11/02/2021

Published: 07/09/2021

Article Online First time: 18 days

Article editing time: 226 days


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