Presentation
Work up for abdominal pain and vomiting. Palpable epigastric mass on physical exam.
Patient Data
Marked increased wall thickness due to tumoral infiltration is present at the second portion of the duodenum, causing luminal dilatation. Surrounding fat stranding is present and the mass invaded the pancreatic head and distal portion of the CBD. Intra and extrahepatic bile ducts are mildly dilated. The gallbladder is also distended without CT-detectable stone.
A well defined mass with a mean attenuation value of 5HU on non contrast images and rapid washout on post contrast images is noted at the left adrenal gland consistent with benign adenoma.
A 10 mm well defined fat density mass is noted at segment VIII of the liver, inferring lipoma.
Case Discussion
Endoscopy and biopsy and then duodenal mass resection was performed for the patient, and histopathology evaluation confirmed primary non-Hodgkin lymphoma of the duodenum (diffuse large B-cell lymphoma).
The differential diagnosis, in this case, would be lymphoma, adenocarcinoma, and gastrointestinal stromal tumor (GIST).
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