Endoscopic Ultrasound-guided Fine Needle Aspiration for the Diagnosis of Duodenal Stenosis Due to Urothelial Carcinoma

Abstract

Upper tract urothelial carcinoma (UTUC) initially presents with hematuria and hydronephrosis. We report a case of UTUC presenting with initial findings of duodenal stenosis before the appearance of hydronephrosis. A 59-year-old man presented with upper abdominal symptoms on his initial visit. Esophagogastroduodenoscopy (EGD) revealed circumferential stenosis at the descending part of the duodenum. However, the underlying cause of duodenal stenosis was unknown as repeated histopathological examinations of endoscopic biopsy specimens showed no specific findings. We then performed endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of the thickened duodenal wall, and successfully diagnosed duodenal metastasis of UTUC. EUS-FNA is an effective diagnostic method in cases in which the cause of duodenal stenosis is unknown.

Renal pelvis cancer with initial symptoms of malignant gastric outlet obstruction

“…To our knowledge, only 12 cases of MGOO caused by UTUC, including 8 case reports (Table S1) and 4 cases from cohort studies (Table 1 and Fig. S1), have been reported in the literature 4–11 . Based on the analysis of 73 cohort studies, only 4 of 5046 patients with MGOO were caused by UTUC (0.08%) (Table 1 and Fig.…”

Duodenal stenosis caused by locally advanced upper tract urothelial carcinoma: a case report

“…Duodenal stenosis caused by UTUCs is rare. To the best of our knowledge, only five cases have been reported to date (Table 1) [3][4][5][6][7] and all were elderly. Four of the five patients were men.…”

EUS-guided fine needle aspiration provides an open view for duodenal obstruction caused by urothelial carcinoma: a case report

“…Lymph node metastasis and involvement in UCC were quite common and UCC usually metastasizes to distant organs, such as the lung, liver, stomach, skin, and eyes [8][9][10][11][12]. Several case reports have described that UCC could metastasize to the duodenum [13][14][15][16][17]. Duodenal malignant was extremely rare and duodenal adenocarcinoma was a primary tumor for malignant disease.…”

“…Our case showed the usefulness of EUS-FNA in the diagnosis of unknown wall thickening of the duodenum. Previously, five cases reported the diagnosis of UTUC with duodenum involvement [14][15][16][17]30]. Only two of them were diagnosed by EUS-FNA [14,15], and three cases were made by surgery or autopsy [16,17,30].…”

“…Previously, five cases reported the diagnosis of UTUC with duodenum involvement [14][15][16][17]30]. Only two of them were diagnosed by EUS-FNA [14,15], and three cases were made by surgery or autopsy [16,17,30]. According to a previous study, EUS-FNA was rarely used to diagnose lesions of duodenal mass [31].…”