A 43-year-old man, an active smoker of about 15 cigarettes a day.
He came to the emergency room for continuous epigastric pain of sudden onset accompanied by nausea and dizziness.
Normal bowel habit.
Located similar episodes of lower intensity related to food intake and that were controlled with fasting.
Asthenia and moderate anorexia, with weight loss of about 15 kg in the last three months.
The patient was afflicted with mild gastritis, TA 80/40, cutaneous-mucosal dryness and abdomen was blushing, depressible, without defense or signs of peritoneal irritation, although painful to increase epigastric discomfort.
Blood tests revealed a 30% Ht° with an Hb of 11.1 g/dl, the rest being normal.
Abdominal X-ray showed dilation of the jejunal loops with air-fluid levels.
Abdominal ultrasound showed the presence in the sagittal plane of an image in "pseudoconus or sandwich" and in the axial section image in "dian, ox of ox or donnut".
The inner layer was hyperechoic and the outer layer hypoechoic, under the presence of intestinal invagination.
Surgical intervention was decided and after anesthetic induction an abdominal mass located in mesogastrium and mobile was established.
A supraumbilical laparotomy was performed, showing a non-existent layer of tumor containing a jejunal loop that was impossible to reduce, so we proceeded to segmental resection of the reported phenotype x 2.5 cm of carcinoma xey 4
The immunohistochemical study showed high positivity for cytokeratins AE-1/AE-3, cytokeratin 7, cytokeratin 5/6/8/18 and vimentin.
Cytokeratin 20 was negative, and the markers CD-30, CD-31, actin, desmin, CD-117, MELAN-A/M arp-1 and TTF-1, pulmonary.
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Chest CT confirmed the presence of a right hiliar mass of about 4 cm, polylobulated and spiculated contours, encompassing the upper lobe bronchus although without significant stenosis.
A bronchoscopy revealed thickening of the carina in separation from the right upper lobe bronchus, with an endobronchial tumor that prevented the passage of the posterior segment of the bronchus.
Biopsy confirmed the diagnosis of undifferentiated carcinoma with the same immunohistochemical pattern as intestinal mass.
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The postoperative course was uneventful and the patient was discharged in good clinical condition.
Subsequently, the patient was treated with methotrexate monotherapy AUC 5 day 1, and gemcitabine 1250 mg/m2/day days 1 and 8, every 21 days, with partial response after the fourth cycle of chemotherapy.
Six months after diagnosis admission due to progressive cognitive impairment secondary to multiple right frontoparietal brain metastases, dying 15 days later.
