case_images: PMC9878825_01
case_images: (A) Endoscopic findings of the duodenum reveal a type 2 tumor on the descending part. (B, C) Abdominal computed tomography shows multiple liver metastases (long arrow) and lymph nodes (arrowhead). (D) After EUS-guided puncture, contrast agent was injected into the common bile duct for cholangiogram. (E) Choledochoduodenostomy was accomplished with a fully covered metallic stent through the duodenal bulb.
case_images: fonc-12-1064944-g001.jpg
case_images: PMC9878825_01_fonc-12-1064944-g001.jpg
case_images: f1
case_images: Urayasu Ichikawa Medical Center. The patient had a medical history of diabetes mellitus and bronchial asthma. Upper gastrointestinal endoscopy revealed Borrmann type 2 duodenal carcinoma in the descending part of the duodenum ( Figure 1A ). Computed tomography (CT) revealed multiple lymph nodes, liver metastases, and lung metastases ( Figures 1B, C ). Guide wire was inserted through the duodenal bulb into the common bile duct and a metallic biliary stent (fully covered metallic stent 6cm) was placed using EUS-CDS ( Figures 1D, E ).
case_images: (A) Hematoxylin and eosin-stained biopsy specimen of the primary tumor. (B) Immunohistochemistry analysis showing strong ALK-positive staining.
case_images: fonc-12-1064944-g002.jpg
case_images: PMC9878825_01_fonc-12-1064944-g002.jpg
case_images: f2
case_images: Immunohistochemistry analysis showed strong ALK expression in over 80% of tumor cells ( Figure 2 ).
case_images: (A) Course of tumor markers (carcinoembryonic antigen [CEA] and carbohydrate antigen 19-9 [CA 19-9]) while receiving treatment with FOLFOX and alectinib. (B) Abdominal computed tomography showing multiple liver metastases pre-FOLFOX therapy, increased tumor volume 4 weeks after the FOLFOX therapy, and reduction of liver metastases 6 weeks after alectinib. the second follow-up CT imaging showed continuing response for liver metastases.
case_images: fonc-12-1064944-g003.jpg
case_images: PMC9878825_01_fonc-12-1064944-g003.jpg
case_images: f3
case_images: Figure 3 ). Furthermore, the patient's serum carcinoembryonic antigen and carbohydrate antigen 19-9 levels markedly decreased.