Case: Malignant Tumor of the Duodenum
Case: Malignant Tumor of the Duodenum
1. Brief Medical History:
The patient, Ding Jian, male, 65 years old, chief complaint: discovered malignant tumor of the duodenum 3 weeks ago. On August 28, 2024, an abdominal + pelvic CT scan at Xi’an Ninth Hospital indicated a suspected occupying lesion in the descending part of the duodenum (approximately 5.3 × 4.1 × 4.6 cm in size), with scattered enlarged lymph nodes around the lesion and in the retroperitoneum (approximately 1.8 × 1.9 cm in size). Pathological results suggested a malignant tumor of the duodenum. On September 18, 2024, a puncture biopsy under endoscopic ultrasound guidance at our hospital showed: (descending part of the duodenum) malignant tumor. Based on morphological changes and immunohistochemistry results, it was highly suspected to be ALK-positive anaplastic large cell lymphoma. The definitive diagnosis was: Malignant tumor of the duodenum, ALK-positive anaplastic large cell lymphoma, IPI score 1, Lugano stage IIE, Ann Arbor stage IIE, TNM staging of gastrointestinal lymphoma (Paris staging) IIE; KPS score: 90.
Carbon ion therapy was initiated on September 30, 2024: PTV: 40Gy (RBE)/10Fx. On September 23, 2024, one cycle of systemic intravenous chemotherapy with the XELOX regimen was administered, specifically: Oxaliplatin (130mg/m²) 244mg IV drip d1 + Capecitabine tablets (800mg/m²) 1.5g PO Bid d1-14 Q3W. On October 17, 2024, one cycle of systemic intravenous chemotherapy with the CHP regimen + targeted therapy with Brentuximab Vedotin was administered, specifically: Cyclophosphamide (750mg/m²) 1300mg IV drip d1 + Doxorubicin (40mg/m²) 70mg IV drip d1 + Prednisone 100mg PO d1-5 Q3W + Brentuximab Vedotin (1.8mg/kg) 100mg IV drip d1 Q3W.
2. Imaging Comparison:
Preliminary Review: Zhang Lihong
Final Review: Zhang Jie