Hemorragia digestiva por metástasis duodenal de mesotelioma pleural maligno

A57-year-old smoker male consulted due to progressive dyspnea, with no cough or expectoration. He also referred history of diffuse abdominal pain, constipation and weight loss of 10 kilograms in the last months. At exploration it was relevant tachypnea, hypoventilation of the right lung and epigastric pain. On chest X-Ray we could observe right pleural effusion. Also a CT was made, informing thickening of right pleura and presence of multiple adenopathies in mediastinum (Fig. 1). After pleural biopsy it was all catalogued as malignant mesothelioma. Barium radiological study of the upper gastrointestinal tract was also carried out to complete the study of the anemia that was diagnosed in laboratory tests. This showed several ulcerative defects on duodenum. Because of these findings, a gastroscopy was performed, and several irregular ulcers with elevated borders were seen on the mucosa of second duodenal portion (Fig. 2). Some biopsies were taken for histological and immunohistochemical study, which informed duodenal infiltration with malignant mesothelioma. PICTURES IN DIGESTIVE PATHOLOGY