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Duodenal mass in a patient with weight loss and liver dysfunction
  1. Takeshi Tsujino1,2,
  2. Yukiko Ito1,2,
  3. Hideo Yoshida1,
  4. Souichiro Ikushima3,
  5. Tamiko Takemura4,
  6. Ryo Nakata1,
  7. Kazuhiko Koike2
  1. 1Department of Gastroenterology, Japanese Red Cross Medical Center, Tokyo, Japan
  2. 2Department of Gastroenterology, Faculty of Medicine, University of Tokyo, Japan
  3. 3Department of Respiratory, Japanese Red Cross Medical Center, Tokyo, Japan
  4. 4Department of Pathology, Japanese Red Cross Medical Center, Tokyo, Japan
  1. Correspondence to Dr Takeshi Tsujino, Department of Gastroenterology, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan; tsujinot3915{at}gmail.com

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Clinical presentation

A 59-year-old Japanese man presented to our hospital with loss of appetite and 7 kg decrease in weight over 6 months. His medical history was unremarkable, except for hearing difficulty. He took medication for hypertension. His vital signs and physical examination were normal. Laboratory data at presentation were as follows: total bilirubin 0.4 mg/dl (reference 0.2–1.0); alanine aminotransferase 58 IU/l (reference 10–40); aspartate aminotransferase 68 IU/l (reference 5–40); alkaline phosphatase 697 IU/l (reference 104–338); gamma-glutamyl transpeptidase 178 IU/l (reference 0–79); white blood cells 4300/microlitre (reference 3700–9300); haemoglobin 12.1 g/dl (reference 13.0–16.5); blood urea nitrogen 38 mg/dl (reference 8–20); and creatinine 3.50 mg/dl (reference 0.50–1.20). Tests for hepatitis B and C were negative.

Abdominal ultrasonography demonstrated slightly increased echogenicity of the liver parenchyma …

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