Primary Duodenal Periampullary Adenocarcinoma: An Uncommon Presentation

Periampullary carcinoma is a broad term used to define the group of carcinomas arising from the head of the pancreas, the distal common bile duct, and the duodenum. It is clinically important to differentiate ampullary from periampullary carcinoma as this can affect resectability and prognosis. Atypical left-sided chest pain is an atypical presentation of periampullary duodenal adenocarcinoma. A 58-year-old man presented with a two-month duration of worsening intermittent, atypical, migratory left-sided chest pain. Imaging studies were unremarkable; however, endoscopic evaluation demonstrated a duodenal mass. While most periampullary carcinomas are generally curable with pancreaticoduodenectomy, if left untreated, these tumors are uniformly fatal.