Inflammatory breast carcinoma obscuring the primary duodenal adenocarcinoma – a case report

The entity of double carcinoma in a single patient of different pathologies is not encountered commonly in clinical practice, especially in Indian subcontinent. Lack of medical insurance and poverty often compels treating surgeons To use minimum of diagnostic tests for the workup of malignancies. This leads to under diagnosis and reporting of such occurrences. Here we present a case report of 60 year old female with a painful swelling of left breast and a left lower neck swelling. On examination there was warmth, oedema with peau d’ orange appearance in more than one third of breast with enlarged solitary axillary lymph node and multiple left supraclavicular lymph nodes. Fine needle aspiration cytology of lymph nodes confirmed left inflammatory breast carcinoma with metastasis. Computerised tomography scan of chest confirmed the malignant changes in breast parenchyma, pectoralis major as well as axillary lymph node. Our protocol of performing oesophago-gastro-duodenoscopy in cases with Virchow’s node involvement unearthed the obscure asysmptomatic primary duodenal adenocarcinoma. Considering the grave prognosis, the patient was considered for palliation with oral Capecitabine. The rarity of such associations together with non-standardised protocol in the metastatic workup in the subcontinent makes us report such an entity to sensitize the clinicians.