Primary Pure Duodenal Squamous Cell Carcinoma

A 68-year-old woman presented with 3 months of bloating and epigastric discomfort with intermittent black stools while taking bismuth subsalicylate during multiple international trips and 1 week of fatigue and dyspnea on exertion without weight loss, fevers, or chills. A colonoscopy 5 years earlier had found a subcentimeter sigmoid hyperplastic polyp. Bloodwork showed hemoglobin of 4.8 g/dL and mean corpuscular volume of 79 fL. Endoscopy found an oozing, 5-cm fungating nonobstructing mass with 4 cm of surrounding ulceration in the third part of the duodenum (Figure A).