S6160 Duodenal Metastasis From Nasopharyngeal Carcinoma: A Case Report of an Uncommon Metastatic Site

Introduction: Nasopharyngeal carcinoma (NPC) is a rare malignancy with variable metastatic patterns, most commonly to bone, lymph nodes, liver, and lungs. Gastrointestinal (GI) involvement is exceedingly rare; 1 report identified only 5 cases. We present a rare case of duodenal metastasis from NPC, highlighting an uncommon pattern of dissemination. Case Description/Methods: A 50-year-old Asian American man with stage IVb World Health Organization type II NPC, diagnosed in 2014 with cerebral and hepatic metastases, presented with hypotension (83/53 mmHg), abdominal pain, coffee-ground emesis, and 30-lb weight loss over 3 months. Exam showed cachexia, jaundice, and epigastric tenderness. Labs revealed marked hepatocellular injury (AST 6000 U/L, ALT 1700 U/L), cholestasis (ALP 500 U/L), hypoalbuminemia (2.0 g/dL), leukocytosis (27 × 10³/μL), anemia (6.7 g/dL), thrombocytopenia (116 × 10³/μL), and coagulopathy (INR 5.15). Computed tomography abdomen showed progression of hepatic metastases. The patient was admitted to ICU, where he developed hematemesis requiring massive transfusion. Esophagogastroduodenoscopy revealed a large, actively bleeding duodenal mass. Despite aggressive resuscitation, the patient expired shortly after. Discussion: NPC is rare globally but more common in East and Southeast Asia. WHO type II NPC is aggressive with a high rate of distant metastasis, though GI spread, especially to the duodenum, is extremely rare. In this case, the patient presented with hypotension, anemia, weight loss, and GI bleeding. Endoscopy showed an ulcerated, fungating, and partially obstructive duodenal mass. Though biopsy was precluded by bleeding risk, the endoscopic appearance and clinical history strongly supported duodenal metastasis. Primary GI malignancies (e.g., adenocarcinoma, GIST, lymphoma) were considered but deemed unlikely due to lack of risk factors and close temporal association with systemic disease progression. Rare reports of duodenal metastases from NPC exist, often presenting with GI bleeding or obstruction. Autopsy studies also reveal small bowel involvement in advanced NPC. This case underscores the importance of considering GI metastasis in NPC patients with GI symptoms and the diagnostic challenges when biopsy is not feasible.