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The risk of extrauterine spread in endometrial cancer depends on the histologic type and grade. Metastatic endometrial cancer typically follows a predictable pattern of spread, favoring the lymphatic route. We report an unusual case of a patient with International Federation of Gynecology and Obstetrics (FIGO) grade 2 endometrioid endometrial cancer who presented with an obstructive duodenal mass with no other preoperative evidence of disease. Available diagnostic data suggested a possible second primary cancer. Upon entering the abdomen, it became apparent that the duodenal mass was a metastatic focus. The final pathology revealed a high-grade serous component. Underestimation of endometrial biopsy, failure of diagnostic imaging, and the nonspecificity of fine needle aspiration led to diagnostic difficulty. Staging laparoscopy may be useful in such cases.

Common cancer, puzzling presentation: A report of endometrial cancer presenting as an obstructive duodenal mass