Supplementary Material for: Small duodenal adenocarcinoma with peritoneal dissemination mimicking duodenal Brunner’s gland hyperplasia

Abstract
Introduction:
Gastric-phenotype non-ampullary duodenal carcinomas are rare but potentially aggressive tumors.

Case Presentation:
A 52-year-old woman was referred for a duodenal polyp. Endoscopy revealed multiple duodenal bulb polyps suggestive of Brunner’s gland hyperplasia. Histopathology confirmed well-differentiated tubular adenocarcinoma with submucosal invasion and a positive margin. The patient underwent pancreaticoduodenectomy, and residual subserosal carcinoma was detected. Despite adjuvant chemotherapy, liver metastases and peritoneal dissemination developed 7 months postoperatively. The patient died 24 months after surgery.

Conclusion:
This case highlights the aggressive nature of gastric-phenotype duodenal adenocarcinoma and the need for early radical surgical intervention when vertical margins are positive after endoscopic resection.