Metastatic placental site trophoblastic tumour in the duodenum presenting with a gastrointestinal bleed

A 31-year-old woman presented with altered bowel habits, black stools and profound weakness. Abdominal ultrasonography performed elsewhere had shown hepatic metastases. Oesophago-gastroduodenoscopy had been reported as normal. A red blood cell labelled blood pool study had shown a slow bleed at the ileocaecal junction, caecum and/or ascending colon. Except for pallor, her general condition was good. There was no supraclavicular adenopathy or ascites. She underwent lower gastrointestinal endoscopy at our hospital and was detected to have a rectal polyp. Because the size and appearance of the polyp did not correlate with the symptoms, the possibility of a separate pathology was considered. Consequently, the patient underwent an upper gastrointestinal endoscopy, which showed friable ulcerated lesions in the third part of the duodenum. The endoscopic differential diagnosis included carcinoma, lymphoma and tuberculosis. The rectal lesion …