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The Journal of Surgical Research Jun 2019Mucin1 (MUC1), a member of the mucin family, is a glycoprotein which is often expressed in malignant cells. However, the expression and function of MUC1 in human...
OBJECTIVE
Mucin1 (MUC1), a member of the mucin family, is a glycoprotein which is often expressed in malignant cells. However, the expression and function of MUC1 in human duodenal adenocarcinoma (DAC) has not yet been characterized because of its low frequency. Here, we examined the functional roles of core protein (MUC1-C) in DAC.
MATERIALS AND METHODS
Using a human duodenal cancer cell line, HuTu80, proliferation, migration, invasion, ALDH activity was assessed by cell counting kit-8, scratch wound healing, matrigel invasion, and ALDEFUOR assays, respectively. The function of MUC1 protein was evaluated with knockdown using specific siRNA as well as anti-MUC1-C peptide, GO203. MUC1 expression in human DAC was evaluated immunohistochemically in surgically resected tumors.
RESULTS
The positive expression of MUC1 in HuTu80 was confirmed by RT-PCR and flow cytometry. In vitro cell growth was inhibited by the addition of 50-100 μM GO203 as well as treatment with siRNA for MUC1-C. Silencing of MUC1-C also significantly reduced migration, invasion, ALDH activity. Local injection of GO-203 (14 mg/kg) significantly suppressed the growth of subcutaneous HuTu80 tumors in nude mice. Immunohistochemically, MUC1 was strongly detected in seven DAC cases, but not in 11 others. The outcome of patients with high MUC1 expression was significantly worse than those without MUC1 expression.
CONCLUSIONS
These results suggest that MUC1 is functionally associated with the malignant potential of DAC and could be a novel therapeutic target for this rare tumor.
Topics: Adenocarcinoma; Adult; Aged; Cell Line, Tumor; Cell Movement; Cell Proliferation; Duodenal Neoplasms; Duodenum; Female; Gene Knockdown Techniques; Humans; Male; Middle Aged; Mucin-1; RNA, Small Interfering; Survival Analysis; Xenograft Model Antitumor Assays
PubMed: 30763811
DOI: 10.1016/j.jss.2019.01.006 -
BMJ Case Reports Oct 2023This report describes an unusual case of a symptomatic Brunner's gland adenoma arising in a man in his 40s that underwent robotic transduodenal resection. Initial...
This report describes an unusual case of a symptomatic Brunner's gland adenoma arising in a man in his 40s that underwent robotic transduodenal resection. Initial investigations revealed a polypoidal, submucosal lesion that was found in the first part of the duodenum. Microscopically, there was neither dysplasia nor evidence of adenocarcinoma, suggesting differentials of gastrointestinal stroma tumour and duodenal adenoma. Given the size of the lesion, he underwent a surgical resection. Symptomatic Brunner's gland adenoma is uncommon and should be considered as a differential diagnosis in patients presenting with obstructive symptoms.
Topics: Male; Humans; Brunner Glands; Robotic Surgical Procedures; Duodenum; Duodenal Neoplasms; Adenoma
PubMed: 37907319
DOI: 10.1136/bcr-2023-254566 -
Digestive Endoscopy : Official Journal... Jan 2020Endoscopic biopsies for nonampullary duodenal epithelial neoplasms (NADENs) can induce submucosal fibrosis, making endoscopic resection difficult. However, no...
OBJECTIVES
Endoscopic biopsies for nonampullary duodenal epithelial neoplasms (NADENs) can induce submucosal fibrosis, making endoscopic resection difficult. However, no biopsy-free method exists to distinguish between NADENs and non-neoplasms. We developed a diagnostic algorithm for duodenal neoplasms based on magnifying endoscopy findings and evaluated the model's diagnostic ability.
METHODS
Magnified endoscopic images and duodenal lesion histology were collected consecutively between January 2015 and April 2016. Diagnosticians classified the surface patterns as pit, groove or absent. In cases of nonvisible surface patterns, the vascular pattern was evaluated to determine regularity or irregularity. The correlation between our algorithm (pit-type or absent with irregular vascular pattern) and the lesion histology were evaluated. Four evaluators, who were blinded to the histology, also classified the endoscopic findings and evaluated the diagnostic performance and interobserver agreement.
RESULTS
Endoscopic images of 114 lesions were evaluated (70 NADENs and 44 non-neoplasms, 31 in the superior and 83 in the descending and horizontal duodenum). Of the NADEN surface patterns, 88% (62/70) were pit-type, while 79% (35/44) of the non-neoplasm surface patterns were groove-type. Our diagnostic algorithm for differentiating NADENs from non-neoplasms was high (sensitivity 96%, specificity 95%) in the descending and horizontal duodenum. The evaluators' diagnostic performances were also high, and interobserver agreement for the algorithm was good between each diagnostician and evaluator (κ = 0.60-0.76).
CONCLUSION
Diagnostic performance of our algorithm sufficiently enabled eliminating endoscopic biopsies for diagnosing the descending and horizontal duodenum.
Topics: Adenocarcinoma; Adult; Aged; Aged, 80 and over; Algorithms; Biopsy; Duodenal Diseases; Duodenal Neoplasms; Duodenoscopy; Duodenum; Female; Humans; Male; Middle Aged; Narrow Band Imaging; Retrospective Studies
PubMed: 31309619
DOI: 10.1111/den.13485 -
BMJ Case Reports Jan 2019We present a case of a healthy 59-year-old woman who presented for a capsule endoscopy to evaluate melaena and iron deficiency anaemia. She had previously underwent an...
We present a case of a healthy 59-year-old woman who presented for a capsule endoscopy to evaluate melaena and iron deficiency anaemia. She had previously underwent an oesophagogastroduodenoscopy and colonoscopy at an outside institution which were unremarkable. Capsule endoscopy showed an ulcerated, bleeding lesion likely in the duodenum. Differential diagnosis included adenocarcinoma, carcinoid tumour, lymphoma, gastrointestinal stromal tumour and metastatic disease. A push enteroscopy was performed after which showed an ulcerated mass in the third portion of the duodenum. Biopsies confirmed adenocarcinoma. Computed tomography of the abdomen showed no signs of distant metastasis and the patient was referred to surgery for evaluation. The patient underwent a pancreaticoduodenectomy, with resection of the mass and negative lymph nodes in all nine that were removed (T3N0). The patient was classified as stage II duodenal adenocarcinoma. Duodenal adenocarcinoma is a rare but clinically significant cause of small bowel bleeding.
Topics: Adenocarcinoma; Biopsy; Capsule Endoscopy; Diagnosis, Differential; Duodenal Neoplasms; Duodenum; Female; Gastrointestinal Hemorrhage; Humans; Middle Aged
PubMed: 30700455
DOI: 10.1136/bcr-2018-227184 -
Journal of Gastroenterology and... Jul 2023
Review
Topics: Humans; Duodenum; Duodenal Neoplasms; Adenocarcinoma; Phenotype; Ampulla of Vater; Common Bile Duct Neoplasms
PubMed: 36342080
DOI: 10.1111/jgh.16044 -
Journal of Gastrointestinal Surgery :... May 2019Site-specific outcomes of resection for periampullary cancer have not been analyzed on a large, registry-based scale.
BACKGROUND
Site-specific outcomes of resection for periampullary cancer have not been analyzed on a large, registry-based scale.
METHODS
We assessed data on periampullary cancers from the SEER database. Site- and stage-specific outcomes were analyzed. Resection was compared to no resection.
RESULTS
Resection was the main therapy in stages 1 and 2 (resection vs. no resection, 8644 vs. 7208 patients), was less frequent in stage 3 (1248 vs. 2783 patients) and was rarely-but still-used in stage 4 disease (541 vs. 11,212 patients). Pancreatic head (75.7%), 11.4% distal bile duct, 7.7% ampullary, and 5.3% duodenal cancers. Cancer subtype-independent median survival was 22.0 (resection) vs. 7.0 months (no resection) in stages 1 and 2, 21.0 vs. 8.0 months in stage 3, and 10.0 vs. 3.0 months in stage 4. Subtype-dependent median survival (resection vs. no resection) was 18.0 vs. 5.0 months in pancreatic head, 19.0 vs 4.0 months in distal bile duct, 41.0 vs 7.0 months in ampullary, and 38.0 vs 4.0 months in duodenal adenocarcinoma. On multivariable analysis, patient comorbidities, marital and insurance status, and income all influenced the decision to undergo resection.
CONCLUSIONS
Surgery is still underutilized in the treatment of periampullary cancers. Patients with cancers originating from the duodenum or the ampulla of Vater benefit most from resectional surgery.
Topics: Adenocarcinoma; Adult; Aged; Aged, 80 and over; Ampulla of Vater; Biliary Tract Surgical Procedures; Common Bile Duct Neoplasms; Duodenal Neoplasms; Female; Follow-Up Studies; Humans; Male; Middle Aged; Pancreatectomy; Pancreatic Neoplasms; Pancreaticoduodenectomy; Procedures and Techniques Utilization; Retrospective Studies; SEER Program; Survival Analysis; Treatment Outcome; United States
PubMed: 30088190
DOI: 10.1007/s11605-018-3897-4 -
Journal of Gastrointestinal Surgery :... Aug 2017Unlike other neuroendocrine tumors of the gastrointestinal tract, management of duodenal and periampullary carcinoids remains controversial. We aimed to determine the...
BACKGROUND
Unlike other neuroendocrine tumors of the gastrointestinal tract, management of duodenal and periampullary carcinoids remains controversial. We aimed to determine the metastatic potential and optimal choice of therapy for these neoplasms.
METHODS
A retrospective review of all patients treated at the Johns Hopkins Hospital between 1996 and 2012 was conducted. Clinicopathologic factors associated with lymph nodal involvement and clinical outcomes were evaluated.
RESULTS
A total of 101 patients were identified. Eighty (79.2%) tumors arose from the duodenum and 21 (20.8%) from the periampullary area. Thirty-five (34.7%) patients underwent pancreaticoduodenectomy (PD), 12 (11.9%) local resection, 38 (37.6%) endoscopic excision, and 16 (15.8%) patients harbored incidental tumors identified in the specimen after PD for another indication. Lymph node (LN) pathologic evaluation was done in 56 patients, among which 27 (48%) had positive LN. Specifically, LN positivity (LN+) for tumors <1 cm in size was 4.5% (1/22), for tumors 1-2 cm 72% (13/18), and for tumors >2 cm 81% (13/16). Tumor size was the only factor associated with LN+ (p = 0.029).
CONCLUSION
Lymph nodal involvement is common for duodenal and periampullary carcinoid tumors, particularly among those >1 cm in size; therefore, resection with lymphadenectomyfor these larger tumors is recommended.
Topics: Adult; Aged; Aged, 80 and over; Ampulla of Vater; Carcinoid Tumor; Common Bile Duct Neoplasms; Duodenal Neoplasms; Female; Humans; Lymph Node Excision; Lymphatic Metastasis; Male; Middle Aged; Pancreaticoduodenectomy; Retrospective Studies; Tumor Burden
PubMed: 28516311
DOI: 10.1007/s11605-017-3448-4 -
Medicina (Kaunas, Lithuania) Nov 2021Orbital metastasis from ampullary carcinoma is rare, with no previously reported cases.
BACKGROUND
Orbital metastasis from ampullary carcinoma is rare, with no previously reported cases.
CASE PRESENTATION
We report the case of a 60-year-old man who complained of a right-sided headache, blurred vision, progressive proptosis, ptosis, and right eye pain for 3 months. His past medical history included an ampullary adenocarcinoma stage IIIA treated via the Whipple procedure and adjuvant chemoradiotherapy 1 year ago. However, he was lost to follow-up. Computed tomography of the orbit showed a soft tissue lesion in the right orbital fossa measuring 3.3 × 2 × 2 cm. An orbital mass biopsy demonstrated an intestinal-type adenocarcinoma that tested positive for cytokeratins 7 and 20 and CDX2 on immunohistochemical staining. The pathologic diagnosis was metastatic adenocarcinoma from the ampulla of Vater. Despite oncological treatment, the patient's illness progressed. He received palliative treatment and died 1 month later.
CONCLUSIONS
We presented a rare case of orbital metastasis from ampullary adenocarcinoma. This should be considered in the differential diagnosis of patients with a history of ampullary adenocarcinoma who present with symptoms referring to the relevant locations.
Topics: Adenocarcinoma; Ampulla of Vater; Common Bile Duct Neoplasms; Humans; Male; Middle Aged; Orbital Neoplasms; Pancreatic Neoplasms; Pancreaticoduodenectomy
PubMed: 34833456
DOI: 10.3390/medicina57111238 -
Digestive Diseases (Basel, Switzerland) 2022This study aimed to evaluate endoscopic findings using linked color imaging (LCI) and blue laser imaging (BLI) and to determine a diagnostic predictor for duodenal...
BACKGROUND AND OBJECTIVE
This study aimed to evaluate endoscopic findings using linked color imaging (LCI) and blue laser imaging (BLI) and to determine a diagnostic predictor for duodenal adenocarcinomas.
METHODS
All consecutive patients who underwent endoscopic resection for superficial non-ampullary duodenal epithelial tumors (SNADETs) between October 2012 and June 2019 were enrolled in this study. Two highly experienced endoscopists investigated six morphological findings using both white light imaging and LCI and three magnifying endoscopic findings using magnifying BLI (M-BLI).
RESULTS
A total of 90 patients with 110 SNADETs, including 87 adenocarcinomas and 23 adenomas, were analyzed in this study. Among the non-magnifying endoscopic findings, the presence of reddish color, orange color on LCI (orange color sign), lobulation, depression, and marginally white opaque substance were found significantly more frequently in adenocarcinomas than in adenomas (p = 0.015, p < 0.001, p = 0.048, p < 0.001, and p = 0.007, respectively). Among the magnifying endoscopic findings, a mixed microsurface pattern (MSP), irregular MSP, and irregular microvascular pattern were found significantly more frequently in adenocarcinomas than in adenomas (p < 0.001, p < 0.001, and p = 0.002, respectively). In the multivariate analysis of all endoscopic findings associated with adenocarcinoma, orange color sign (odds ratio [OR] 10.46; 95% confidence interval [CI]: 1.42-77.08; p = 0.021), mixed MSP (OR 4.66; 95% CI: 1.02-21.40; p = 0.048), and irregular MSP (OR 13.11; 95% CI: 1.41-121.99; p = 0.024) were independent predictors of adenocarcinoma.
CONCLUSIONS
The presence of orange color sign on LCI and mixed/irregular MSP on M-BLI were independent diagnostic predictors that were frequently observed in duodenal adenocarcinoma.
Topics: Humans; Duodenal Neoplasms; Adenoma; Adenocarcinoma; Light; Pancreatic Neoplasms; Lasers
PubMed: 35176739
DOI: 10.1159/000522399 -
Digestive and Liver Disease : Official... Feb 2019Lynch syndrome (LS) is associated with an increased risk of small bowel tumors but routine screening is not recommended in international guidelines. The aim of our study...
BACKGROUND AND AIMS
Lynch syndrome (LS) is associated with an increased risk of small bowel tumors but routine screening is not recommended in international guidelines. The aim of our study was to determinate the prevalence of duodenal tumors in a French cohort of LS patients.
METHODS
Patients carrying a germline pathogenic variant in a MMR gene, supported by our local network, in which at least one upper endoscopy had been performed, were included. We registered the occurrence of duodenal lesions in those patients.
RESULTS
154 LS patients were identified including respectively 85 MSH2 and 41 MLH1 mutated patients respectively. Seven out of 154 (4.5%) had at least one duodenal lesion. Median age at diagnosis was 58 years (range: 49-73). The twelve lesions locations were: descending duodenum (n = 7), genu inferius (n = 2), duodenal bulb (n = 1), ampulla (n = 1), fourth duodenum (n = 1). Three lesions were invasive adenocarcinomas. The incidence rate of duodenal lesions in patients with MSH2 or MLH1 pathogenic variants was respectively 7.1% (6 out of 85) and 2.4% (1 out of 41) emphasizing a trend toward increased risk of developing duodenal lesion in MSH2 mutated patients: OR: 5.17, IC95% (0.8-60.07), p = 0.1307.
CONCLUSION
Regarding this high prevalence rate, especially in MSH2 patients, regular duodenal screening during upper endoscopy should be considered in routine in LS patients.
Topics: Adenocarcinoma; Cohort Studies; Colorectal Neoplasms, Hereditary Nonpolyposis; DNA Repair; DNA Repair Enzymes; Duodenal Neoplasms; Duodenum; Endoscopy, Gastrointestinal; Female; France; Genetic Predisposition to Disease; Germ-Line Mutation; Humans; Male; Middle Aged; MutL Protein Homolog 1; MutS Homolog 2 Protein; Prevalence; Protein Subunits
PubMed: 30448460
DOI: 10.1016/j.dld.2018.10.005