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Surgical Case Reports Feb 2023Ectopic gastric mucosa mainly occurs in the duodenal bulb, and its etiology is thought to be congenital straying of gastric tissues. Primary duodenal carcinoma is a rare...
BACKGROUND
Ectopic gastric mucosa mainly occurs in the duodenal bulb, and its etiology is thought to be congenital straying of gastric tissues. Primary duodenal carcinoma is a rare disease; however, reports of carcinoma arising from ectopic gastric mucosa are extremely rare. We report a case of primary duodenal carcinoma suspected to arise from ectopic gastric mucosa, which discovered as a result of duodenal stenosis.
CASE PRESENTATION
The patient was a 71-year-old man with persistent weight loss and white stools. Enhanced computed tomography showed stenosis of the third portion of the duodenum and main pancreatic duct dilatation. Upper gastrointestinal endoscopy revealed irregularity of the duodenal mucosa from the anorectal side of the papilla of Vater to the stenosis of the third portion. No malignant cells were found by biopsies from the duodenal mucosa. Endoscopic ultrasonography did not detect the tumor in the pancreatic head. The possibility of a pancreatic tumor could not be ruled out based on findings of main pancreatic duct dilatation in the pancreatic head, and the patient had long-term poor oral intake because of duodenal stenosis; thus, surgical treatment was planned. Intraoperative findings showed palpable induration of the third portion of the duodenum and white nodules on the serosal surface. This was diagnosed as primary duodenal carcinoma, and pylorus-preserving pancreatoduodenectomy was performed. Histopathological diagnosis revealed ectopic gastric mucosa in the papilla of Vater and well-differentiated tubular adenocarcinoma invaded the normal duodenal submucosa and extended to the duodenal serosa. No mass lesion was detected in the pancreas, and an intraductal papillary mucinous neoplasm was observed in the branch pancreatic duct. The main pancreatic duct stricture was caused by the duodenal carcinoma invasion.
CONCLUSIONS
This case of primary duodenal carcinoma was suspected to arise from ectopic gastric mucosa and review the relevant literature.
PubMed: 36781821
DOI: 10.1186/s40792-023-01605-y -
Digestion 2021We aimed to clarify the endoscopic/clinicopathological features of superficial non-ampullary duodenal epithelial tumors (SNADETs) based on their mucin phenotypes.
AIMS
We aimed to clarify the endoscopic/clinicopathological features of superficial non-ampullary duodenal epithelial tumors (SNADETs) based on their mucin phenotypes.
METHODS
We analyzed 62 SNADET lesions and classified them based on mucin phenotypic expression. Endoscopic and clinicopathological findings were compared according to mucin phenotypes.
RESULTS
Eleven lesions had the gastric phenotype (GP) and 43 lesions had the intestinal phenotype (IP). All GP lesions were located in the first portion of the duodenum, while most IP lesions (72.1%) were located in the second portion (p < 0.01). Tumor size was significantly larger in the GP than in the IP group (14.4 mm vs. 10.2 mm, p < 0.05). Reddish color (72.7% in GP vs. 37.2% in IP, p < 0.05), type 0-I (72.7% vs. 11.6%, p < 0.01), lobular/granular pattern (81.8% vs. 4.7%, p < 0.01), and category 4/5 in Vienna classification (81.8% vs. 30.2%, p < 0.01) were observed significantly more often in the GP than in the IP group. Regarding findings of magnifying endoscopy with narrow-band imaging (M-NBI), white opaque substance (22.2% in GP vs. 89.7% in IP, p < 0.01) and light blue crest (0% vs. 43.6%, p < 0.05) were significantly less frequently observed in the GP group. Oval-shaped marginal epithelium (66.7% vs. 17.9%, p < 0.01), dense pattern (55.6% vs. 2.6%, p < 0.01), and dilatation of the intervening part (100% vs. 12.8%, p < 0.01) were more frequently observed in the GP group.
CONCLUSIONS
SNADETs showed distinct endoscopic/clinicopathological features according to the mucin phenotype. Tumor location, coloration, macroscopic type, and endoscopic findings including M-NBI are useful to distinguish the mucin phenotypes of SNADETs.
Topics: Duodenal Neoplasms; Duodenum; Endoscopy; Humans; Mucins; Phenotype
PubMed: 32516774
DOI: 10.1159/000508040 -
European Journal of Medical Research Dec 2022Preoperative endoscopic diagnosis and timely treatment are important for the clinical management of sporadically superficial nonampullary duodenal epithelial tumours... (Review)
Review
BACKGROUND
Preoperative endoscopic diagnosis and timely treatment are important for the clinical management of sporadically superficial nonampullary duodenal epithelial tumours (SNADETs), including adenoma and adenocarcinoma limited to the submucosal layer.
METHODS
This review explores current endoscopic diagnosis and endoscopic resection technology for SNADETs. We compare endoscopic diagnosis accuracy using white light imaging, narrow band imaging, and magnification endoscopy alone or in combination. In addition, we review the current endoscopic resection methods for SNADETs and discuss the limitations and applicable future directions of each technology.
RESULTS
A simple scoring system based on the endoscopic findings of white light imaging or magnified endoscopy combined with image-enhanced techniques was applied for the prediction of the histological grade of SNADETs. Benign or low-grade adenoma can be followed up without biopsy, and high-grade adenoma and adenocarcinoma should be resected by endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), or surgery. EMR frequently leads to a piecemeal resection, while ESD ensures a high en bloc resection rate with a high risk of complications. Covering or closing post-ESD ulcers is an effective strategy to reduce the risk of delayed perforation and bleeding. Laparoscopic endoscopic cooperative surgery is a promising treatment for SNADETs with excellent rates of en bloc resection and a low risk of complications, although it is expensive and requires many specialists.
CONCLUSIONS
Early endoscopic diagnosis and optimal treatment selection for SNADETs may improve the poor prognosis of duodenal cancer.
Topics: Humans; Duodenal Neoplasms; Treatment Outcome; Adenoma; Laparoscopy; Adenocarcinoma; Retrospective Studies
PubMed: 36517862
DOI: 10.1186/s40001-022-00940-4 -
The Turkish Journal of Gastroenterology... Jul 2023Duodenal lipomas are rarely found in the gastrointestinal tract. Most published literature referring to the tumors is limited to case series. There remained issues about...
BACKGROUND/AIMS
Duodenal lipomas are rarely found in the gastrointestinal tract. Most published literature referring to the tumors is limited to case series. There remained issues about the understanding and management of duodenal lipomas to be clarified. We aimed to investigate the clinical and endoscopic features of duodenal lipomas. Additionally, outcomes of endoscopic resection for duodenal lipomas were evaluated.
MATERIALS AND METHODS
A total of 29 duodenal lipomas resected endoscopically from December 2011 to October 2021 were included. Clinical characteristics, endoscopic features, and endoscopic ultrasound findings were analyzed retrospectively. The endoscopic resection was performed in 3 ways: hot snare polypectomy, endoscopic mucosa resection, and endoscopic submucosal dissection.
RESULTS
Of the 29 duodenal lipomas, 21 were located at the second portion with a mean size of 25.8 mm (range, 7-60 mm). Yamada type IV was the most common macroscopic type in 14 lesions, exhibiting a tendency of forming large peduncles. Seven patients had digestive symptoms. The occurrence of symptoms is associated with the tumor size. Endoscopic ultrasound was performed on 23 duodenal lipomas, of which 20 demonstrated homogenous echogenicity and 3 presented heterogeneous with tubular anechoic region. The endoscopic resection operation was successfully conducted on 29 patients without severe adverse events. The rate of en bloc and endoscopic complete resection was 93.1% and 86.2%, respectively. Recurrence was noted in 1 patient.
CONCLUSIONS
Clinical characteristics with typical endoscopic ultrasound features are helpful in duodenal lipomas diagnosis. The endoscopic resection is a safe and effective treatment for duodenal lipomas with considerable long-term outcomes.
Topics: Humans; Endoscopic Mucosal Resection; Endosonography; Lipoma; Retrospective Studies; Treatment Outcome; Duodenal Neoplasms
PubMed: 37326152
DOI: 10.5152/tjg.2023.22617 -
Annals of Hepato-biliary-pancreatic... May 2022Pancreaticoduodenectomy is the most common procedure for the management of duodenal pathologies. However, it is associated with substantial morbidity and a low risk of...
BACKGROUNDS/AIMS
Pancreaticoduodenectomy is the most common procedure for the management of duodenal pathologies. However, it is associated with substantial morbidity and a low risk of mortality. Pancreas-preserving limited duodenal resection (PPLDR) can be performed under specific scenarios. We share our experience with PPLDR and its outcome.
METHODS
We retrospectively analyzed a prospectively maintained database of patients undergoing limited duodenal resection in the form of wedge (sleeve) resection or segmental resection of one or more duodenal segments from March 2016 to March 2021 at a tertiary care center in North India.
RESULTS
During the study period, 10 patients (including 9 males) underwent PPLDR. Five of these 10 patients showed primary duodenal or proximal jejunal pathology, while the remaining five had duodenal pathology involving an adjacent organ tumor. Four patients underwent wedge (sleeve) resection, while the remaining six underwent segmental duodenal resection of one or more duodenal segments. Mean hospital stay was 6 days (range, 3-11 days) without 30-day mortality. Morbidity occurred in 4 patients (Grade I-II, n = 3; Grade III, n = 1). All patients were alive and disease-free at the time of last follow-up. The mean follow-up duration was 23 months (range, 2-48 months).
CONCLUSIONS
PPLDR is a safe and effective alternative for pancreaticoduodenectomy when selected carefully for specific tumor types and location.
PubMed: 35168204
DOI: 10.14701/ahbps.21-124 -
International Journal of... 2023To investigate the computed tomography (CT) findings of chronic duodenal papilla mucositis and duodenal papillary carcinoma, and provide more imaging information for...
To investigate the computed tomography (CT) findings of chronic duodenal papilla mucositis and duodenal papillary carcinoma, and provide more imaging information for early diagnosis of duodenal malignant diseases. CT findings and clinical data of 40 patients with chronic duodenal papilla mucositis and 46 patients with duodenal papillary carcinoma were retrospectively analyzed. Observation and measuring of direct duodenal papilla signs (including size, shape, density, enhancement uniformity, etc.), indirect duodenal papilla signs (including pancreaticobiliary dilatation) and clinical indicators (including tumor markers CA19-9, CA125, CEA, blood routine white blood cell count, bilirubin, age, gender, etc.) were carried out according to CT as well as statistical analysis. There were significant differences in duodenal papilla regular morphology, age and CA19-9 ( < .05), and significant differences in duodenal papilla maximum transverse diameter, diameter of common bile duct, diameter of pancreatic duct, total bilirubin, direct bilirubin, and jaundice in duodenal papillary carcinoma group ( < 0.01). There were no significant differences in duodenal papilla enhancement uniformity, plain CT value, arterial CT value, portal CT value, enhancement uniformity, presence or not of calculus at the lower end, gender, CEA, CA125, white blood cell count, and abdominal pain with fever (all > .05). CT is helpful for the diagnosis of duodenal papilla disease, but the CT findings of patients with duodenal papillary carcinoma tend to be similar to findings of chronic duodenal papilla mucositis, which is easy to lead to misdiagnosis, so comprehensive diagnosis should be made according to the direct and indirect CT signs as well as laboratory and clinical manifestations of duodenal papilla, so as to improve the diagnosis of duodenal papillary carcinoma, and reduce missed diagnosis and misdiagnosis.
Topics: Humans; Carcinoma, Papillary; CA-19-9 Antigen; Retrospective Studies; Mucositis; Duodenal Neoplasms; Tomography, X-Ray Computed; Bilirubin
PubMed: 36762724
DOI: 10.1177/03946320231157868 -
Clinical and Translational... Apr 2020Data about the efficacy of palliative double stenting for malignant duodenal and biliary obstruction are limited. (Comparative Study)
Comparative Study Meta-Analysis
INTRODUCTION
Data about the efficacy of palliative double stenting for malignant duodenal and biliary obstruction are limited.
METHODS
A systematic literature search was performed to assess the feasibility and optimal method of double stenting for malignant duodenobiliary obstruction compared with surgical double bypass in terms of technical and clinical success, adverse events, reinterventions, and survival. Event rates with 95% confidence intervals were calculated.
RESULTS
Seventy-two retrospective and 8 prospective studies published until July 2018 were included. Technical and clinical success rates of double stenting were 97% (95%-99%) and 92% (89%-95%), respectively. Clinical success of endoscopic biliary stenting was higher than that of surgery (97% [94%-99%] vs 86% [78%-92%]). Double stenting was associated with less adverse events (13% [8%-19%] vs 28% [19%-38%]) but more frequent need for reintervention (21% [16%-27%] vs 10% [4%-19%]) than double bypass. No significant difference was found between technical and clinical success and reintervention rate of endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic drainage, and endoscopic ultrasound-guided biliary drainage. ERCP was associated with the least adverse events (3% [1%-6%]), followed by percutaneous transhepatic drainage (10% [0%-37%]) and endoscopic ultrasound-guided biliary drainage (23% [15%-33%]).
DISCUSSION
Substantially high technical and clinical success can be achieved with double stenting. Based on the adverse event profile, ERCP can be recommended as the first choice for biliary stenting as part of double stenting, if feasible. Prospective comparative studies with well-defined outcomes and cohorts are needed.
Topics: Bile Duct Neoplasms; Cholestasis; Drainage; Duodenal Neoplasms; Duodenal Obstruction; Endoscopy, Digestive System; Feasibility Studies; Humans; Neoplasm Invasiveness; Palliative Care; Pancreatic Neoplasms; Postoperative Complications; Reoperation; Stents; Stomach Neoplasms; Treatment Outcome
PubMed: 32352679
DOI: 10.14309/ctg.0000000000000161 -
British Journal of Haematology Oct 2020Despite duodenal-type follicular lymphoma (DTFL) being morphologically, immunophenotypically and genetically indistinguishable from nodal FL (nFL), this entity typically...
Despite duodenal-type follicular lymphoma (DTFL) being morphologically, immunophenotypically and genetically indistinguishable from nodal FL (nFL), this entity typically shows a significantly better prognosis. Here, we analysed the tumour immune microenvironments of diagnostic specimens from patients with DTFL (n = 30), limited-stage FL (LSFL; n = 19) and advanced-stage FL (ASFL; n = 31). The mean number of CD8 tumour-infiltrating lymphocytes (TILs) in the neoplastic follicles was higher in DTFL (1,827/mm ) than in LSFL (1,150/mm ) and ASFL (1,188/mm ) (P = 0·002, P = 0·002, respectively). In addition, CD8 PD1 T cells with non-exhausting phenotype were more abundant in the peripheral blood (PB) of DTFL than in LSFL and ASFL, indicating that DTFL may exhibit a better and longer-lasting T cell-mediated immune response. Moreover, whereas FOXP3 CTLA-4 effector regulatory T cells (eTregs) were rarely observed in the neoplastic follicles of DTFL (mean: 12/mm ), they were more abundant in LSFL (78/mm ) and ASFL (109/mm ) (P = 2·80 × 10 , P = 4·74 × 10 , respectively), and the numbers of eTregs correlated inversely with those of CD8 TILs (r = -0267; P = 0·018). Furthermore, DTFL showed significantly fewer circulating FOXP3 CD45RA CD25 eTregs (0·146%) than ASFL (0·497%) and healthy controls (0·639%) (P = 0·0003, P = 6·79 × 10 , respectively). These results suggest that the augmented anti-tumour immune reactions may contribute to a better prognosis on DTFL.
Topics: Adult; Aged; Aged, 80 and over; CD8-Positive T-Lymphocytes; Duodenal Neoplasms; Female; Humans; Lymphocytes, Tumor-Infiltrating; Lymphoma, Follicular; Male; Middle Aged; T-Lymphocytes, Regulatory; Tumor Microenvironment
PubMed: 32383789
DOI: 10.1111/bjh.16715 -
World Journal of Gastroenterology Feb 2024In this editorial we comment on the article published "Clinical significance of programmed cell death-ligand expression in small bowel adenocarcinoma is determined by...
In this editorial we comment on the article published "Clinical significance of programmed cell death-ligand expression in small bowel adenocarcinoma is determined by the tumor microenvironment". Small bowel adenocarcinoma (SBA) is a rare gastrointestinal neoplasm and despite the small intestine's significant surface area, SBA accounts for less than 3% of such tumors. Early detection is challenging and the reason arises from its asymptomatic nature, often leading to late-stage discovery and poor prognosis. Treatment involves platinum-based chemotherapy with a 5-fluorouracil combination, but the lack of effective chemotherapy contributes to a generally poor prognosis. SBAs are linked to genetic disorders and risk factors, including chronic inflammatory conditions. The unique characteristics of the small bowel, such as rapid cell renewal and an active immune system, contributes to the rarity of these tumors as well as the high intratumoral infiltration of immune cells is associated with a favorable prognosis. Programmed cell death-ligand 1 (PD-L1) expression varies across different cancers, with potential discrepancies in its prognostic value. Microsatellite instability (MSI) in SBA is associated with a high tumor mutational burden, affecting the prognosis and response to immunotherapy. The presence of PD-L1 and programmed cell death 1, along with tumor-infiltrating lymphocytes, plays a crucial role in the complex microenvironment of SBA and contributes to a more favorable prognosis, especially in the context of high MSI tumors. Stromal tumor-infiltrating lymphocytes are identified as independent prognostic indicators and the association between MSI status and a favorable prognosis, emphasizes the importance of evaluating the immune status of tumors for treatment decisions.
Topics: Humans; Tumor Microenvironment; B7-H1 Antigen; Ligands; Prognosis; Lymphocytes, Tumor-Infiltrating; Adenocarcinoma; Intestine, Small; Duodenal Neoplasms
PubMed: 38516246
DOI: 10.3748/wjg.v30.i8.794 -
Medicine Feb 2024Duodenal malignant melanoma is rare, and its early clinical symptoms are insidious, making it difficult to diagnose in its early stages. Combined with previous... (Review)
Review
RATIONALE
Duodenal malignant melanoma is rare, and its early clinical symptoms are insidious, making it difficult to diagnose in its early stages. Combined with previous literature, We explored the clinicopathological characteristics and v-raf murine sarcoma viral oncogene homolog B1 mutations in primary and metastatic duodenal malignant melanoma, in order to provide some experience on its differential diagnosis and treatment.
PATIENT CONCERNS
The 2 patients (a 63-year-old female [Patient 1] and a 54-year-old male [Patient 2]) experienced pain and discomfort in their upper abdomen. Additionally, one of them had a history of skin malignant melanoma.
DIAGNOSES
Patient 1 was diagnosed with primary duodenal malignant melanoma; and Patient 2 was diagnosed with metastatic duodenal malignant melanoma.
INTERVENTIONS
Patient 1 underwent pancreaticoduodenectomy; and patient 2 underwent complete surgical resection and lymph node dissection.
OUTCOMES
After surgery, Patient 1 survived after 26 months follow-up, and Patient 2 died of systemic multi-organ circulatory failure after 1 month follow-up.
LESSONS
Primary and metastatic cases should be diagnosed through previous medical history analysis and detailed physical and auxiliary examinations. This would enable a diagnosis based on characteristic histomorphology and immunohistochemical markers. An early diagnosis and surgical treatment can prolong patient survival and the molecular inspection of v-raf murine sarcoma viral oncogene homolog B1 mutations can guide follow-up treatment.
Topics: Female; Humans; Male; Middle Aged; Diagnosis, Differential; Lymph Node Excision; Melanoma; Pancreaticoduodenectomy; Skin Neoplasms
PubMed: 38335433
DOI: 10.1097/MD.0000000000037138