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Polski Merkuriusz Lekarski : Organ... Feb 2018The diagnosis of duodenal adenocarcinoma is still a complex gastrological and oncological problem. The described case illustrates the unusual character of the course,...
The diagnosis of duodenal adenocarcinoma is still a complex gastrological and oncological problem. The described case illustrates the unusual character of the course, the reasonableness of the diagnostic procedures and the scope of the therapy undertaken. The causes of anemia, which was the first symptom of the disease, were not revealed in the tests carried out at this stage - gastroscopy, colonoscopy, with normal other basic laboratory tests. At the next episode, after 6 months from the first, the presence of a bleeding lesion within the duodenum was revealed. Further imaging and endoscopic examinations as well as the results of histopathological examinations from duodenum collected material were enabled the diagnosis of adenocarcinoma. In urgent mode, the operation was performed using the Whipplle method, removing the duodenum, the pyloric part of the stomach, the part of the pancreas head and the gallbladder. After 6 weeks, chemotherapy was applied in accordance with accepted standards, obtaining stabilization and gradual improvement of the general condition of the patient, which was confirmed in the performed tests.
Topics: Adenocarcinoma; Aged; Duodenal Neoplasms; Duodenum; Humans; Male; Pancreas; Stomach; Treatment Outcome
PubMed: 29498368
DOI: No ID Found -
Journal of Gastrointestinal Surgery :... Feb 2012To evaluate the role of neoadjuvant chemoradiation therapy and rescue surgery in the management of unresectable or recurrent duodenal adenocarcinoma.
AIM
To evaluate the role of neoadjuvant chemoradiation therapy and rescue surgery in the management of unresectable or recurrent duodenal adenocarcinoma.
METHODS
Retrospective review of all adults treated with neoadjuvant therapy and rescue surgery for locally unresectable or locally recurrent duodenal adenocarcinoma from 1994 to 2010.
RESULTS
Ten patients received various forms of neoadjuvant therapy prior to operative exploration for potential resection. Six patients presented with locally unresectable disease, while four had local recurrences. Six patients had vascular encasement, three had retroperitoneal extension with vascular invasion, and one had invasion of surrounding organs. Of the six patients with locally advanced disease, preoperative therapy consisted of chemotherapy alone (3) or chemoradiotherapy (3). Of the four patients with local recurrences, preoperative therapy consisted of chemotherapy alone (1), chemoradiotherapy alone (1), chemoradiotherapy after chemotherapy (1), and chemoradiotherapy followed by combination chemotherapy (1). Nine of ten patients became resectable after neoadjuvant therapy. Clinically, two patients had complete responses, and four had partial responses. Histopathology revealed complete pathologic response in two patients and near-complete pathologic response in one (<1 mm of residual disease). Currently, five patients are alive (range 18-83 months postoperatively). All have no evidence of disease.
CONCLUSION
Neoadjuvant therapy may convert locally unresectable duodenal adenocarcinoma to resectable disease with subsequent prolonged survival.
Topics: Adenocarcinoma; Adult; Aged; Aged, 80 and over; Chemoradiotherapy, Adjuvant; Duodenal Neoplasms; Duodenum; Female; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Neoadjuvant Therapy; Neoplasm Recurrence, Local; Retrospective Studies; Survival Rate; Treatment Outcome
PubMed: 21956430
DOI: 10.1007/s11605-011-1667-7 -
Monographs in Clinical Cytology 2020The pancreas is a retroperitoneal organ located in the duodenal loop with the posterior wall of the stomach overlying it and the left lobe of the liver lying anteriorly... (Review)
Review
The pancreas is a retroperitoneal organ located in the duodenal loop with the posterior wall of the stomach overlying it and the left lobe of the liver lying anteriorly to it. Tissues from these organs, in addition to the lesion of interest within the pancreas, may be sampled during fine-needle aspiration (FNA) procedures. Therefore, it is important to recognize the cytology of normal benign components of the pancreas and potential contaminants in order to render a correct diagnosis and avoid pitfalls. Normal components of the pancreas include ductal epithelial cells, acinar cells, and islet cells. In addition to the normal pancreatic cells, it is not uncommon to encounter epithelial cells from the duodenal and gastric mucosa with endoscopic ultrasound-guided fine-needle aspiration. It is important to recognize these cells as benign and to distinguish them from a well-differentiated pancreatic adenocarcinoma. Besides these, mesothelial cells and hepatocytes and bile duct cells from the liver may be sampled as well. Here, the cytological features of normal components and contaminants are described in detail.
Topics: Adenocarcinoma; Duodenum; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Gastric Mucosa; Humans; Pancreas; Pancreatic Neoplasms; Stomach
PubMed: 32987395
DOI: 10.1159/000455733 -
American Journal of Physiology.... Dec 2019Pancreatic ductal adenocarcinoma (PDAC)'s growing incidence has been linked to the rise in obesity and type 2 diabetes mellitus. In previous work, we have shown that...
Pancreatic ductal adenocarcinoma (PDAC)'s growing incidence has been linked to the rise in obesity and type 2 diabetes mellitus. In previous work, we have shown that metformin can prevent the increased incidence of PDAC in a Kras mouse model subjected to a diet high in fat and calories (HFCD). One potential way that metformin can affect the host is through alterations in the gut microbiome. Therefore, we investigated microbial associations with PDAC development and metformin use in the same mouse model. Lox-Stop-Lox Kras G12D/+ (LSL-Kras G12D/+); p48-Cre (KC) mice were given control diet, HFCD, or HFCD with 5 mg/mL metformin in drinking water for 3 mo. At the end of the 3 mo, 16S rRNA sequencing was performed to characterize microbiome composition of duodenal mucosal, duodenal luminal, and cecal luminal samples. KC mice on an HFCD demonstrated depletion of intact acini and formation of advanced pancreatic intraepithelial neoplasia. This effect was completely abrogated by metformin treatment. HFCD was associated with significant changes in microbial composition and diversity in the duodenal mucosa and lumen, much of which was prevented by metformin. In particular, was negatively correlated with percent intact acini and seemed to be inhibited by the addition of metformin while on an HFCD. Administration of metformin eliminated PDAC formation in KC mice. This change was associated with significant microbial changes in both the mucosal and luminal microbiome of the duodenum. This suggests that the microbiome may be a potential mediator of the chemopreventive effects of metformin. Pancreatic ductal adenocarcinoma (PDAC)'s growing incidence has been linked to the rise in obesity and type 2 diabetes mellitus. Administration of metformin eliminated PDAC formation in KC mice with diet-induced obesity. This change was associated with significant microbial changes in both the mucosal and luminal microbiome of the duodenum. This suggests that the microbiome may be a potential mediator of the chemopreventive effects of metformin.
Topics: Animals; Carcinoma, Pancreatic Ductal; Diabetes Mellitus, Type 2; Diet, High-Fat; Disease Models, Animal; Duodenum; Gastrointestinal Microbiome; Hypoglycemic Agents; Metformin; Mice; Obesity; Treatment Outcome
PubMed: 31545922
DOI: 10.1152/ajpgi.00170.2019 -
Abdominal Imaging Jun 2015Duodenal adenocarcinomas are the most common duodenal tumors, and represent 15-25% of small bowel carcinomas. Their management differs from other small bowel tumors,... (Review)
Review
Duodenal adenocarcinomas are the most common duodenal tumors, and represent 15-25% of small bowel carcinomas. Their management differs from other small bowel tumors, with imaging playing a very important role. In this article, we provide a comprehensive review of the diagnosis and management of duodenal adenocarcinomas, emphasizing the role of the radiologist in the same.
Topics: Adenocarcinoma; Adult; Contrast Media; Diagnosis, Differential; Duodenal Neoplasms; Duodenum; Female; Humans; Male; Middle Aged; Radiographic Image Enhancement; Tomography, X-Ray Computed
PubMed: 25427987
DOI: 10.1007/s00261-014-0309-4 -
International Surgery 2011This single-institution experience retrospectively reviewed the outcomes in 21 patients with primary duodenal adenocarcinoma. Twelve patients underwent curative surgery,...
This single-institution experience retrospectively reviewed the outcomes in 21 patients with primary duodenal adenocarcinoma. Twelve patients underwent curative surgery, and 9 patients underwent palliative surgery at the Chiba University Hospital. The maximum follow-up period was 8650 days. All pathologic specimens from endoscopic biopsy and surgical specimens were reviewed and categorized. Twelve (57.1%) patients underwent curative surgery (R0): 4 pancreaticoduodenectomies (PD), 4 pylorus-preserving PDs (PpPD), 2 local resections of the duodenum and 2 endoscopic mucosal resections (EMR). Palliative surgery was performed for 9 patients (42.9%) following gastro-intestinal bypass. The median cause-specific survival times were 1784 days (range 160-8650 days) in the curative surgery group and 261 days (range 27-857 days) in the palliative surgery group (P = 0.0003, log-rank test). The resectability of primary duodenal adenocarcinoma was associated with a smaller tumor size, a lower degree of tumor depth invasiveness, and less spread to the lymph nodes and distant organs.
Topics: Adenocarcinoma; Duodenal Neoplasms; Duodenum; Female; Humans; Intestinal Mucosa; Kaplan-Meier Estimate; Lymph Nodes; Male; Middle Aged; Neoplasm Invasiveness; Palliative Care; Pancreaticoduodenectomy
PubMed: 22026300
DOI: 10.9738/1381.1 -
Journal of Visceral Surgery Jun 2020
Topics: Adenocarcinoma; Digestive System Surgical Procedures; Duodenum; Humans
PubMed: 31221550
DOI: 10.1016/j.jviscsurg.2019.06.002 -
Gan To Kagaku Ryoho. Cancer &... Feb 2020A 66-year-old woman admitted for nausea was found to have a type 2 tumor with stenosis at the fourth portion of the duodenum by upper gastrointestinal series and...
A 66-year-old woman admitted for nausea was found to have a type 2 tumor with stenosis at the fourth portion of the duodenum by upper gastrointestinal series and endoscopy, which was diagnosed as an adenocarcinoma by endoscopic biopsy. Abdominal computed tomography(CT)showed an irregular thick wall at the fourth portion of the duodenum but without metastasis or invasion to the adjacent vessels. We examined the lymph nodes around the pancreatic head intraoperatively and partially resected the duodenum and jejunum based on the diagnosis of negative swollen nodes. The definitive diagnosis was primary tubular adenocarcinoma of the fourth portion of the duodenum, T3, N0, M0, Stage ⅡA. Reports of primary cancer of the fourth portion of the duodenum are very rare, and we include a discussion of the current literature.
Topics: Adenocarcinoma; Aged; Duodenal Neoplasms; Duodenum; Female; Humans; Pancreas; Tomography, X-Ray Computed
PubMed: 32381985
DOI: No ID Found -
Updates in Surgery Jan 2024There is little information about the relevance of extra-ampullary duodenal adenocarcinoma (EDA) subtypes. The aim of this study was to evaluate the impact of EDA...
BACKGROUND
There is little information about the relevance of extra-ampullary duodenal adenocarcinoma (EDA) subtypes. The aim of this study was to evaluate the impact of EDA subtypes on surgical and oncological outcomes following pancreatoduodenectomy (PD).
METHODS
Consecutive patients undergoing PD for EDA from 2000 to 2019 were analyzed. Results were stratified by pathologic subtype (intestinal versus non-intestinal). Uni-and multivariable analyses were performed using standard statistical methods.
RESULTS
The study population consisted of 70 patients, of whom 49 (70%) had an intestinal phenotype. EDA with intestinal phenotype was more frequently proximal to the Ampulla of Vater, while non-intestinal EDA was more frequently found distally (76% vs. 33%, p = 0.002). Patients with intestinal EDA were less likely to experience severe morbidity, with decreased reoperation and unplanned Intensive Care Unit admission rates relative to non-intestinal subtypes (2% vs. 29% p = 0.002, and 2% vs. 19%, p = 0.007, respectively). The median follow-up post-pancreatectomy was 73 months. Intestinal EDA was associated with improved overall and disease-free survival, with 3-year and 5-year survival rates of 71% vs. 29% and 53% vs. 24%, respectively. (p = 0.019 and p = 0.025).
CONCLUSION
Intestinal-type EDA, which more often arises from supra-ampullary duodenum, was associated with better postoperative outcomes and improved survival.
Topics: Humans; Pancreaticoduodenectomy; Ampulla of Vater; Adenocarcinoma; Pancreatic Neoplasms; Duodenal Neoplasms; Common Bile Duct Neoplasms; Retrospective Studies
PubMed: 38093152
DOI: 10.1007/s13304-023-01688-0 -
Pancreas 2017The development of an effective screening method for pancreatic ductal adenocarcinoma (PDAC) is of paramount importance. This study assessed the diagnostic utility in...
OBJECTIVES
The development of an effective screening method for pancreatic ductal adenocarcinoma (PDAC) is of paramount importance. This study assessed the diagnostic utility in pancreatic diseases of duodenal markers during upper gastrointestinal endoscopy (GIE) or endoscopic ultrasonography.
METHODS
This study prospectively enrolled 299 consecutive participants, including 94 patients with PDACs, 144 patients with other pancreatic diseases, and 61 normal individuals as control subjects. All subjects underwent upper GIE or endoscopic ultrasonography either at Kyushu University Hospital (Fukuoka, Japan) or the Mayo Clinic (Jacksonville, Fla) from October 2011 to July 2014. Duodenal fluid (DF) was collected without secretin stimulation and of carcinoembryonic antigen and S100 calcium-binding protein P (S100P) concentrations were measured.
RESULTS
Concentrations of S100P in DF were significantly higher in patients with PDAC and chronic pancreatitis than in control subjects (P < 0.01). A logistic regression model that included age found that the sensitivity and specificity of S100P concentration in diagnosing stages 0/IA/IB/IIA PDAC were 85% and 77%, respectively, with an area under the receiver operating characteristic curve of 0.82. Carcinoembryonic antigen concentrations in DF of patients with pancreatic disease did not differ significantly from control subjects.
CONCLUSIONS
Analysis of S100P concentration in DF, in combination with routine screening upper GIE, may facilitate the detection of PDAC.
Topics: Adult; Aged; Aged, 80 and over; Biomarkers, Tumor; Body Fluids; Calcium-Binding Proteins; Carcinoma, Pancreatic Ductal; Duodenum; Endoscopy, Gastrointestinal; Female; Humans; Logistic Models; Male; Middle Aged; Neoplasm Proteins; Pancreatic Neoplasms; ROC Curve; Young Adult
PubMed: 28984789
DOI: 10.1097/MPA.0000000000000940