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Seminars in Oncology Feb 2015Malignant biliary obstruction, duodenal, and gastric outlet obstruction, and tumor-related pain are the complications of unresectable pancreatic adenocarcinoma that most... (Review)
Review
Malignant biliary obstruction, duodenal, and gastric outlet obstruction, and tumor-related pain are the complications of unresectable pancreatic adenocarcinoma that most frequently require palliative intervention. Surgery involving biliary bypass with or without gastrojejunostomy was once the mainstay of treatment in these patients. However, advances in non-operative techniques-most notably the widespread availability of endoscopic biliary and duodenal stents-have shifted the paradigm of treatment away from traditional surgical management. Questions regarding the efficacy and durability of endoscopic stents for biliary and gastric outlet obstruction are reviewed and demonstrate high rates of therapeutic success, low rates of morbidity, and decreased cost. Surgery remains an effective treatment modality, and still produces the most durable relief in appropriately selected patients.
Topics: Biliary Tract Surgical Procedures; Carcinoma, Pancreatic Ductal; Duodenum; Endoscopy, Digestive System; Gastric Outlet Obstruction; Humans; Laparoscopy; Palliative Care; Pancreatic Neoplasms
PubMed: 25726060
DOI: 10.1053/j.seminoncol.2014.12.014 -
The Journal of International Medical... Aug 2023Malignant transformation of a heterotopic pancreas in the duodenum is very rare. To our knowledge, only 15 cases have been reported worldwide, including the present... (Review)
Review
Malignant transformation of a heterotopic pancreas in the duodenum is very rare. To our knowledge, only 15 cases have been reported worldwide, including the present case. We herein report a rare case of malignant transformation of a heterotopic pancreas in the duodenum along with a review of the literature.A 65-year-old man was admitted to our hospital for evaluation of dyspepsia and vomiting. Esophagogastroduodenoscopy showed a stricture of the duodenal bulb. Laparoscopic distal gastrectomy was performed. Although a duodenal tumor had not been suspected, histopathological examination of the surgical specimen showed adenocarcinoma arising from a heterotopic pancreas (Heinrich type III) in the duodenum. Four months postoperatively, the patient received adjuvant chemotherapy. He was still alive without recurrence at 24 months of follow-up.Adenocarcinoma arising in a heterotopic pancreas is rare; therefore, preoperative diagnosis is difficult to obtain. Effective management of a heterotopic pancreas depends on the presence or absence of symptoms. Awareness of the possibility of malignant change in a heterotopic pancreas of the duodenum prior to surgery is helpful for the diagnosis and appropriate management of such patients.
Topics: Male; Humans; Aged; Duodenum; Adenocarcinoma; Chemotherapy, Adjuvant; Constriction, Pathologic; Pancreas
PubMed: 37632411
DOI: 10.1177/03000605231194902 -
Minerva Chirurgica Nov 1998A rare case of adenocarcinoma of the duodenal bulb, arising from adenoma and submitted to Whipple's procedure is presented. A diagnostic delay of about 3 months,... (Review)
Review
A rare case of adenocarcinoma of the duodenal bulb, arising from adenoma and submitted to Whipple's procedure is presented. A diagnostic delay of about 3 months, according to literature is observed. This delay is generally due to the low incidence of the illness, aspecific symptoms and frequent endoscopic and radiologic false negative, most of all in lesions of the third and fourth duodenal portions. Diagnostic tools for these duodenal tumors are endoscopy and upper gastrointestinal barium studies (UGI). CT is useful to determine preoperatively the stage of the illness and can occasionally show the primary duodenal lesion, as in this case. Surgical approach is still controversial, except in lesions of the second duodenal portion, where Whipple operation is the procedure of choice, if the tumor is resectable, of course. In the other duodenal portions some authors suggest segmental duodenal resections instead of Whipple's procedure.
Topics: Adenocarcinoma, Mucinous; Aged; Duodenal Neoplasms; Duodenum; Humans; Male; Preoperative Care
PubMed: 9973799
DOI: No ID Found -
Gan To Kagaku Ryoho. Cancer &... Aug 2023A 69-year-old man was referred for vomiting. CT and upper gastrointestinal endoscopy revealed a circumferential stenotic lesion in the third portion of the duodenum, and...
A 69-year-old man was referred for vomiting. CT and upper gastrointestinal endoscopy revealed a circumferential stenotic lesion in the third portion of the duodenum, and partial duodenectomy and lymph node dissection were performed for the diagnosis of duodenal adenocarcinoma. The histopathological diagnosis was pT3, pN0, pStage ⅡA(UICC 8th)well differentiated tubular adenocarcinoma. The patient was treated with FOLFOX as adjuvant chemotherapy and is alive 2 years and 4 months postoperatively without recurrence. Primary duodenal adenocarcinoma in the third portion is rare, and further case experience is required for selection of the operation and adjuvant therapy.
Topics: Male; Humans; Aged; Duodenum; Duodenal Neoplasms; Digestive System Surgical Procedures; Chemotherapy, Adjuvant; Adenocarcinoma
PubMed: 37608423
DOI: No ID Found -
Gastrointestinal Endoscopy Aug 2017Endoscopic biopsy sampling for the diagnosis of duodenal adenocarcinoma is not perfect. We investigated the accuracy of biopsy specimen diagnoses of superficial...
BACKGROUND AND AIMS
Endoscopic biopsy sampling for the diagnosis of duodenal adenocarcinoma is not perfect. We investigated the accuracy of biopsy specimen diagnoses of superficial nonampullary duodenal epithelial tumors (NADETs).
METHODS
Clinicopathologic data were retrospectively reviewed for 95 superficial NADETs from 95 patients who underwent endoscopic resection. Preoperative diagnoses based on biopsy specimens were compared with histologic diagnoses of resected specimens.
RESULTS
Among the 21 lesions with biopsy specimen diagnoses of carcinoma, 12 (57.1%) were histologically diagnosed as adenomas after resection. Among the 74 lesions with biopsy specimen diagnoses of adenoma, 15 (20.3%) were histologically diagnosed as carcinomas after resection. The duodenal biopsy specimen predicted final histologic diagnoses of carcinoma with a sensitivity of 37.5% (95% CI, 18.8-59.4), specificity of 83.1% (95% CI, 72.3-91.0), accuracy of 71.6% (95% CI, 61.4-80.4), positive predictive value of 42.9% (95% CI, 21.8-66.0), and negative predictive value of 79.7% (95% CI, 68.8-88.2). Among 61 cases considered suitable for EMR, treatment modality was converted from EMR to endoscopic submucosal dissection because of the nonlifting sign in 15 cases (24.6%).
CONCLUSIONS
The accuracy of duodenal biopsy sampling was relatively low. Duodenal biopsy sampling may induce unexpected fibrosis. New endoscopic modalities that can improve preoperative diagnosis yield of NADETs are eagerly awaited.
Topics: Adenocarcinoma; Adenoma; Aged; Biopsy; Diagnosis, Differential; Duodenal Neoplasms; Duodenum; Endoscopic Mucosal Resection; Female; Humans; Male; Middle Aged; Predictive Value of Tests; Preoperative Period; Retrospective Studies
PubMed: 28003118
DOI: 10.1016/j.gie.2016.12.007 -
JAMA Jun 1979
Topics: Adenocarcinoma; Adenoma; Duodenal Neoplasms; Duodenum; Female; Humans; Jejunum; Middle Aged; Radiography
PubMed: 448823
DOI: No ID Found -
International Journal of Clinical and... 2013We investigated a series of pancreaticoduodenectomy and duodenal biopsies with a panel of immunohistochemical markers to identify duodenal mucosal invasion by pancreatic...
BACKGROUND
We investigated a series of pancreaticoduodenectomy and duodenal biopsies with a panel of immunohistochemical markers to identify duodenal mucosal invasion by pancreatic ductal adenocarcinoma (PDAC), including markers of poor prognosis and targets of promising novel immunotherapies.
MATERIALS AND METHODS
Eighteen consecutive pancreaticoduodenectomy specimens with duodenal mucosal invasion by PDAC were examined for expression of MUC1, MUC4, MUC5AC, MUC6, mesothelin, MUC2, CDX2, and DPC4 on formalin-fixed, paraffin-embedded sections of duodenal-ampullary-pancreatic junctions. Expression of all but MUC6 was also assessed in duodenal biopsies from 12 patients with duodenal mucosal invasion by PDAC.
RESULTS
The duodenal mucosa expressed MUC1 (crypts), MUC2 (goblet cells), MUC6 (Brunner glands), CDX2, and DPC4. PDACs in the duodenal mucosa from the resection (n=16-18) and biopsy (n=12) specimens were marked as follows: MUC1 100% (30/30), MUC4 83% (24/29), MUC5AC 83% (25/30), mesothelin 82% (23/28), MUC2 7% (2/30), and CDX2 36% (10/28). Loss of DPC4 expression was seen in 16 of 29 (55%) cases. Reactive mucosa adjacent to PDAC expressed MUC4, MUC5AC and mesothelin in 65% (17/26), 19% (5/27), and 19% (5/26) of cases, respectively. While MUC5AC and mesothelin had high diagnostic accuracy for detection of PDAC, MUC2, CDX2 and DPC4 expression demonstrated negative correlation with PDAC, with absent expression being highly specific for PDAC.
CONCLUSION
Immunohistochemical labeling for PDAC biomarkers may aid the diagnosis of PDAC in duodenal biopsy, especially in situations where diagnosis of a pancreatic mass is challenging.
Topics: Biomarkers, Tumor; Biopsy; Carcinoma, Pancreatic Ductal; Duodenum; Humans; Immunohistochemistry; Intestinal Mucosa; Neoplasm Invasiveness; Pancreatic Neoplasms; Pancreaticoduodenectomy; Predictive Value of Tests; Prognosis
PubMed: 24228110
DOI: No ID Found -
European Journal of Cancer Prevention :... May 2020Duodenal neoplasms of gastric phenotype are uncommon epithelial neoplasms. Pyloric gland adenomas should be recognized as neoplasms with risk for transformation into... (Review)
Review
Duodenal neoplasms of gastric phenotype are uncommon epithelial neoplasms. Pyloric gland adenomas should be recognized as neoplasms with risk for transformation into invasive adenocarcinoma (). Here we report the case histories of two male patients, who presented with duodenal polypoid lesion. Endoscopic polypectomy and endoscopic submucosal dissection were carried out, respectively. Histopathologically, both polyps showed features of neoplasms of gastric phenotype. The clinical and endoscopic features, pathologic features, immunophenotype, molecular pathogenesis, clinical management and prognosis of the two cases will be discussed. We will also briefly review the latest literatures on duodenal neoplasms of gastric phenotype.
Topics: Adenocarcinoma; Adenoma; Aged; Duodenal Neoplasms; Duodenoscopy; Duodenum; Endoscopic Mucosal Resection; Humans; Intestinal Mucosa; Intestinal Polyps; Male; Middle Aged; Prognosis; Treatment Outcome
PubMed: 32168033
DOI: 10.1097/CEJ.0000000000000530 -
BMC Surgery Aug 2022Local duodenectomy and primary closure is a simple option for some nonampullary duodenal neoplasms. Minimizing the resection area while ensuring curability is necessary... (Observational Study)
Observational Study
BACKGROUND
Local duodenectomy and primary closure is a simple option for some nonampullary duodenal neoplasms. Minimizing the resection area while ensuring curability is necessary for safe primary duodenal closure. However, it is often difficult to determine the appropriate resection line from the serosal side. We developed clip-guided local duodenectomy to easily determine the resection range and perform local duodenectomy safely, then performed a retrospective observational study to confirm the safety of clip-guided local duodenectomy.
METHODS
The procedure is as follows: placing endoscopic metal clips at four points on the margin around the tumor within 3 days before surgery, identifying the tumor extent with the clips under X-ray imaging during surgery, making an incision to the duodenum just outside of the clips visualized by X-ray imaging, full-thickness resection of the duodenum with the clips as guides of tumor demarcation, and transversely closure by Gambee suture. We evaluated clinicopathological data and surgical outcomes of patients who underwent clip-guided local duodenectomy at two surgical centers between January 2010 and May 2020.
RESULTS
Eighteen patients were included. The pathological diagnosis was adenoma (11 cases), adenocarcinoma (6 cases), and GIST (1 case). The mean ± SD tumor size was 18 ± 6 mm, and the tumor was mainly located in the second portion of the duodenum (66%). In all cases, the duodenal defect was closed with primary sutures. The mean operation time and blood loss were 191 min and 79 mL, respectively. The morbidity was 22%, and all complications were Clavien-Dindo grade II. No anastomotic leakage or stenosis was observed. In the 6 adenocarcinoma patients, all were diagnosed with pT1a, and postoperative recurrence was not observed. The 1-year overall and recurrence free survival rate was 100%.
CONCLUSIONS
Clip-guided local duodenectomy is a safe and useful surgical option for minimally local resection of nonampullary duodenal neoplasms such as duodenal adenoma, GIST, and early adenocarcinoma.
Topics: Adenocarcinoma; Adenoma; Duodenal Neoplasms; Duodenum; Gastrointestinal Stromal Tumors; Humans; Retrospective Studies; Surgical Instruments; Treatment Outcome
PubMed: 36038851
DOI: 10.1186/s12893-022-01771-0 -
Digestive Diseases and Sciences Oct 2018Sporadic nonampullary duodenal epithelial tumors (NADETs) are uncommon, and thus their clinicopathological features have not been fully assessed.
BACKGROUND
Sporadic nonampullary duodenal epithelial tumors (NADETs) are uncommon, and thus their clinicopathological features have not been fully assessed.
AIMS
In this study, we have analyzed a series of early sporadic NADETs, focusing on various immunohistological features.
METHODS
We conducted a multicenter retrospective analysis of 68 patients with endoscopically resected sporadic NADETs. Associations between immunohistological features and clinicopathological features were statistically analyzed.
RESULTS
The 68 patients consisted of 46 men (68%) and 22 women (32%) with a mean age of 60.7 ± 12.2 years (range 37-85 years). The 68 tumors were composed of 39 adenomas (57%) and 29 early-stage adenocarcinomas (43%). Duodenal adenocarcinomas were larger in size than adenomas and had papillary architecture in their pathological diagnosis with statistical significance. Duodenal adenocarcinomas also demonstrated a significantly higher expression of gastric markers (MUC5AC and MUC6) and a higher MIB-1 index. Duodenal adenomas were contrastively apt to express intestinal markers (MUC2, CDX1 and CDX2). Of the 68 cases analyzed, there were only 3 tumors positive for p53 staining, all of which were adenocarcinoma. When 7 submucosal invasive cancers and 21 intramucosal cancers were compared, submucosal invasion was positively associated with expression of MUC5AC. Also, submucosal invasion showed strong association with double-positivity of MUC5AC and MUC6.
CONCLUSIONS
Our results indicate that immunohistochemical evaluation is useful for predicting malignant potential of NADETs, especially focusing on the expression of gastrointestinal markers.
Topics: Adenocarcinoma; Adenoma; Aged; Biomarkers, Tumor; Duodenal Neoplasms; Duodenum; Endoscopy, Digestive System; Female; Homeodomain Proteins; Humans; Immunohistochemistry; Japan; Male; Middle Aged; Mucin 5AC; Mucin-2; Mucin-6; Neoplasm Staging; Retrospective Studies; Statistics as Topic
PubMed: 29956011
DOI: 10.1007/s10620-018-5179-0