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Khirurgiia Apr 1994Primary duodenal carcinoma is a relatively rare oncological disease and accounts for 0.04-0.5% of all tumors of the gastrointestinal tract. The absence of pathognomonic...
Primary duodenal carcinoma is a relatively rare oncological disease and accounts for 0.04-0.5% of all tumors of the gastrointestinal tract. The absence of pathognomonic symptoms and insufficient knowledge and watchfulness on the part of doctors in relation to this pathological condition are the main causes of the difficult diagnosis and early detection of the disease. Esophagogastroduodenoscopy with biopsy, radiological duodenography, ultrasonic examination, and computered tomography of the abdominal organs play the main role in timely diagnosis of primary duodenal carcinoma. Pancreatoduodenal resection is the optimal method of treatment.
Topics: Adenocarcinoma; Aged; Biopsy; Duodenal Neoplasms; Duodenum; Endoscopy, Digestive System; Female; Humans; Tomography, X-Ray Computed
PubMed: 8041073
DOI: No ID Found -
Annals of Diagnostic Pathology Jun 2019Russell body gastritis is considered as a rare, benign, incidental finding characterized by dense accumulation of plasma cells containing Russell bodies in the lamina... (Review)
Review
INTRODUCTION
Russell body gastritis is considered as a rare, benign, incidental finding characterized by dense accumulation of plasma cells containing Russell bodies in the lamina propria. In this study, clinical and histopathological features of 12 cases of Russell body gastritis/duodenitis were presented.
MATERIALS AND METHODS
Clinical data, histopathological findings including Helicobacter pylori infection, Sydney system classification, Russell body density and immunohistochemical findings were evaluated in 11 gastric and 1 duodenal mucosal biopsy from 11 patients.
RESULTS
Six cases were male, 5 were female and the mean age was 72 (44-87). The most common site was antrum (10/12), one case was located in cardia and one in heterotopic gastric mucosa of duodenal bulb. H. pylori was detected in half of the cases. One of the cases was accompanied by gastric tubular adenoma, one by gastric well-differentiated adenocarcinoma and one by plasma cell neoplasm. In all cases, globules were positive with PAS stain.
CONCLUSION
Russell body gastritis must be kept in mind while reporting endoscopic biopsies because this entity may be misdiagnosed as signet ring carcinoma and may be associated with neoplasms. Absence of nuclear atypia, mucin stains, cytokeratins, plasma cell and hematolymphoid antigen markers are useful in differential diagnosis. Associated H. pylori infection, as well as rarely carcinomas, adenomas and plasma cell neoplasms, may be observed.
Topics: Adult; Aged; Aged, 80 and over; Biopsy; Duodenitis; Duodenum; Female; Gastric Mucosa; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Male; Middle Aged; Plasma Cells; Stomach
PubMed: 31031217
DOI: 10.1016/j.anndiagpath.2019.04.003 -
Pathology International Mar 2019
Topics: Adenocarcinoma; Aged, 80 and over; Brunner Glands; Duodenum; Humans; Hyperplasia; Male; Stomach Neoplasms
PubMed: 30694586
DOI: 10.1111/pin.12759 -
JOP : Journal of the Pancreas Sep 2012Ampullary adenocarcinomas and bile duct cancers represent a very small minority of all gastrointestinal malignancies. Synchronous presentation of both malignancies is... (Review)
Review
CONTEXT
Ampullary adenocarcinomas and bile duct cancers represent a very small minority of all gastrointestinal malignancies. Synchronous presentation of both malignancies is extremely rare.
CASE REPORT
We report a case of a 76-year-old male who presented with painless jaundice. His work-up showed an ampullary mass and a separate common bile duct stricture. Attempted endoscopic resection established the diagnosis of ampullary adenocarcinoma. Pathologic examination of the Whipple specimen identified a separate focus of bile duct cancer.
CONCLUSION
Synchronous presentation of an ampullary mass and separate distal bile duct stricture, especially in elderly patients, should raise concern for both lesions representing malignancies. In the absence of conclusive evidence for survival advantage in resected early stage ampullary and biliary cancers, close observation should be considered a valid alternative to adjuvant chemotherapy and radiation.
Topics: Adenocarcinoma; Aged; Ampulla of Vater; Common Bile Duct Neoplasms; Diagnosis, Differential; Duodenal Neoplasms; Female; Humans; Male; Neoplasms, Multiple Primary
PubMed: 22964962
DOI: 10.6092/1590-8577/836 -
Digestion 2021The natural history and prognosis of superficial nonampullary duodenal epithelial tumors (SNADETs) remain uncertain. We elucidated the relationship between...
INTRODUCTION
The natural history and prognosis of superficial nonampullary duodenal epithelial tumors (SNADETs) remain uncertain. We elucidated the relationship between immunophenotype and clinicopathological features.
MATERIALS AND METHODS
A total of 98 SNADETs were divided into 3 groups according to immunohistochemical findings: gastric phenotype (G type), gastrointestinal phenotype (GI type), and intestinal phenotype (I type). Cellular dysplasia was divided into low-grade dysplasia and high-grade dysplasia/adenocarcinoma (≥HGD). White opaque substance (WOS) deposition was categorized into diffuse WOS, partial WOS, and no WOS, based on endoscopic findings.
RESULTS
Of the 98 SNADETs, 4 lesions (4.1%) were G type, 32 lesions (32.7%) were GI type, and 62 lesions (63.2%) were I type. All G-type SNADETs were located in the oral side of the papilla including the bulb, and the rate of bulbar lesions was significantly higher in the G type than in the GI and I types (p = 0.004). The most frequent type of WOS was no WOS (4/4, 100%) for G type, partial WOS (19/32, 59.4%) for GI type, and diffuse WOS (34/62, 54.8%) for I type (p < 0.001), and loss of intestinal character was significantly correlated with WOS deficiency. GI/I-type SNADETs with partial or no WOS and G-type SNADETs were associated with ≥HGD. Additionally, the frequency of ≥HGD lesion was significantly higher in the CD10-negative group than in the CD10-positive group (57.1 vs. 19.8%, p = 0.043).
CONCLUSION
Pathological intestinal character was correlated with the presence of WOS, and CD10 loss was associated with malignant potential of SNADETs.
Topics: Adenocarcinoma; Duodenal Neoplasms; Duodenum; Humans; Hyperplasia; Stomach
PubMed: 33794536
DOI: 10.1159/000514812 -
Laparoscopy-assisted transduodenal excision of superficial non-ampullary duodenal epithelial tumors.Asian Journal of Endoscopic Surgery Aug 2015Transduodenal excision (transduodenal submucosal dissection) is an alternative to pancreaticoduodenectomy for the treatment of benign and low-grade malignant tumors of...
INTRODUCTION
Transduodenal excision (transduodenal submucosal dissection) is an alternative to pancreaticoduodenectomy for the treatment of benign and low-grade malignant tumors of the duodenum. However, laparoscopic transduodenal excision or laparoscopy-assisted transduodenal excision (LATDE) of such tumors has been rarely reported. In this paper, we present the preliminary results of LATDE in patients with superficial non-ampullary duodenal epithelial tumors.
METHODS
Three patients with superficial non-ampullary duodenal epithelial tumors (mucosal adenocarcinoma, n = 1; tubular adenoma, n = 2) underwent LATDE. LATDE consists of four major procedures: (i) laparoscopic wide Kocher maneuver (mobilization of the pancreaticoduodenum); (ii) extracorporeal approach to the fully mobilized duodenum through the upper median longitudinal incision (4 cm in length); (iii) tumor excision by submucosal dissection under direct vision through longitudinal duodenotomy (4 cm in length); and (iv) hand-sewn closure of the mucosal defect and duodenotomy.
RESULTS
LATDE was successfully carried out without any intraoperative or postoperative adverse events. The mean operating time and estimated blood loss were 155 min and 17 mL, respectively. Contrast roentgenography on postoperative day 4 showed neither duodenal deformity nor disturbance of gastroduodenal emptying in any of the patients.
CONCLUSIONS
LATDE could eliminate the possibility of peritoneal or port-site seeding of tumor cells because the duodenotomy and tumor excision are performed extracorporeally. The meticulously hand-sewn closures of the mucosal defect and duodenotomy can minimize the possibility of postoperative hemorrhage and/or anastomotic leakage. LATDE is a feasible, safe, and minimally invasive treatment for patients with superficial non-ampullary duodenal epithelial tumors that have no risk of lymph node metastasis in the first and second portions of the duodenum.
Topics: Adenocarcinoma; Adenoma; Duodenal Neoplasms; Duodenum; Female; Humans; Intestinal Mucosa; Laparoscopy; Middle Aged; Treatment Outcome
PubMed: 25950619
DOI: 10.1111/ases.12191 -
Seminars in Diagnostic Pathology Aug 1991This review considers the pathologic features of epithelial tumors and tumor-like lesions of the duodenum and highlights potential pitfalls in their histological... (Review)
Review
This review considers the pathologic features of epithelial tumors and tumor-like lesions of the duodenum and highlights potential pitfalls in their histological diagnosis. The tumor-like lesions include Brunner's gland hamartoma, myoepithelial hamartoma, and the mucosal polyps of the Peutz-Jeghers and juvenile polyposis syndromes. The true neoplasms are of two broad groups. The first includes duodenal adenomas and carcinomas, whose microscopic features, histogenetic relationships, and clinical significance closely mimic their commoner counterparts in the large intestine and which, when multiple, are closely associated with familial adenomatous polyposis coli. The second includes a number of uncommon endocrine cell tumors showing a great diversity of histological pattern, and which may be single or multiple. Among these are typical argyrophil carcinoids, which may secrete gastrin to give rise to the Zollinger-Ellison syndrome, and which may occur as part of the inherited multiple endocrine neoplasia syndrome type 1 (MEN-1); glandular somatostatin-rich, apparently nonargyrophil, carcinoids containing psammoma bodies that can be easily confused histologically with adenocarcinomas, and which are linked to type 1 neurofibromatosis (von Recklinghausen's disease) and phaeochromocytoma; and the gangliocytic paraganglioma, a rare tumor composed of neural elements, ganglion cells, and endocrine cells. Accurate histologic diagnosis of mucosal tumors and tumor-like lesions of the duodenum is important not only for immediate patient management, but also because it may provide the first clue to the existence of an inherited tumor syndrome, with its broader implications for the patient's family and potentially important consequences for genetic counseling.
Topics: Adenocarcinoma; Adenoma; Brunner Glands; Carcinoid Tumor; Duodenal Neoplasms; Duodenum; Epithelium; Hamartoma; Humans; Intestinal Polyps; Neurosecretory Systems; Paraganglioma; Peutz-Jeghers Syndrome
PubMed: 1925122
DOI: No ID Found -
World Journal of Gastroenterology Mar 2016To investigate estrogen receptors expression in duodenal familial adenomatous polyposis (FAP) and any relationship with epithelial proliferation/apoptosis markers.
AIM
To investigate estrogen receptors expression in duodenal familial adenomatous polyposis (FAP) and any relationship with epithelial proliferation/apoptosis markers.
METHODS
Twenty-two patients affected by FAP undergoing duodenal resection for malignancies were recruited. Controls were 15 healthy subjects undergoing endoscopy for dyspeptic symptoms. ER-α, ER-α, Ki-67, TUNEL and caspase 3 expression (labeling index: percentage of positive cells) were evaluated by immunohistochemistry or immunofluorescence and examined by light or confocal microscopy. Samples were assigned to four groups: normal tissue, low (LGD) and high-grade dysplasia (HGD), adenocarcinoma (AC). One-way analysis of variance, corrected by Bonferroni's test, and Pearson's correlation test were applied for statistical analysis.
RESULTS
ER-beta showed a progressive decline: normal tissue (23.5 ± 4.9), LGD (21.1 ± 4.8), HGD (9.3 ± 3.5), AC (7.1 ± 3.1). The normal tissue of FAP subjects expressed ER-beta like the controls (23.9 ± 6.2). Conversely, ER-α showed a progressive increase from normal tissue (24.8 ± 5.6) to AC (52.0 ± 8.2); the expression in normal tissue was similar to controls (22.5 ± 5.3). Ki67 demonstrated a statistically significant progressive increase at each disease stage up to AC. TUNEL did not reveal differences between controls and normal tissue of FAP subjects, but progressive decreases were observed in LGD, through HGD to AC. Pearson's correlation test showed a direct relationship between ER-β and TUNEL LI (r = 0.8088, P < 0.0001). Conversely, ER-α was inversely correlated with TUNEL LI (r = - 0.7257, P < 0.0001). The co-expression of ER-β and caspase 3 declined progressively from normal to neoplastic tissue.
CONCLUSION
This study confirmed that ER-β is strongly decreased in duodenal FAP carcinomas, declining in a multiple step fashion, thereby suggesting a putative anti-carcinogenic effect. ER-α showed the opposite trend. ER-β/caspase 3 co-expression suggests this hormone's possible involvement in apoptosis. Hormonal influences in FAP duodenal tumorigenesis, and modulation of these as a possible chemoprevention strategy, may be a promising approach.
Topics: Adenocarcinoma; Adenomatous Polyposis Coli; Adult; Apoptosis; Biomarkers, Tumor; Caspase 3; Cell Proliferation; Duodenal Neoplasms; Duodenum; Estrogen Receptor alpha; Estrogen Receptor beta; Female; Humans; Intestinal Mucosa; Ki-67 Antigen; Male; Middle Aged; Retrospective Studies; Young Adult
PubMed: 27003997
DOI: 10.3748/wjg.v22.i11.3202 -
Digestive Endoscopy : Official Journal... Mar 2021Differentiating superficial non-ampullary duodenal epithelial tumors (SNADETs) that harbor malignant potential is important. We developed a simple scoring system and...
BACKGROUND AND AIMS
Differentiating superficial non-ampullary duodenal epithelial tumors (SNADETs) that harbor malignant potential is important. We developed a simple scoring system and investigated whether it enables the differentiation of low-grade adenoma and high-grade adenoma/adenocarcinoma.
PATIENTS AND METHODS
We retrospectively enrolled 197 consecutive patients with 207 SNADETs who underwent endoscopic resection at NTT Medical Center Tokyo between March 2016 and May 2019. Endoscopic findings were compared between Vienna Classification (VCL) C3 and C4/5 lesions. A multivariate logistic regression analysis was performed to develop a scoring system to identify VCL C4/5 lesions. The efficacy of our scoring system was elucidated among five novice and five expert endoscopists.
RESULTS
Of 207 SNADETs, 66 and 141 lesions were pathologically diagnosed as VCL C3 and C4/5. A multivariate logistic regression analysis identified a tumor diameter of 10-19 mm (OR, 3.81; 95% CI, 1.02-14.2; P = 0.04), a tumor diameter ≥20 mm (OR, 95.2; 95% CI, 10.4-871.0; P < 0.001), a red color (OR, 14.5; 95% CI, 3.55-59.6; P < 0.001), the presence of irregular surface pattern (OR, 12.4; 95% CI, 3.00-51.4; P < 0.001), and the presence of irregular vessel pattern (OR, 13.7; 95% CI, 4.03-46.6; P < 0.001) as independent significant predictors of VCL C4/5. Considering these results, we developed a scoring system. Using an appropriate cutoff value, the diagnostic accuracy, sensitivity and specificity were calculated as 92%, 95% and 93%. The average diagnostic accuracy did not differ between novice and expert endoscopists (86% vs 87%, P = 0.76).
CONCLUSIONS
Our scoring system was useful for differentiating VCL C3 and C4/5 lesions. UMIN Clinical Trials (No. 000039063).
Topics: Adenocarcinoma; Duodenal Neoplasms; Duodenoscopy; Duodenum; Humans; Retrospective Studies
PubMed: 32506480
DOI: 10.1111/den.13762 -
Journal of Hepato-biliary-pancreatic... Mar 2024There is currently no consensus on the use of endoscopic papillectomy (EP) for early stage duodenal ampullary adenocarcinoma. This study aimed to evaluate the...
BACKGROUND/PURPOSE
There is currently no consensus on the use of endoscopic papillectomy (EP) for early stage duodenal ampullary adenocarcinoma. This study aimed to evaluate the feasibility of EP for patients with early stage duodenal ampullary adenocarcinoma.
METHODS
Patients who underwent EP for ampullary adenocarcinomas were investigated. Complete and clinical complete resection rates were evaluated. Clinical complete resection was defined as either complete resection or resection with positive or unknown margins but no cancer in the surgically resected specimen, or no recurrence on endoscopy after at least a 1-year follow-up.
RESULTS
Adenocarcinoma developed in 30 patients (carcinoma in situ [Tis]: 21, mucosal tumors [T1a(M)]: 4, tumors in the sphincter of Oddi [T1a(OD)]: 5). The complete resection rate was 60.0% (18/30) (Tis: 66.7% [14/21], T1a[M]: 50.0% [2/4], and T1a[OD]: 40.0% [2/5]). The mean follow-up period was 46.8 months. The recurrence rate for all patients was 6.7% (2/30). The clinical complete resection rates of adenocarcinoma were 89.2% (25/28); rates for Tis, T1a(M), and T1a(OD) were 89.4% (17/19), 100% (4/4), and 80% (4/5), respectively.
CONCLUSIONS
EP may potentially achieve clinical complete resection of early stage (Tis and T1a) duodenal ampullary adenocarcinomas.
Topics: Humans; Ampulla of Vater; Treatment Outcome; Retrospective Studies; Adenocarcinoma; Endoscopy, Gastrointestinal; Common Bile Duct Neoplasms; Pancreatic Neoplasms
PubMed: 38014632
DOI: 10.1002/jhbp.1398