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Clinical Journal of Gastroenterology Apr 2023A 61-year-old woman was referred to our hospital for intraductal papillary mucinous neoplasm with no symptoms. Magnetic resonance imaging (MRI) depicted a 15 mm nodular... (Review)
Review
A 61-year-old woman was referred to our hospital for intraductal papillary mucinous neoplasm with no symptoms. Magnetic resonance imaging (MRI) depicted a 15 mm nodular lesion at the descending portion of duodenum. Upper gastrointestinal endoscopy showed a submucosal tumor-like mass at the minor duodenal papilla. A boring biopsy of the tumor revealed a neuroendocrine neoplasm (NEN). Various blood hormone tests were all within normal limits, and the tumor was considered to be nonfunctional. Contrast-enhanced computed tomography showed no obvious distant metastasis, and subtotal stomach-preserving pancreaticoduodenectomy (SSPPD) was performed. Histopathological examination revealed a dense cluster of spindle-shaped cells forming a sheet-like foci and areas showing glandular lumen formation, and immunohistochemistry showed synaptophysin ( + ), chromogranin ( + ). Mitotic rate was about 11 mitoses per 2 square millimeters, Ki-67 index was about 0.2%. She was pathologically diagnosed with NEN G2 at the minor duodenal papilla with regional lymph node metastasis according to the WHO2010 classification. The patient has been currently under outpatient observation with a good postoperative course. Review of the literature identified 43 cases of NENs of the minor duodenal papilla. NENs of the minor duodenal papilla have a high rate of lymph node metastasis, even if the tumor size is small.
Topics: Female; Humans; Middle Aged; Lymphatic Metastasis; Duodenal Neoplasms; Neuroendocrine Tumors; Pancreatic Ducts; Pancreaticoduodenectomy
PubMed: 36542298
DOI: 10.1007/s12328-022-01739-w -
Revista Espanola de Enfermedades... Feb 2022An 83-year-old male presented to the Emergency Department with long lasting epigastric discomfort, weight loss and diarrhea. Physical exam and basic laboratory tests...
An 83-year-old male presented to the Emergency Department with long lasting epigastric discomfort, weight loss and diarrhea. Physical exam and basic laboratory tests showed no remarkable findings. Upper endoscopy revealed a sessile lesion (Paris 0-IIa) in the anterior wall of the duodenal bulb, with smooth surface and slightly ulcerated at the top.
Topics: Aged, 80 and over; Duodenal Neoplasms; Duodenum; Gastroscopy; Humans; Male
PubMed: 34607439
DOI: 10.17235/reed.2021.8349/2021 -
Clinical Journal of Gastroenterology Jun 2023The pathologic diagnosis of duodenal tumors is a developing field; however, its overview remains unclear. We describe a rare case of a duodenal gastric-type neoplasm in...
The pathologic diagnosis of duodenal tumors is a developing field; however, its overview remains unclear. We describe a rare case of a duodenal gastric-type neoplasm in a 50-year-old woman. She visited her primary care doctor with complaints of upper abdominal pain, tarry stools, and shortness of breath on exertion. She was admitted owing to a stalked polyp with erosion and hemorrhage in the descending part of the duodenum. Endoscopic mucosal resection (EMR) was performed on the polyp. Histologically, the resected polyp was a lipomatous lesion in the submucosal layer, composed of mature adipose tissues. Scattered irregular lobules of Brunner's gland-like structures with well-preserved construction but mildly enlarged nuclei and occasional conspicuous nucleoli of the constituent cells were observed. The resection margin was negative. EMR findings of the duodenal polyp showed a gastric epithelial tumor within a lipoma, a rare histological type that has not been reported previously. This tumor may be classified as a "neoplasm with uncertain malignant potential" in a lipoma, an intermediate category between adenoma and invasive adenocarcinoma. There is no consensus on treatment, and careful follow-up is recommended. This is the first report of a duodenal gastric-type neoplasm with uncertain malignant potential in a lipoma.
Topics: Female; Humans; Middle Aged; Duodenal Neoplasms; Brunner Glands; Duodenum; Duodenal Diseases; Lipoma; Stomach Neoplasms
PubMed: 36867353
DOI: 10.1007/s12328-023-01774-1 -
Pathology International May 2023
Topics: Humans; Duodenal Neoplasms; Duodenum; Stomach; Phenotype; Ampulla of Vater; Neoplasm Staging; Retrospective Studies
PubMed: 36970951
DOI: 10.1111/pin.13319 -
Scandinavian Journal of Gastroenterology 2018Duodenal neuroendocrine neoplasms (dNENs) are rare tumors, which usually show good prognosis. The optimal management of these tumors is still far from being clearly... (Review)
Review
BACKGROUND
Duodenal neuroendocrine neoplasms (dNENs) are rare tumors, which usually show good prognosis. The optimal management of these tumors is still far from being clearly understood because of their rarity and the poor level of knowledge about their natural history. Herein, we have reviewed the literature on dNENs to collect and analyze the current data on epidemiology, diagnosis and management of these rare tumors.
METHODS
Bibliographical searches were performed in PubMed, using the following keywords: duodenal neuroendocrine neoplasm; duodenum; gastrinoma; diagnosis; therapy; guidelines. We searched for all relevant articles published over the last 15 years. Non-English language papers were excluded.
RESULTS
We reviewed the pertinent articles about dNENs. Upper gastrointestinal endoscopy with biopsy is the cornerstone of the dNENs diagnostic process. Endoscopic ultrasound with fine-needle aspiration/biopsy should be performed in order to locally stage the disease and in all cases of non-diagnostic endoscopy. Endoscopic or complete surgical removal of the primary lesion is the recommended treatment and is generally achievable for the majority of the patients. A less aggressive approach may be suggested for well-differentiated low-stage tumors. After NEN removal, patients should be closely followed-up especially during the first 3 years by endoscopic examination, imaging tests and CgA measurements.
CONCLUSIONS
The multi-disciplinary approach and the preservation of the quality of life of the patients play a key role in the therapeutic process for dNENs. Further studies are needed to better define standardized guidelines specific to dNENs, including optimal management approaches and follow-up intervals.
Topics: Duodenal Neoplasms; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Endoscopy, Digestive System; Gastrinoma; Humans; Neuroendocrine Tumors; Practice Guidelines as Topic; Quality of Life
PubMed: 29726295
DOI: 10.1080/00365521.2018.1468479 -
Archives of Surgery (Chicago, Ill. :... Aug 1990The treatment of 36 patients with duodenal villous tumors was reviewed to determine the long-term outcome of various surgical treatment options for specific adenoma...
The treatment of 36 patients with duodenal villous tumors was reviewed to determine the long-term outcome of various surgical treatment options for specific adenoma histopathology. Duodenal villous tumors were typically solitary and periampullary in location. Villous adenomas contained epithelial atypia in 30% of patients, in situ carcinoma in 14%, and invasive carcinoma in 33%. Treatment consisted of transduodenal submucosal excision in 19 patients and radical pancreaticoduodenectomy in 15. There was no perioperative mortality. Perioperative morbidity for transduodenal excision and pancreaticoduodenectomy was 16% and 47%, respectively. Benign adenomas recurred more than 5 years postoperatively in 17% of patients undergoing transduodenal excision. Five-year survival following radical resection for invasive cancers was 45%. Overall median follow-up was 5.8 years. We conclude that duodenal villous tumors without invasive cancer can be managed successfully by local submucosal excision, but invasive carcinoma requires radical resection.
Topics: Adenoma; Adult; Aged; Aged, 80 and over; Duodenal Neoplasms; Duodenoscopy; Duodenum; Female; Follow-Up Studies; Humans; Male; Methods; Middle Aged; Neoplasm Invasiveness; Pancreatectomy; Retrospective Studies; Survival Rate
PubMed: 2378560
DOI: 10.1001/archsurg.1990.01410200019001 -
Cirugia Espanola Apr 2005Duodenal adenocarcinoma is an infrequent neoplasm. Consequently, there are no large series that would allow conclusions to be reached on its diagnosis and treatment.
INTRODUCTION
Duodenal adenocarcinoma is an infrequent neoplasm. Consequently, there are no large series that would allow conclusions to be reached on its diagnosis and treatment.
PATIENTS AND METHOD
A retrospective study (1999-2003) of five patients diagnosed with duodenal adenocarcinoma in our service was performed.
RESULTS
The mean age was 54 years. Eighty percent were male. All patients showed weight loss and abdominal pain. The tumors were localized in the second portion in three patients and in the third portion in two patients. All patients underwent gastrointestinal endoscopy with biopsy, which revealed adenocarcinoma. The most effective diagnostic test was computed tomography. In all patients, the preoperative diagnosis was correct. The technique performed was cephalic duodenopancreatectomy in three patients and duodenectomy with atypical pancreatic resection and right hemicolectomy in one patient. A decision not to perform surgery was made in one patient with liver metastases. Two patients who underwent surgery showed no complications. The remaining two patients showed slow gastric emptying in one patient and pancreatitis of the stump leading to fatal systemic inflammatory response syndrome in the other. Patient survival was 60, 13 and 1 month respectively. There were no recurrences. The patient who did not undergo surgery died at 4 months.
CONCLUSION
Duodenal adenocarcinoma is an infrequent tumor that is associated with various diseases. Surgical treatment is usually cephalic duodenopancreatectomy. Survival in resected patients is better than that obtained in primary pancreatic tumors.
Topics: Adenocarcinoma; Adolescent; Adult; Aged; Duodenal Neoplasms; Female; Humans; Male; Middle Aged; Retrospective Studies
PubMed: 16420919
DOI: 10.1016/s0009-739x(05)70839-3 -
BMC Gastroenterology Sep 2020We experienced a rare case of intraductal papillary mucinous neoplasm arising from Santorini's duct (SD) forming a tumor protruding into the duodenum .
BACKGROUND
We experienced a rare case of intraductal papillary mucinous neoplasm arising from Santorini's duct (SD) forming a tumor protruding into the duodenum .
CASE PRESENTATION
A 71-year-old woman was incidentally diagnosed with a 3 cm type Isp polypoid tumor in the second portion of the duodenum at another hospital. Enhanced CT and endoscopic ultrasound revealed that the origin of this protruding tumor was arising from SD and that the tumor mimicked a pedunculated duodenal tumor. Our preoperative diagnosis was a malignant pancreatic tumor arising from SD with invasion into the duodenum. She underwent a subtotal stomach-preserving pancreaticoduodenectomy, and the resected specimen showed a 25 mm tumor protruding into the duodenum with a villous surface. The pathological findings revealed that the tumor was intraductal papillary mucinous adenoma (IPMA) arising from SD.
CONCLUSIONS
To the best of our knowledge, this is the first case of IPMA protruding into the duodenal lumen from SD, although most of the tumors arising from SD have been reported to be malignant.
Topics: Aged; Carcinoma, Pancreatic Ductal; Duodenal Neoplasms; Female; Humans; Pancreas; Pancreatic Ducts; Pancreatic Neoplasms
PubMed: 32938427
DOI: 10.1186/s12876-020-01449-y -
World Journal of Gastroenterology Sep 2014Because of the low prevalence of non-ampullary duodenal epithelial tumors (NADETs), standardized clinical management of sporadic superficial NADETs, including diagnosis,... (Review)
Review
Because of the low prevalence of non-ampullary duodenal epithelial tumors (NADETs), standardized clinical management of sporadic superficial NADETs, including diagnosis, treatment, and follow-up, has not yet been established. Retrospective studies have revealed certain endoscopic findings suggestive of malignancy. Duodenal adenoma with high-grade dysplasia and mucosal cancer are candidates for local resection by endoscopic or minimally invasive surgery. The use of endoscopic treatment including endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), for the treatment for superficial NADETs is increasing. EMR requires multiple sessions to achieve complete remission and repetitive endoscopy is needed after resection. ESD provides an excellent complete resection rate, however it remains a challenging method, considering the high risk of intraoperative or delayed perforation. Minimally invasive surgery such as wedge resection and pancreas-sparing duodenectomy are beneficial for superficial NADETs that are technically difficult to remove by endoscopic treatment. Pancreaticoduodenectomy remains a standard surgical procedure for treatment of duodenal cancer with submucosal invasion, which presents a risk of lymph node metastasis. Endoscopic or surgical treatment outcomes of superficial NADETs without submucosal invasion are satisfactory. Establishing an endoscopic diagnostic tool to differentiate superficial NADETs between adenoma and cancer as well as between mucosal and submucosal cancer is required to select the most appropriate treatment.
Topics: Adenoma; Carcinoma; Dissection; Duodenal Neoplasms; Duodenoscopy; Humans; Lymphatic Metastasis; Neoplasm Invasiveness; Pancreaticoduodenectomy; Treatment Outcome
PubMed: 25253950
DOI: 10.3748/wjg.v20.i35.12501 -
The American Surgeon Oct 2014Adenocarcinoma of the small bowel accounts for only one per cent of all gastrointestinal malignancies. Duodenal adenocarcinoma accounts for half of all small bowel... (Review)
Review
Adenocarcinoma of the small bowel accounts for only one per cent of all gastrointestinal malignancies. Duodenal adenocarcinoma accounts for half of all small bowel adenocarcinomas. The duodenum is divided into four segments: D1 (proximal horizontal 5 cm beginning with the 3-cm duodenal bulb), D2 (descending), D3 (distal horizontal), and D4 (ascending). The most common location of duodenal adenocarcinomas is the ampullary region of D2. Based on observational experience, our hypothesis was that primary adenocarcinomas arising from the mucosa of the duodenal bulb are extremely rare or possibly nonexistent. Our institutional cancer registry provided a list of patients for the years 1990 through 2012 who had small bowel cancers. Only those patients with primary adenocarcinomas of the duodenal mucosa were reviewed. Ampullary cancers arising from bile duct mucosa were specifically excluded. Medical records were abstracted to obtain patient age, sex, race, anatomic location of the tumor, disease stage (as per American Joint Committee on Cancer 7th edition staging guidelines), operation performed, and current vital status. A total of 30 patients with primary duodenal adenocarcinomas were identified. The mean age was 58 years and 17 (57%) patients were male. The tumor locations were: D2 in 26 (87%), D3 in two (7%), and D4 in two (7%). No tumors arose from D1. The patients presented with the following stages of disease: Stage 0is in three (10%), Stage I in three (10%), Stage II in five (17%), Stage III in 15 (50%), and Stage IV in four (13%). These findings combined with a diligent review of 724 reported cases in the English language literature yielded only five clearly defined cases of adenocarcinoma arising from the mucosa of the duodenal bulb. Although a 1991 published multicenter tumor registry series of 128 localized duodenal adenocarcinomas reported 29 D1 tumors, no anatomic distinction was made between duodenal bulb and more distal D1 tumors. Earlier reports used nonanatomic divisions of the duodenum or a simple breakdown into supra-ampullary, periampullary, and infra-ampullary portions. These data beg the question as to why primary duodenal bulb adenocarcinomas are so exceedingly rare. The obvious implication is that the duodenal bulb mucosa may be physiologically, immunologically, or otherwise uniquely privileged to virtually escape oncogenic transformation. The scientific challenge and opportunity is to explore and understand the important phenomena responsible for this finding.
Topics: Adenocarcinoma; Duodenal Neoplasms; Duodenum; Female; Humans; Intestinal Mucosa; Male; Middle Aged; Neoplasm Staging; Registries
PubMed: 25264638
DOI: No ID Found