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Annali Italiani Di Chirurgia 2007The authors report on twelve cases of non-ampullary duodenal neoplasm and remark the rarity of this pathology. According to the literature, the traditional endoscopy is...
The authors report on twelve cases of non-ampullary duodenal neoplasm and remark the rarity of this pathology. According to the literature, the traditional endoscopy is the mainstay diagnostic test, because of aspecific digestive symptoms, but the authors stress the importance of the "longue" endoscopy or endoscopy integrated with duodenography in non-responders patients who had non-diagnostic traditional endoscopy for neoplasm. Duodeno-cephalo-pancreatectomy and segmentary duodenal resection are proposed by tumor site. Better results for prognosis can be obtained only with an early diagnosis and radical surgical therapy, because of chemotherapy and radiotherapy don't improve survival.
Topics: Adenocarcinoma; Aged; Duodenal Neoplasms; Endoscopy, Gastrointestinal; Female; Humans; Incidence; Italy; Male; Pancreaticoduodenectomy; Prognosis; Retrospective Studies; Treatment Outcome
PubMed: 17518326
DOI: No ID Found -
Magyar Sebeszet Sep 2017Neoplasms of the small bowel are rare and comprise only 1-5% of all gastrointestinal neoplasms. The most frequent malignant tumors located in the small bowel are...
Neoplasms of the small bowel are rare and comprise only 1-5% of all gastrointestinal neoplasms. The most frequent malignant tumors located in the small bowel are adenocarcinomas, lymphomas and neuroendocrine tumors. Rarely observed are gastrointestinal stromal tumors (GIST), leiomyosarcomas and leiomyomas. Leiomyomas are most frequently seen in the jejunum followed by the ileum and lastly the duodenum. In most cases, a definite diagnosis of these tumors is not possible prior to surgical treatment. The treatment of choice for these tumors is surgery. Surgical treatment of duodenal leiomyomas has been local tumor excision, segmental duodenal resection and pancreaticoduodenectomy. The prognosis for these well-differentiated smooth muscle tumors is favorable. The authors of this article presented a case of a 61-year-old white man who was admitted to the hospital because of diagnosed duodenal tumor. The patient was suffering for periodically appearing blunt pain in the upper abdomen and periodic vomiting for three months. He underwent surgical excision of a benign duodenum neoplasm and left the ward on the seventh day after surgery. After operation, the symptoms of disease were alleviated. The author performed a review of the literature concerning duodenal leiomyoma.
Topics: Digestive System Surgical Procedures; Duodenal Neoplasms; Duodenum; Humans; Leiomyoma; Male; Middle Aged
PubMed: 28876117
DOI: 10.1556/1046.70.2017.3.3 -
Gut Mar 2004The prevalence of duodenal carcinoma is much higher in familial adenomatous polyposis (FAP) than in the background population, and duodenal adenomatosis is found in most...
BACKGROUND
The prevalence of duodenal carcinoma is much higher in familial adenomatous polyposis (FAP) than in the background population, and duodenal adenomatosis is found in most polyposis patients.
AIMS
To describe the long term natural history of duodenal adenomatosis in FAP and evaluate if cancer prophylactic surveillance of the duodenum is indicated.
METHODS
A prospective five nation study was carried out in the Nordic countries and the Netherlands.
PATIENTS
A total of 368 patients were examined by gastroduodenoscopy at two year intervals during the period 1990-2001.
RESULTS
At the first endoscopy, 238 (65%) patients had duodenal adenomas at a median age of 38 years. Median follow up was 7.6 years. The cumulative incidence of adenomatosis at age 70 years was 90% (95% confidence interval (CI) 79-100%), and of Spigelman stage IV 52% (95% CI 28-76%). The probability of an advanced Spigelman score increased during the study period (p<0.0001) due to an increasing number and size of adenomas. Two patients had asymptomatic duodenal carcinoma at their first endoscopy while four developed carcinoma during the study at a median age of 52 years (range 26-58). The cumulative incidence rate of cancer was 4.5% at age 57 years (95% CI 0.1-8.9%) and the risk was higher in patients with Spigelman stage IV at their first endoscopy than in those with stages 0-III (p<0.01).
CONCLUSIONS
The natural course of duodenal adenomatosis has now been described in detail. The high incidence and increasing severity of duodenal adenomatosis with age justifies prophylactic examination, and a programme is presented for upper gastrointestinal endoscopic surveillance.
Topics: Adenomatous Polyposis Coli; Adolescent; Adult; Aged; Child; Disease Progression; Duodenal Diseases; Duodenal Neoplasms; Female; Follow-Up Studies; Humans; Intestinal Polyposis; Male; Middle Aged; Neoplasm Staging; Population Surveillance; Prospective Studies
PubMed: 14960520
DOI: 10.1136/gut.2003.027771 -
Abdominal Radiology (New York) Oct 2022Adequate TNM-staging is important to determine prognosis and treatment planning of duodenal adenocarcinoma. Although current guidelines advise contrast-enhanced CT...
PURPOSE
Adequate TNM-staging is important to determine prognosis and treatment planning of duodenal adenocarcinoma. Although current guidelines advise contrast-enhanced CT (CECT) for staging of duodenal adenocarcinoma, literature about diagnostic tests is sparse.
METHODS
In this retrospective single-center cohort study, we analyzed the real life performance of routine CECT for TNM-staging and the assessment of resectability of duodenal adenocarcinoma. Intraoperative findings and pathological staging served as reference standard for resectability, T-, and N-staging. Biopsies, FDG-PET-CT, and follow-up were used as the reference standard for M-staging.
RESULTS
Fifty-two consecutive patients with duodenal adenocarcinoma were included, 26 patients underwent resection. Half of the tumors were isodense to normal duodenum on CECT. The tumor was initially missed in 7/52 patients (13%) on CECT. The correct T-stage was assigned with CECT in 14/26 patients (54%), N-stage in 11/26 (42%), and the M-stage in 42/52 (81%). T-stage was underestimated in (27%). The sensitivity for detecting lymph node metastases was only 24%, specificity was 78%. Seventeen percent of patients had indeterminate liver or lung lesions on CECT. Surgery with curative intent was started in 32 patients, but six patients (19%) could not be resected due to unexpected local invasion or metastases.
CONCLUSION
Radiologists and clinicians have to be aware that routine CECT is insufficient for staging and determining resectability in patients with duodenal adenocarcinoma. CECT underestimates T-stage and N-stage, and M-stage is often unclear, resulting in futile surgery in 19% of patients. Alternative strategies are required to improve staging of duodenal adenocarcinoma. We propose to combine multiphase hypotonic duodenography CT with MRI.
Topics: Adenocarcinoma; Cohort Studies; Duodenal Neoplasms; Fluorodeoxyglucose F18; Humans; Neoplasm Staging; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Radiopharmaceuticals; Retrospective Studies; Sensitivity and Specificity
PubMed: 35864264
DOI: 10.1007/s00261-022-03589-z -
Journal of Gastroenterology Feb 2022As non-ampullary duodenal cancer is relatively rare, the optimal treatment strategy, including the appropriate surgical procedure and efficacy of adjuvant chemotherapy,...
BACKGROUND
As non-ampullary duodenal cancer is relatively rare, the optimal treatment strategy, including the appropriate surgical procedure and efficacy of adjuvant chemotherapy, remains unclear. This nationwide survey aimed to clarify the actual lymph node spread pattern and determine the optimal treatment strategy for this disease, using a large-scale database.
METHODS
We used a questionnaire and a retrospective registry of 1083 patients with non-ampullary duodenal cancer who had undergone surgery during 2008-2017 in 114 high-volume Japanese Society of Hepatobiliary and Pancreatic Surgery-certified training institutions. Propensity score-matched analyses were conducted to minimise background bias. Cox regression was performed to identify covariates associated with recurrence-free survival. There were distinct disparities in the nodal dissection rate according to the predominant tumor location and tumor invasion depth. Metastases were frequently observed in the peripancreatic nodes and those along the superior mesenteric artery, irrespective of tumor location. Their dissection seemed to be beneficial for improved survival. In the overall cohort, no survival benefit was observed in patients who received adjuvant chemotherapy when compared with that in patients who underwent surgery alone. Nevertheless, in the matched cohort, adjuvant chemotherapy for > 6 months was associated with a significant improvement in recurrence-free survival (median: 43.5 vs. 22.5 months, p = 0.016), particularly in patients with tumor invasion of the subserosa or deeper tumor invasion, lymph node metastasis, or elevated serum carbohydrate antigen 19-9 levels.
CONCLUSION
Pancreatoduodenectomy should be the standard procedure for advanced non-ampullary duodenal cancer. Adjuvant chemotherapy for > 6 months, especially for advanced tumors, significantly improves survival.
Topics: Adenocarcinoma; Chemotherapy, Adjuvant; Duodenal Neoplasms; Humans; Japan; Neoplasm Staging; Retrospective Studies; Surveys and Questionnaires
PubMed: 34988688
DOI: 10.1007/s00535-021-01841-9 -
Medicine Jan 2021Endoscopic resection of superficial non-ampullary duodenal epithelial neoplasm (SNADEN) is a challenging procedure owing to the high recurrence rate and considerable...
Underwater endoscopic mucosal resection of an incompletely resected superficial non-ampullary duodenal epithelial neoplasm using the loop-and-let-go technique: A case report.
RATIONALE
Endoscopic resection of superficial non-ampullary duodenal epithelial neoplasm (SNADEN) is a challenging procedure owing to the high recurrence rate and considerable incidence rate of adverse events.
PATIENT CONCERNS
SNADEN accidentally found during a medical examination in a 56-year-old man.
DIAGNOSIS
The patient was diagnosed as having a 20-mm-sized flat elevated SNADEN at the superior duodenal angle.
INTERVENTIONS
First, we tried to perform conventional EMR (CEMR). However, the submucosal injection interrupted the endoscopic view and did not provide enough space for CEMR because of its angulated location. Therefore, we chose to perform endoscopic resection using the "loop-and-let-go" technique. Follow-up duodenoscopy after 2 days revealed post CEMR ulcer with suspicious remnant lesion. Underwater endoscopic mucosal resection (UEMR) was successfully performed 3 months after the first session of endoscopic resection.
OUTCOMES
Complete endoscopic en bloc resection and histological complete resection were achieved with UEMR. Follow-up duodenoscopy revealed no recurrence.
LESSONS
Step-by-step endoscopic treatment with UEMR following loop-and-let-go technique may be a good strategy for SNADEN over 20-mm in diameter.
Topics: Duodenal Neoplasms; Endoscopic Mucosal Resection; Humans; Male; Middle Aged
PubMed: 33466153
DOI: 10.1097/MD.0000000000024041 -
Journal of Neuroendocrinology Jan 2022The incidence of duodenal neuroendocrine neoplasms has risen over the past decades as a result of the wide availability of endoscopy and associated expertise. Although...
The incidence of duodenal neuroendocrine neoplasms has risen over the past decades as a result of the wide availability of endoscopy and associated expertise. Although it is considered that tumour size greater than 10 mm, higher tumour grade and/or location in relation to the ampulla of Vater represent the main risk factors for local or distant metastases, we describe two cases of well differentiated grade 1 and grade 2 neuroendocrine tumours, which measured < 10 mm at the time of diagnosis but had an aggressive course during follow-up. Furthermore, we also summarise the available therapeutic strategies for the management of small, low grade, non-functioning, non-ampullary duodenal neuroendocrine neoplasms.
Topics: Adult; Aged; Disease Progression; Duodenal Neoplasms; Female; Humans; Lymphatic Metastasis; Neoplasm Invasiveness; Neuroendocrine Tumors; Prognosis; Risk Factors; Tumor Burden; Watchful Waiting
PubMed: 34914146
DOI: 10.1111/jne.13067 -
Future Oncology (London, England) Mar 2022This study aimed to develop a predictive model for patients with duodenal carcinoma. Duodenal carcinoma patients from the Surveillance, Epidemiology, and End Results...
This study aimed to develop a predictive model for patients with duodenal carcinoma. Duodenal carcinoma patients from the Surveillance, Epidemiology, and End Results database (2010-2015) and the First Affiliated Hospital of Nanchang University (2010-2021) were enrolled. A nomogram was constructed according to least absolute shrinkage and selection operator regression analysis, the Akaike information criterion approach and Cox regression analysis. Five independent prognostic factors were significantly associated with the prognosis of the duodenal carcinoma patients. A nomogram was constructed with a C-index in the training and validation cohorts of 0.671 (95% CI: 0.578-0.716) and 0.662 (95% CI: 0.529-0.773), respectively. The established nomogram model provided visualization of the risk of each prognostic factor.
Topics: China; Duodenal Neoplasms; Female; Humans; Kaplan-Meier Estimate; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Grading; Neoplasm Staging; Nomograms; Prognosis; Risk Assessment; SEER Program; United States
PubMed: 35114801
DOI: 10.2217/fon-2021-0622 -
Revista de Chirurgie, Oncologie,... 1980
Topics: Adenocarcinoma; Duodenal Neoplasms; Female; Humans; Middle Aged
PubMed: 6453368
DOI: No ID Found -
Neuro Endocrinology Letters Jul 2023Neuroendocrine tumors (NETs) of duodenal origin are an unusual subset among all NETs, comprising only about 3% of this neoplasm class. In general, NETs are characterized...
Neuroendocrine tumors (NETs) of duodenal origin are an unusual subset among all NETs, comprising only about 3% of this neoplasm class. In general, NETs are characterized by overexpression of somatostatin receptors and carry an excellent prognosis with early diagnosis and intervention. Chromogranin A (CgA), a protein originating in secretory vesicles of neurons and endocrine cells, has gained wide usage in NET diagnosis and surveillance. Lanreotide is a synthetic octapeptide somatostatin analog with potent anti-proliferative action which has been approved by the FDA (U.S.) and EMA (E.U.) for NET treatment. It is known for its inhibitory effects on growth hormone, serotonin, CgA, and other markers. Here we describe a 56yr-old female with functional NET of duodenal origin, where serum CgA was successfully reduced from 3636 to <100 ng/mL after multidose lanreotide within five months. Of note, no metastatic spread was identified on positron emission tomography/computed tomography with 64Cu-labeled somatostatin analog tracer. Surgical resection of distal antrum, pylorus, and proximal duodenum was completed without complication. Histology revealed well-differentiated tumor cells with characteristic neuroendocrine features and clear surgical margins; low proliferation index (2%) was noted on Ki-67 staining. While select laboratory and imaging modalities are available for diagnosis and monitoring of duodenal NET, this is the first reported therapeutic use of lanreotide in this NET setting. The observed serum chromogranin A attenuation, even before surgery, supports its effectiveness in management of primary nonmetastatic duodenal NET after resection.
Topics: Female; Humans; Chromogranin A; Duodenal Neoplasms; Neuroendocrine Tumors; Receptors, Somatostatin; Somatostatin; Middle Aged
PubMed: 37466065
DOI: No ID Found