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Journal of Gastrointestinal Cancer Mar 2023Small intestinal cancers have a non-specific clinical presentation and hence a delayed diagnosis. The prevalence of small intestinal cancers is low, and there are no...
PURPOSE
Small intestinal cancers have a non-specific clinical presentation and hence a delayed diagnosis. The prevalence of small intestinal cancers is low, and there are no cost-effective methods of screening. This study aimed to identify clinical characteristics of duodenal and jejunal adenocarcinomas that can assist in the early detection and diagnosis of disease.
METHODS
Duodenal adenocarcinoma and jejunal adenocarcinoma in Explorys database (1999-2019) were compared using odds ratio (OR) with 95% confidence intervals. Data on demographic characteristics, risk factors, clinical features, and treatment were collected.
RESULTS
Out of a total of 8100 patients with a diagnosis of primary adenocarcinoma of the small intestine, 5110 are primary adenocarcinoma of duodenum (63%), and 600 are primary adenocarcinoma of jejunum (7.4%). Patients with jejunal adenocarcinoma when compared with patients with duodenal adenocarcinoma are more obese (OR, 1.36) and have a significantly higher prevalence of malignant neoplasm of colon (OR, 3.07), Crohn's disease (OR, 4.42), and celiac disease (OR, 2.48). Jejunal adenocarcinoma patients presented more frequently with intestinal obstruction (OR, 1.99), whereas duodenal adenocarcinoma patients more commonly presented with iron deficiency anemia (OR, 0.16). Patients with jejunal adenocarcinoma are less likely to undergo therapy with anti-neoplastic agents when compared with duodenal adenocarcinoma (OR, 0.81). There are no differences in patients undergoing surgical intervention or a combination of surgical intervention and antineoplastic therapy.
CONCLUSIONS
Jejunal adenocarcinoma is more commonly associated with colorectal cancer, celiac disease, and Crohn's disease. They also had lower odds of requiring chemotherapeutic agents.
Topics: Humans; Crohn Disease; Celiac Disease; Intestine, Small; Jejunal Neoplasms; Duodenal Neoplasms; Ileal Neoplasms; Adenocarcinoma
PubMed: 35001295
DOI: 10.1007/s12029-021-00653-7 -
The American Surgeon Nov 2015Duodenal adenocarcinoma is rare. We aimed to evaluate survival outcome and prognostic factors for survival in patients with duodenal adenocarcinoma in recent years,...
Duodenal adenocarcinoma is rare. We aimed to evaluate survival outcome and prognostic factors for survival in patients with duodenal adenocarcinoma in recent years, marked by advancement in chemotherapy for gastrointestinal cancers. All patients treated for duodenal adenocarcinoma at our institution between January 2000 and July 2013 were reviewed. Thirty-nine patients were identified: 27 operative patients [21(53.8%) curative and 6 (15.4%) palliative operations] and 12 nonoperative patients [primary systemic chemotherapy, 4 (10.3%), palliative radiotherapy, 1 (2.6%), and no treatment, 7 (17.9%)]. Curative resections included 13 pancreaticoduodenectomies and eight segmental resections. Median overall survival (OS) for entire cohort was 14.4 months. Median OS and one-, three-, and five-year OS were operative group (41.4 months; 79.1%, 50.6%, and 10.6%, respectively); nonoperative group (7.4 months; 25.0%, 8.3%, and 0%, respectively); curative surgery (45.4 months; 92.9%, 62.5%, and 16.7%, respectively) and palliative surgery (5.4 months; 33.3%, 16.7%, and 0%, respectively). Female gender (P = 0.04), curative resection (P = 0.03), nodal metastasis (P = 0.047) and advanced T stage (P = 0.047) were predictive of OS. Two factors were independently predictive of OS--female gender and curative resection. Overall survival still hinges on curative resection. This favors early detection. Adjuvant treatment modalities such as chemotherapy and radiation require further investigation.
Topics: Adenocarcinoma; Aged; Duodenal Neoplasms; Female; Humans; Lymphatic Metastasis; Male; Neoplasm Staging; Prognosis; Sex Factors; Treatment Outcome
PubMed: 26672582
DOI: No ID Found -
The Italian Journal of Gastroenterology Nov 1996Duodenal tumours is an extremely fragmentary topic since the experience of various specialists: gastroenterologists, pathologists, radiologists and surgeons is involved.... (Review)
Review
Duodenal tumours is an extremely fragmentary topic since the experience of various specialists: gastroenterologists, pathologists, radiologists and surgeons is involved. At present, correct epidemiologic data is lacking whereas much progress has been made in the diagnostic field, thanks to the endoscopic, histologic and radiologic techniques. Thus a different classification scheme has been suggested in the attempt to codify the fundamental aspects of this lesion. An interdisciplinary data base has been proposed in order to provide useful data for an epidemiological evaluation.
Topics: Duodenal Neoplasms; Humans; Precancerous Conditions
PubMed: 14502787
DOI: No ID Found -
Annali Italiani Di Chirurgia 2014Reporting our experience in the treatment of duodenal neoplasms.
AIM
Reporting our experience in the treatment of duodenal neoplasms.
MATERIAL OF STUDY
Management and treatment of four patients presenting a duodenal neoplasm.
RESULTS
Three out of four patients died after surgery for dehiscence and/or bleeding. One, who underwent palliative bypass, died after four months from unknown causes.
DISCUSSION
Duodenal neoplasms are rare and their diagnosis is difficult and late. In literature, there is no standardized management of this kind of neoplasm; the commonest surgical approaches are pancreaticoduodenectomy, segmental duodenal resection and palliative operations. The surgical choice is based on site and stage, both in Literature than in our experience. Regardless of the surgical decision, the patients have a poor outcome because of an advanced stage at diagnosis.
CONCLUSIONS
It can be asserted that duodenal neoplasia offers many diagnostic and therapeutic difficulties. This may be due to its rarity, which does not allow the definition of a standard course of treatment, resulting in the inability to have a unique diagnostic and therapeutic approach. There is often a late diagnosis and the need to perform emergency surgery. Therefore prognosis is greatly aggravated by the high incidence of postoperative complications, in part due to the urgency in which the surgeries are carried out.
Topics: Aged; Aged, 80 and over; Duodenal Neoplasms; Fatal Outcome; Female; Humans; Male
PubMed: 25262760
DOI: No ID Found -
Annals of Surgical Oncology Apr 2004
Topics: Adenocarcinoma; Duodenal Neoplasms; Humans; Lymph Nodes; Neoplasm Staging; Predictive Value of Tests
PubMed: 15070591
DOI: 10.1245/ASO.2004.02.914 -
Gan To Kagaku Ryoho. Cancer &... Dec 2022Primary duodenal cancer is a rare disease. We examined 8 resected cases of duodenal cancer at our hospital from June 2003 to February 2022. Patients with resected...
Primary duodenal cancer is a rare disease. We examined 8 resected cases of duodenal cancer at our hospital from June 2003 to February 2022. Patients with resected duodenal cancer had an average age of 69.3 years(45-84 years), with a male-female ratio of 3 : 5. Of the 8 cases, 6 cases were adenocarcinomas and 2 were neuroendocrine carcinomas. Among those with adenocarcinomas, 3 cases were Stage Ⅰ, while Stage ⅡA, ⅢA, and ⅢB accounted for one case each(UICC 8th edition). Five patients underwent a pancreaticoduodenectomy(PD), while 1 underwent partial duodenal resection. Except for 1 case of Stage ⅢB(death from tumor recurrence in 1 year), tumor recurrence was not observed in the 5 remaining cases(survival period; >1 month to >97 months). The patient with a pT3pN1M0, Stage Ⅲ neuroendocrine carcinoma underwent a partial duodenal resection due to poor cardiac and renal function. Meanwhile, the patient with a pT4pN0M0, Stage Ⅲ neuroendocrine carcinoma underwent a PD. The survival time was 123 months for the former(death from other diseases, no tumor recurrence)and 7 months for the latter(death from recurrence).
Topics: Humans; Male; Female; Aged; Duodenal Neoplasms; Neoplasm Recurrence, Local; Pancreaticoduodenectomy; Carcinoma, Neuroendocrine; Adenocarcinoma; Hospitals; Retrospective Studies
PubMed: 36733135
DOI: No ID Found -
The American Journal of Surgical... Mar 2017Duodenal neoplasm of gastric phenotype (DNGP) is very rare, and details of its histopathologic, genetic, and biological features are still unclear. Frequent gene...
Duodenal neoplasm of gastric phenotype (DNGP) is very rare, and details of its histopathologic, genetic, and biological features are still unclear. Frequent gene mutations in GNAS, KRAS, and APC have been reported in pyloric gland adenomas and fundic gland-type neoplasms (initially reported as low-grade adenocarcinomas) of the stomach. Here we retrospectively analyzed 16 cases of extra-ampullary DNGP (benign to malignant), and we examined the mucin immunoprofile and oncogene mutations (GNAS, KRAS, APC, BRAF, and CTNNB1). The 16 DNGPs were histologically classified into adenomas (5 pyloric gland adenomas and 2 foveolar-type adenomas), neoplasms of uncertain malignant potential (NUMPs, n=6), and invasive adenocarcinomas (n=3). NUMPs consisted of slightly atypical epithelial cells with pale, eosinophilic, or basophilic cytoplasm growing in an anastomosing or branching glandular pattern, often with expansive submucosal extension. In contrast to invasive adenocarcinomas, NUMPs lacked significant nuclear irregularity, desmoplastic stromal reaction, lymphovascular invasion, and metastasis; their features were reminiscent of fundic gland-type neoplasms of the stomach. Immunophenotypically, most of NUMPs were predominantly positive for MUC6 with variable expressions of pepsinogen-I, HKATPase, human gastric mucin, and MUC5AC. Molecular analyses revealed the gene mutations of GNAS in 6 (38%) of 16 DNGPs (4 [57%] adenomas, 1 [16%] NUMP, and 1 [33%] invasive adenocarcinoma) and APC in 4 of 15 (27%) DNGPs: no adenomas, 2 (33%) NUMPs, and 2 (67%) invasive adenocarcinomas. BRAF mutation was present in only 1 (16%) NUMP, and KRAS and CTNNB1 mutations were absent. In conclusion, gastric-phenotype adenomas and NUMPs of the duodenum are similar to their counterparts of the stomach, in terms of histologic, genetic, and clinicopathologic features. We propose the term "NUMP" as an intermediate category between adenoma and definitely invasive adenocarcinoma. Our findings may provide novel insights into the classification of undescribed but distinctive duodenal tumors showing similarity to gastric-phenotype neoplasms of the stomach.
Topics: Adenocarcinoma; Adenoma; Aged; Aged, 80 and over; Biomarkers, Tumor; Duodenal Neoplasms; Female; Follow-Up Studies; Humans; Immunohistochemistry; Male; Middle Aged; Mutation; Neoplasm Invasiveness; Phenotype; Retrospective Studies; Stomach
PubMed: 27984236
DOI: 10.1097/PAS.0000000000000785 -
Medicine Oct 2017Duodenal obstructions caused by congenital anatomic abnormalities are rare in adults. Several patients in whom the duodenal obstruction was caused by a congenital...
INTRODUCTION
Duodenal obstructions caused by congenital anatomic abnormalities are rare in adults. Several patients in whom the duodenal obstruction was caused by a congenital duodenal diaphragm have been described. The duodenal obstruction in the patient presented herein was caused by a transverse septum, which has not been previously reported. A transverse septum is usually observed in the vagina; those involving the digestive tract have been rarely observed.
CASE PRESENTATION
We herein report a case involving a 69-year-old woman with a congenital duodenal transverse septum causing partial obstruction. She was admitted to our hospital with a 3-month history of epigastric pain and vomiting. Upper gastrointestinal endoscopy, iodinated water-soluble contrast imaging, and abdominal computed tomography revealed dilation of the stomach and a neoplasm in the descending part of the duodenum. The patient was suspected to have a tumor in the descending part of the duodenum. Exploratory laparotomy showed a banded duodenal transverse septum at the junction of the second part of the duodenum. The duodenal transverse septum was approximately 2 mm thick and 1 cm wide and divided the duodenal lumen into 2 parts. The duodenal papillae were completely normal and located under the duodenal transverse septum. Histopathological analysis of the transverse septum showed that it was similar to the organizational structure of the duodenal wall.
CONCLUSION
The possibility of congenital disease should be considered in older patients with intestinal obstruction, even when imaging studies reveal a duodenal neoplasm.
Topics: Abdominal Pain; Aged; Diagnosis, Differential; Duodenal Neoplasms; Duodenal Obstruction; Duodenum; Female; Humans; Vomiting
PubMed: 29049170
DOI: 10.1097/MD.0000000000007093 -
European Journal of Cancer Care May 2010Duodeno-pancreatic neuroendocrine tumours (DP-ETs) are increasingly diagnosed today due to the widespread use of modern imaging methods. Duodeno-pancreatic endocrine...
Duodeno-pancreatic neuroendocrine tumours (DP-ETs) are increasingly diagnosed today due to the widespread use of modern imaging methods. Duodeno-pancreatic endocrine tumours should be treated by radical surgical resection, which offers a high chance for cure when the disease is localized. A high index of suspicion is required in these patients for the presence of a multiple endocrine neoplasia type syndrome. We present four patients with DP-ET surgically treated at our department between 2000 and 2004. Histological/immunohistochemical diagnosis was somatostatin-producing tumour in the first patient, oncocytic endocrine tumour positive for neurone-specific enolase and focally for chromogranin in the second patient, glucagonoma and pancreatic polypeptide-producing endocrine pancreatic tumour in the third patient, and gastrin, somatostatin, calcitonin, insulin and adrenocorticotropic hormone (ACTH)-producing tumour in the fourth. The second patient died 6.5 years following surgery due to disseminated disease.
Topics: Adult; Aged; Biomarkers, Tumor; Biopsy; Duodenal Neoplasms; Female; Humans; Immunohistochemistry; Male; Middle Aged; Neoplasm Proteins; Neuroendocrine Tumors; Pancreatic Neoplasms; Treatment Outcome
PubMed: 19708940
DOI: 10.1111/j.1365-2354.2007.00894.x -
American Journal of Surgery May 2016Duodenal gastrointestinal tumors (GIST) present infrequently, and surgical resection with negative margins remains the mainstay of therapy; however, given the lack of... (Comparative Study)
Comparative Study
BACKGROUND
Duodenal gastrointestinal tumors (GIST) present infrequently, and surgical resection with negative margins remains the mainstay of therapy; however, given the lack of lymphatic and submucosal spread and anatomic location near the bile duct and pancreas, the optimal approach for resection is unknown. Options include local resection (LR), segmental resection, and pancreaticoduodenectomy (PD).
METHODS
All cases of gastrointestinal stromal tumors originating from the duodenum from 2000 to 2015 were identified from administrative databases. Clinical and pathologic information was abstracted from the medical record and compared between patients who received LR vs PD. The chi-square with Fisher's exact test was used to detect differences between groups.
RESULTS
Fifteen patients met the inclusion criteria, of which 7 had an LR and 8 had a PD. The second portion of the duodenum was the most common origin of GIST in the PD group, whereas the third portion was most common in the LR group. Patients who underwent LR tended to be younger, but there was no difference in tumor size, mitotic rate, margin positivity, readmission rate, or recurrence. PD was associated with more complications, higher blood loss, and longer length of stay.
CONCLUSIONS
Local resection is a reasonable option for resection of duodenal GIST and should be routinely considered if technically feasible.
Topics: Adult; Aged; Colectomy; Databases, Factual; Disease-Free Survival; Duodenal Neoplasms; Duodenoscopy; Duodenum; Endosonography; Female; Gastrointestinal Stromal Tumors; Humans; Male; Middle Aged; Multimodal Imaging; Neoplasm Invasiveness; Neoplasm Staging; Pancreaticoduodenectomy; Prognosis; Retrospective Studies; Risk Assessment; Survival Analysis; Tomography, X-Ray Computed
PubMed: 27033254
DOI: 10.1016/j.amjsurg.2016.02.006