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Journal of Medical Case Reports Jan 2024Recent advances in chemotherapy and chemoradiotherapy have enabled conversion surgery (CS) to be performed for selected patients with initially unresectable locally...
BACKGROUND
Recent advances in chemotherapy and chemoradiotherapy have enabled conversion surgery (CS) to be performed for selected patients with initially unresectable locally advanced (LA) pancreatic ductal adenocarcinoma (PDAC). Many studies indicate CS might extend the survival of patients with initially unresectable LA PDAC. However, several clinical questions concerning CS remain, such as the optimal preoperative treatment. Carbon-ion radiotherapy (CIRT) is a unique radiotherapy that offers higher biological effectiveness than conventional radiotherapy. Here, we report a long-term survival case with initially unresectable LA PDAC who underwent CS after chemotherapy followed by CIRT.
CASE PRESENTATION
The patient was a 72-year-old Japanese woman with unresectable LA pancreatic head cancer with tumor contact to the superior mesenteric artery (SMA). She underwent four courses of chemotherapy (gemcitabine plus nanoparticle albumin-bound paclitaxel). However, the lesion did not shrink and tumor contact with the SMA did not improve after chemotherapy. Because the probability of achieving curative resection was judged to be low, she underwent radical dose CIRT, and chemotherapy was continued. She complained of vomiting 2 months after CIRT. Although imaging studies showed no tumor growth or metastasis, a duodenal obstruction which was speculated to be an adverse effect of CIRT was observed. She could not eat solid food and a trans-nasal feeding tube was inserted. Therapeutic intervention was required to enable enteral nutrition. We proposed several treatment options. She chose resection with the expectation of an anti-tumor effect of chemotherapy and CIRT rather than course observation with tube feeding or bypass surgery. Therefore, subtotal-stomach-preserving pancreatoduodenectomy with portal vein resection was performed as CS. Pathological examination of the resected specimen revealed an R0 resection with a histological response of Evans grade IIA. Postoperatively, she recovered uneventfully. Adjuvant chemotherapy with tegafur/gimeracil/oteracil (S1) was administrated. At the time of this report, 5 years have passed since the initial consultation and she has experienced no tumor recurrence.
CONCLUSIONS
The present case suggests that multidisciplinary treatment consisting of a combination of recent chemotherapy and CIRT may be beneficial for unresectable LA PDAC. However, further studies are required to assess the true efficacy of this treatment strategy.
Topics: Female; Humans; Aged; Neoplasm Recurrence, Local; Pancreatic Neoplasms; Drug-Related Side Effects and Adverse Reactions; Adenocarcinoma; Carbon
PubMed: 38200536
DOI: 10.1186/s13256-023-04311-3 -
Asian Journal of Surgery Mar 2024
Topics: Humans; Pancreaticoduodenectomy; Pancreatic Neoplasms; Postoperative Complications; Aneurysm
PubMed: 38199883
DOI: 10.1016/j.asjsur.2023.12.046 -
Endoscopy Dec 2024
Topics: Humans; Neuroendocrine Tumors; Pancreatic Neoplasms; Stomach Neoplasms; Duodenal Neoplasms
PubMed: 38194990
DOI: 10.1055/a-2222-8259 -
Endoscopy Dec 2024
A key to unlocking the door: water pressure method for endoscopic submucosal dissection of a superficial non-ampullary duodenal epithelial tumor with a history of multiple biopsies.
Topics: Humans; Endoscopic Mucosal Resection; Biopsy; Duodenum; Neoplasms, Glandular and Epithelial; Water
PubMed: 38194979
DOI: 10.1055/a-2218-2670 -
Medicine Jan 2024Brunner gland adenoma (BGA) is a rare benign duodenal tumor that is an adenomatoid lesion in nature rather than an actual tumor. Patients with different adenoma sizes...
RATIONALE
Brunner gland adenoma (BGA) is a rare benign duodenal tumor that is an adenomatoid lesion in nature rather than an actual tumor. Patients with different adenoma sizes have various clinical manifestations with nonspecific clinical symptoms. Here, We report a case of BGA with black stool and anemia as the primary manifestations.
PATIENT CONCERNS
A young female patient was admitted to the hospital because of black stool and anemia. Endoscopic surgery was performed to a definitive diagnosis, and endoscopic tumor-like lesions were resected.
DIAGNOSIS
The patient was diagnosed with duodenal Brunner adenoma and received related treatment.
OUTCOMES
After treatment, the patient symptoms improved, and he was discharged.
LESSONS
Brunner adenoma of the duodenum is a rare benign duodenum tumor. This report paper describes a case of BGA with black stool and anemia as the primary manifestations, followed by endoscopic resection and treatment. The literature on Brunner adenoma of the duodenum has been analyzed and discussed. Clinicians should pay attention to differentiating the disease based on atypical symptoms.
Topics: Male; Humans; Female; Occult Blood; Duodenum; Melena; Duodenal Neoplasms; Anemia; Adenoma
PubMed: 38181268
DOI: 10.1097/MD.0000000000036737 -
The Canadian Veterinary Journal = La... Jan 2024Two shih tzu dogs were referred to our clinic because of hematochezia and vomiting. Abdominal ultrasonography revealed a focal, asymmetric, exophytic small intestinal...
Two shih tzu dogs were referred to our clinic because of hematochezia and vomiting. Abdominal ultrasonography revealed a focal, asymmetric, exophytic small intestinal mass with loss of wall layering and muscular layer thickening of the adjacent intestine. Computed tomography (CT) in both dogs revealed a focal, asymmetric, homogenously contrast-enhanced exophytic jejunal and duodenal mass with an intact mucosal layer and generalized lymphadenopathy. Metastasis and ulceration were not detected on CT. The initial imaging diagnosis was lymphoma in both dogs; however, histopathological examination revealed the presence of intestinal mast cell tumors (iMCTs). Despite its similarity to alimentary lymphoma, iMCT should be considered a possible diagnosis, based on imaging characteristics, to ensure that proper treatments are selected. This is the first veterinary report describing detailed ultrasonographic and CT characteristics of iMCTs. Key clinical message: This is the first veterinary case report demonstrating sonographic and computed tomographic features of canine iMCT, which can be misdiagnosed as alimentary lymphoma. This report provides another differential diagnosis to consider when determining the appropriate patient treatment direction and histopathological examination.
Topics: Dogs; Animals; Mast Cells; Intestinal Neoplasms; Lymphoma; Tomography, X-Ray Computed; Ultrasonography; Dog Diseases; Retrospective Studies
PubMed: 38164388
DOI: No ID Found -
Asian Pacific Journal of Cancer... Dec 2023Helicobacter pylori (H. pylori) have been accepted as having an etiologic role in gastro-duodenal diseases as chronic gastritis, peptic ulcer, and gastric carcinoma....
BACKGROUND
Helicobacter pylori (H. pylori) have been accepted as having an etiologic role in gastro-duodenal diseases as chronic gastritis, peptic ulcer, and gastric carcinoma. Methylation of CGI has been correlated with the tumorigenic process since it can inactivate tumor suppressor genes. CDH1 is a tumor suppressor gene that encodes the E-cadherin protein, which is preserving cell-cell connections. Early stages of gastric carcinogenesis may be affected by the promoter methylation-mediated inactivation of this gene.
OBJECTIVE
This study aimed to investigate the methylation status of CDH1 using Methylation-Specific PCR (MSP) technique in clinical suspected patients with H. pylori infection who undergoing upper gastrointestinal endoscopy and correlated it with H. pylori detection by glmM PCR test.
METHODS
Fifty gastric mucosal biopsies were selected from one hundred and five samples included in this study. The detection of H. pylori was performed with the PCR primers specific to glmM gene. Bisulfite modification was done and the methylation status of the CDH1 gene was detected using MSP reaction.
RESULTS
H. pylori was detected in 36% (18/50) of study population using glmM gene PCR test, 89% (16/18) of H. pylori positive cases were CDH1 methylated positive (chi-square, p-value=0.002). CDH1 methylation can be present in cancerous and noncancerous gastric mucosa, where 60% (18/30) of CDH1 methylation positive gastric mucosa showed gastritis as an endoscopy finding and gastric cancer in 6% (2/30). There was a significant correlation between and CDH1 methylation positive results and age group (P-value = 0.02). There was no significant correlation between CDH1 methylation positive results and participants gender (p-value=0.431) and clinical symptoms (all P-value > 0.05).
CONCLUSION
This work suggested strong significance association between H. pylori infection and CDH1 methylation.
Topics: Humans; Helicobacter pylori; DNA Methylation; Gastritis; Gastritis, Atrophic; Gastric Mucosa; Stomach Neoplasms; Biopsy; Transcription Factors; Helicobacter Infections; Antigens, CD; Cadherins
PubMed: 38156839
DOI: 10.31557/APJCP.2023.24.12.4071 -
Journal of Gastrointestinal and Liver... Dec 2023Endoscopic ultrasound (EUS) guided biliary drainage (BD) is an accepted salvage procedure in patients with distal malignant biliary obstruction (DMBO) when endoscopic... (Review)
Review
Endoscopic ultrasound (EUS) guided biliary drainage (BD) is an accepted salvage procedure in patients with distal malignant biliary obstruction (DMBO) when endoscopic retrograde cholangiopancreatography (ERCP) is unsuccessful. The potential advantages of EUS-BD include gastric or duodenal biliary access, utilization of novel biliary stents and stent placement away from the area of stenosis, resulting in longer stent patency. These features make EUS-BD very appealing as a primary procedure for biliary drainage. There is a growing body of evidence supporting the utilization of EUS as a primary drainage procedure instead of ERCP, with comparable outcomes.
Topics: Humans; Endosonography; Pancreatic Neoplasms; Duodenum; Cholangiopancreatography, Endoscopic Retrograde; Stents; Drainage; Cholestasis; Ultrasonography, Interventional
PubMed: 38147611
DOI: 10.15403/jgld-4922 -
Arquivos Brasileiros de Cirurgia... 2023Despite endoscopic eradication therapy being an effective and durable treatment for Barrett's esophagus-related neoplasia, even after achieving initial successful...
DEVELOPMENT OF ADENOCARCINOMA AFTER RADIOFREQUENCY ABLATION OF BARRETT'S ESOPHAGUS ASSOCIATED TO FUNDOPLICATION AND SUPPRESSION-DUODENAL DIVERSION PROCEDURE: A LESSON TO BE LEARNED.
Despite endoscopic eradication therapy being an effective and durable treatment for Barrett's esophagus-related neoplasia, even after achieving initial successful eradication, these patients remain at risk of recurrence and require ongoing routine examinations. Failure of radiofrequency ablation and argon plasma coagulation is reported in 10-20% of cases.
Topics: Humans; Barrett Esophagus; Fundoplication; Adenocarcinoma; Radiofrequency Ablation; Esophagoscopy; Esophageal Neoplasms; Treatment Outcome
PubMed: 38126438
DOI: 10.1590/0102-672020230068e1786 -
Medicine Dec 2023Gangliocytic paraganglioma is a rare tumor that can occur in several organs throughout the body. Gangliocytic paraganglioma of the main duodenal papilla is even rarer....
RATIONALE
Gangliocytic paraganglioma is a rare tumor that can occur in several organs throughout the body. Gangliocytic paraganglioma of the main duodenal papilla is even rarer. This study analyzes and discusses the endoscopic management of a case of gangliocytic paraganglioma of the main duodenal papilla and reviews the relevant literature. It is hoped that this study will increase clinicians' awareness of this disease.
PATIENT CONCERNS
Electron endoscopy reveals a duodenal main papillary tumor, and the patient desires further clarification of the nature of the tumor and the next step in the treatment plan.
DIAGNOSES
Duodenal gangliocytic paraganglioma.
INTERVENTIONS
As the patient lesion was located in the main duodenal papilla, we successfully performed endoscopic minimally invasive treatment of the tumor by endoscopic papillectomy combined with endoscopic retrograde cholangiopancreatography.
OUTCOMES
The patient was discharged after the postoperative removal of the nasobiliary drain and returned to the hospital 2 months later to have the biliary stent removed; the patient was in good general condition at follow-up.
LESSONS
For duodenal main papillary tumor, we need to be alert to the possibility of gangliocytic paraganglioma. Since the tumor is located in the submucosa of the juxta-abdominal region, the preoperative biopsy positivity rate is low, and the tumor is often adjacent to or involves the biliopancreatic duct, endoscopic resection combined with endoscopic retrograde cholangiopancreatography can be considered for diagnosis and treatment.
Topics: Humans; Cholangiopancreatography, Endoscopic Retrograde; Ampulla of Vater; Paraganglioma; Endoscopy, Gastrointestinal; Duodenal Neoplasms
PubMed: 38115359
DOI: 10.1097/MD.0000000000036662