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Scientific Reports Oct 2023Duodenal neuroendocrine tumors (d-NETs) ≤ 10 mm in size, confined to the submucosal layer, without lymph node or distant metastasis, can be treated safely and...
Duodenal neuroendocrine tumors (d-NETs) ≤ 10 mm in size, confined to the submucosal layer, without lymph node or distant metastasis, can be treated safely and effectively by endoscopic management. However, most results are based on limited data and short follow-up outcomes. Herein, we aimed to evaluate the short-term and long-term outcomes of endoscopic resection for d-NETs. We retrospectively analyzed 63 patients with 68 d-NETs who had undergone endoscopic resection at two hospitals between January 2009 and December 2021. En-bloc resection, endoscopically complete resection, and histopathologically complete resection rates were evaluated as short-term outcomes. Furthermore, long-term outcomes were analyzed in 46 patients with 50 d-NETs with a follow-up period of > 1 year. The overall en-bloc, endoscopically complete, and histopathologically complete resection rates were 92.6% (63/68), 100% (68/68), and 69.1% (47/68), respectively. Tumor size (> 5 mm) was the only predictive factor for histopathologically incomplete resection (p = 0.015). The procedure-related bleeding and perforation rates were 0% and 5.9%, respectively. No recurrences were observed in patients with histopathologically complete resection and those with histopathologically incomplete resection at a median follow-up period of 48 months (range 12-132 months). Endoscopic resection for d-NETs ≤ 10 mm in size, limited to the submucosal layer, and without lymph node or distant metastasis provides favorable long-term outcomes when endoscopically complete resection is achieved.
Topics: Humans; Neuroendocrine Tumors; Treatment Outcome; Retrospective Studies; Duodenal Neoplasms
PubMed: 37863959
DOI: 10.1038/s41598-023-45243-8 -
Medicine Feb 2021Duodenal neuroendocrine tumor (d-NET) is a rare tumor originating in the neuroendocrine system. The clinical manifestations of d-NET are similar to those of other...
RATIONALE
Duodenal neuroendocrine tumor (d-NET) is a rare tumor originating in the neuroendocrine system. The clinical manifestations of d-NET are similar to those of other digestive tract tumors, resulting in a lack of specificity and complex clinical symptoms.
PATIENT CONCERNS
A 55-year-old female patient was admitted to our hospital with a chief complaint of an abdominal mass that had been present for more than 4 months.
DIAGNOSES
The upper abdomen enhanced computed tomography scan showed an uneven density mass across the upper abdomen, and the tumor size was approximately 6.2 × 5.8 cm with obvious visible enhancement present in 1 area and a cystic nonenhanced area. The postoperative pathology showed the tumor cells to be positive for chromogranin, synaptophysin, cytokeratin, CD56 (partial weak), negative for vimentin, CD117, DOG-1, CD34, S-100, SMA, desmin, and Ki-67 approximately 2%, which confirmed the diagnosis of d-NETs.
INTERVENTIONS
We preferred laparoscopic surgical exploration, but the tumor started at the ascending part of the duodenum and involved the mesenteric artery. As the branches of the superior mesenteric artery were intertwined with the tumor, it was difficult to operate with the endoscope, so we converted to open laparotomy. The postoperative pathology revealed the presence of d-NET.
OUTCOMES
The patient recovered uneventfully and was discharged after the operation. One-month and 3-month follow-up after surgery, showed no evidence of recurrence.
LESSONS
Radiological imaging studies are insufficient for the differential diagnosis of abdominal mass from other diseases, whereas surgery is the only radical treatment method, and the preferred surgical method is still active radical resection of the tumor.
Topics: Diagnosis, Differential; Duodenal Neoplasms; Female; Humans; Laparotomy; Middle Aged; Neuroendocrine Tumors; Tomography, X-Ray Computed
PubMed: 33578581
DOI: 10.1097/MD.0000000000024635 -
Gut Jul 2005
Review
Topics: Adenomatous Polyposis Coli; Anti-Inflammatory Agents, Non-Steroidal; Disease Progression; Duodenal Neoplasms; Duodenoscopy; Humans
PubMed: 15951555
DOI: 10.1136/gut.2004.053843 -
Gastroenterology Feb 2021
Topics: Adenomatous Polyps; Adult; Aged; Aged, 80 and over; DNA Glycosylases; Duodenal Neoplasms; Duodenoscopy; Duodenum; Female; Humans; Intestinal Mucosa; Male; Middle Aged; Prevalence; Prospective Studies; Young Adult
PubMed: 33130102
DOI: 10.1053/j.gastro.2020.10.038 -
Annals of Surgery Jul 2003Primary duodenal gastrinomas are now recognized as a common etiology for patients with sporadic Zollinger Ellison Syndrome (ZES); however, the clinical and pathologic...
BACKGROUND
Primary duodenal gastrinomas are now recognized as a common etiology for patients with sporadic Zollinger Ellison Syndrome (ZES); however, the clinical and pathologic features of this condition and long-term outcome after operation are not well characterized.
METHODS
Between November 1982 and September 2000, 63 patients diagnosed with sporadic ZES underwent resection of a primary duodenal gastrinoma and regional nodal metastases with curative intent. Data from a prospectively maintained database were reviewed for clinical and pathologic parameters relating to primary tumor size, location, frequency of lymph node metastases, and disease-specific and disease-free survival.
RESULTS
There were 41 males and 22 females (mean age, 48.6 years). The majority of duodenal gastrinomas were in the first or second portions of the duodenum (83%). Tumor size ranged from 0.2 to 2.0 cm with 62% measuring less than 1.0 cm. Sixty percent of individuals had regional lymph node metastases identified primarily in proximity to the primary tumor. At a median 10-year follow-up, the overall disease-specific and disease-free survivals were 100% and 60%, respectively. Actuarial 10-year disease-free survival was significantly higher for patients without lymph node metastases versus those with lymph node metastases (78% versus 48%, P = 0.0137).
CONCLUSIONS
Duodenal gastrinomas in patients with sporadic ZES are frequently small, most commonly located in the proximal duodenum, and associated with regional lymph node metastases in 60%. Disease-free survival is lower for patients with regional lymph node metastases suggesting that a more systematic lymphadenectomy to extirpate occult disease may be indicated in this group.
Topics: Adolescent; Adult; Digestive System Surgical Procedures; Duodenal Neoplasms; Female; Gastrinoma; Humans; Lymphatic Metastasis; Male; Middle Aged; Survival Analysis; Treatment Outcome; Zollinger-Ellison Syndrome
PubMed: 12832964
DOI: 10.1097/01.SLA.0000074963.87688.31 -
Toxicologic Pathology Feb 2016Thirteen-week and 2-year drinking water studies conducted by the National Toxicology Program (NTP) reported that hexavalent chromium (Cr(VI)) induced diffuse epithelial...
Thirteen-week and 2-year drinking water studies conducted by the National Toxicology Program (NTP) reported that hexavalent chromium (Cr(VI)) induced diffuse epithelial hyperplasia in the duodenum of B6C3F1 mice but not F344 rats. In the 2-year study, Cr(VI) exposure was additionally associated with duodenal adenomas and carcinomas in mice only. Subsequent 13-week Cr(VI) studies conducted by another group demonstrated non-neoplastic duodenal lesions in B6C3F1 mice similar to those of the NTP study as well as mild duodenal hyperplasia in F344 rats. Because intestinal lesions in mice are the basis for proposed safety standards for Cr(VI), and the histopathology data are relevant to the mode of action, consistency (an important Hill criterion for causality) was assessed across the aforementioned studies. Two veterinary pathologists applied uniform diagnostic criteria to the duodenal lesions in rats and mice from the 4 repeated-dose studies. Comparable non-neoplastic intestinal lesions were evident in mice and rats from all 4 studies; however, the incidence and severity of intestinal lesions were greater in mice than rats. These findings demonstrate consistency across studies and species and highlight the importance of standardized nomenclature for intestinal pathology. The differences in the severity of non-neoplastic lesions also likely contribute to the differential tumor response.
Topics: Administration, Oral; Animals; Chromium; Drinking Water; Duodenal Neoplasms; Duodenum; Environmental Exposure; Female; Male; Mice; Mice, Inbred Strains; Rats; Rats, Inbred F344; Toxicity Tests
PubMed: 26538584
DOI: 10.1177/0192623315611501 -
Neuroendocrinology 2006
Topics: Carcinoma; Duodenal Neoplasms; Humans
PubMed: 17312376
DOI: 10.1159/000098008 -
Annals of the Royal College of Surgeons... May 2017Primary malignant melanoma of the gastrointestinal tract is extremely rare. A 35-year-old man presented with complaints of abdominal pain and weight loss. Contrast...
Primary malignant melanoma of the gastrointestinal tract is extremely rare. A 35-year-old man presented with complaints of abdominal pain and weight loss. Contrast enhanced computed tomography showed a large mass involving the duodenum and the superior mesenteric vessels. Upper gastrointestinal endoscopy demonstrated a large, friable mass along the duodenal wall and biopsy was suggestive of malignant melanoma. A detailed physical examination and whole body imaging (positron emission tomography and computed tomography) did not reveal any other lesion. The patient underwent a pancreaticoduodenectomy with segmental resection and anastomosis of the superior mesenteric vein as well as a segmental colectomy. His postoperative recovery was uneventful. The histopathology of the operative specimen showed a malignant amelanotic melanoma arising from the duodenum with lymph nodal involvement. He received oral temozolomide. However, he developed liver metastasis at six months and again at ten months, which was managed with radiofrequency ablation both times. He is doing well at 32 months of follow-up review. Multimodality treatment including surgery, adjuvant chemotherapy and salvage therapy appears to be a promising tool for achieving long-term survival in such patients.
Topics: Adult; Catheter Ablation; Duodenal Neoplasms; Humans; Male; Melanoma, Amelanotic; Pancreaticoduodenectomy
PubMed: 28462646
DOI: 10.1308/rcsann.2016.0323 -
The Korean Journal of Gastroenterology... Feb 2022Neuroendocrine tumors (NETs) that arise from neuroendocrine cells can develop in most organs; however, it is rarely found in the duodenal papilla. Conversely,...
Neuroendocrine tumors (NETs) that arise from neuroendocrine cells can develop in most organs; however, it is rarely found in the duodenal papilla. Conversely, gastrointestinal stromal tumors (GISTs), which are mostly asymptomatic and detected incidentally, are usually found in the stomach and very rarely occur metachronously with NETs. A 42-year-old female with no specific underlying disease underwent gastroscopy due to epigastric pain. Biopsy of enlarged major and minor duodenal papilla confirmed the diagnosis of a NET. Endoscopic papillectomy of the major and minor papillae was performed. Multiple duodenal and jejunal submucosal nodules were seen on biliary CT performed at the 30 months follow-up. Pylorus-preserving pancreaticoduodenectomy was performed due to the suspicion of multiple recurrent NETs and muscularis propria involvement on endoscopic ultrasound. Surgical specimen biopsy confirmed the diagnosis of multiple duodenal and jejunal GIST lesions and a metastatic NET in the duodenal lymph node. We report a rare case of a GIST detected in the duodenum during follow-up after the diagnosis and papillectomy of duodenal papilla NET.
Topics: Adult; Duodenal Neoplasms; Female; Gastrointestinal Stromal Tumors; Humans; Neuroendocrine Tumors; Pancreatic Ducts; Pancreaticoduodenectomy
PubMed: 35232922
DOI: 10.4166/kjg.2022.020 -
Blood Oct 2018Duodenal-type follicular lymphoma (DTFL) is a rare and highly indolent follicular lymphoma (FL) variant. It is morphologically and immunophenotypically indistinguishable...
Duodenal-type follicular lymphoma (DTFL) is a rare and highly indolent follicular lymphoma (FL) variant. It is morphologically and immunophenotypically indistinguishable from typical FL, characterized by restricted involvement of intestinal mucosa, and lacks extraintestinal manifestations. The molecular determinants of this distinct clinical behavior are largely unknown. Thirty-eight diagnostic biopsies from patients with DTFL were evaluated. The 10-year overall survival rate was 100% in clinically evaluable patients (n = 19). We compared the targeted mutation profile of DTFL (n = 31), limited-stage typical FL (LSTFL; n = 17), and advanced-stage typical FL (ASTFL; n = 241). The mutation frequencies of recurrently mutated genes, including , /, and were not significantly different. However, was less commonly mutated in DTFL (52%) and LSTFL (24%) as compared with ASTFL (79%). In ASTFL, 41% of mutated cases harbored multiple mutations in , as compared with only 12% in LSTFL ( = .019) and 0% in DTFL ( < .0001). Whole exome and targeted sequencing of DTFL revealed high mutation frequencies of (35%) and (22%). We compared the immune microenvironment gene expression signatures of DTFL (n = 8) and LSTFL (n = 7). DTFL clearly separated from LSTFL by unsupervised, hierarchical clustering of 147 chemokines and cytokines and was enriched for a chronic inflammation signature. In conclusion, the mutational landscape of DTFL is highly related to typical FL. The lower frequency of multiple mutations in in DTFL and LSTFL indicates an increasing selection pressure for complete KMT2D loss in ASTFL pathogenesis. The highly dissimilar immune microenvironment of DTFL suggests a central role in the biology of this disease.
Topics: Adult; Aged; Aged, 80 and over; Biomarkers, Tumor; Cytokines; DNA Mutational Analysis; DNA-Binding Proteins; Duodenal Neoplasms; Exome; Female; Follow-Up Studies; Gene Expression Regulation, Neoplastic; Humans; Inflammation; Lymphoma, Follicular; Male; Middle Aged; Mutation; Neoplasm Proteins; Prognosis; Survival Rate; Tumor Microenvironment; Young Adult
PubMed: 30126979
DOI: 10.1182/blood-2018-03-837252