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HPB Surgery : a World Journal of... Aug 2000Malignant tumours of the duodenum are rare and often difficult to diagnose. Due to the small clinical experience with duodenal malignancies their prognosis is unknown...
BACKGROUND
Malignant tumours of the duodenum are rare and often difficult to diagnose. Due to the small clinical experience with duodenal malignancies their prognosis is unknown and resection is the treatment of choice.
CASE REPORT
Adding to a small series of incidental tumours, we report the case of a 65-year-old patient with primary extranodal (MALT-) lymphoma of the duodenum infiltrating the pancreatic head. The patient was admitted because of anaemia and epigastric discomfort with a history of Helicobacter-pylori associated gastric ulceration. Physical examination and bloodchemical values were otherwise normal. Endoscopy revealed duodenal ulceration but the biopsies taken from the ulceration did not give any evidence of malignancy or residual Helicobacter pylori infection. But MRT showed a circular intramural tumour of the duodenum. On laparotomy a large duodenal tumour adherent to the pancreatic head was found and a Whipple procedure was performed.
CONCLUSION
Apart from describing the case of a rare lymphoproliferative disorder of the duodenum, this report illustrates the diagnostic difficulties with uncommon neoplasm's of the duodenopancreatic region and the value of MRT prior to resection of a duodenopancreatic mass.
Topics: Aged; Duodenal Neoplasms; Humans; Lymphoma, B-Cell, Marginal Zone; Male; Pancreatic Neoplasms
PubMed: 10977120
DOI: 10.1155/2000/68578 -
World Journal of Gastroenterology Jan 2013To investigate endoscopic ultrasound (EUS) for predicting depth of mucosal invasion and to analyze outcomes following endoscopic and transduodenal resection.
AIM
To investigate endoscopic ultrasound (EUS) for predicting depth of mucosal invasion and to analyze outcomes following endoscopic and transduodenal resection.
METHODS
Records of 111 patients seen at our institution from November 1999 to July 2011 with the post-operative pathological diagnosis of benign ampullary and duodenal adenomas were reviewed. Records of patients who underwent preoperative EUS for diagnostic purposes were identified. The accuracy of EUS in predicting the absence of muscular invasion was assessed by comparing EUS reports to the final surgical pathological results. In addition, the incidence of the post-operative complications over a period of 30 d and the subsequent long-term outcome (recurrence) over a period of 30 mo associated with endoscopic and transduodenal surgical resection was recorded, compared and analyzed.
RESULTS
Among 111 patients with benign ampullary and duodenal adenomas, 47 underwent preoperative EUS for 29 peri-ampullary lesions and 18 duodenal lesions. In addition, computed tomography was performed in 18 patients, endoscopic retrograde cholangio-pancreatography in 10 patients and esophagogastroduodenoscopy in 22 patients. There were 43 patients with sporadic adenomas and 4 patients with familial adenomatous polyposis (FAP)/other polyposis syndromes. In 38 (81%, P < 0.05) patients, EUS reliably identified absence of submucosal and muscularis invasion. In 4 cases, EUS underestimated submucosal invasion that was proven by pathology. In the other 5 patients, EUS predicted muscularis invasion which could not be demonstrated in the resected specimen. EUS predicted tumor muscularis invasion with a specificity of 88% and negative predictive value of 90% (P < 0.05). Types of resection performed included endoscopic resection in 22 cases, partial duodenectomy in 9 cases, transduodenal ampullectomy with sphincteroplasty in 10 cases and pancreaticoduodenectomy in 6 cases. The main post-operative final pathological results included villous adenoma (n = 5), adenoma (n = 8), tubulovillous adenoma (n = 10), tubular adenoma (n = 20) and hyperplastic polyp (n = 2). Among the 47 patients who underwent resection, 8 (17%, 5 of which corresponded to surgical resection) developed post-procedural complications which included retroperitoneal hematoma, intra-abdominal abscess, wound infection, delayed gastric emptying and prolonged ileus. After median follow-up of 20 mo there were 6 local recurrences (13%, median follow-up = 20 mo) 4 of which were in patients with FAP.
CONCLUSION
EUS accurately predicts the depth of mucosal invasion in suspected benign ampullary and duodenal adenomas. These patients can safely undergo endoscopic or local resection.
Topics: Adenoma; Adult; Aged; Aged, 80 and over; Ampulla of Vater; Cholangiopancreatography, Endoscopic Retrograde; Common Bile Duct Neoplasms; Duodenal Neoplasms; Endoscopy, Digestive System; Endosonography; Female; Humans; Intestinal Mucosa; Male; Middle Aged; Neoplasm Invasiveness; Patient Selection; Postoperative Complications; Predictive Value of Tests; Retrospective Studies; Time Factors; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 23382629
DOI: 10.3748/wjg.v19.i4.511 -
Clinical and Translational... Nov 2021The genomic characterization of primary nonampullary duodenal adenocarcinoma indicates a genetic resemblance to gastric and colorectal cancers. However, a correlation...
INTRODUCTION
The genomic characterization of primary nonampullary duodenal adenocarcinoma indicates a genetic resemblance to gastric and colorectal cancers. However, a correlation between the clinical and molecular characteristics of these cancers has not been established. This study aimed to elucidate the clinicopathological features of sporadic nonampullary duodenal epithelial tumors, including their molecular characteristics and prognostic factors.
METHODS
One hundred forty-eight patients with sporadic nonampullary duodenal epithelial tumors were examined in this study. Patient sex, age, TNM stage, tumor location, treatment methods, histology, KRAS mutation, BRAF mutation, Fusobacterium nucleatum, mucin phenotype, and programmed death-ligand 1 (PD-L1) status were evaluated. KRAS and BRAF mutations, Fusobacterium nucleatum, mucin phenotype, and PD-L1 status were analyzed by direct sequencing, quantitative polymerase chain reaction, and immunochemical staining.
RESULTS
The median follow-up duration was 119.4 months. There were no deaths from duodenal adenoma (the primary disease). Kaplan-Meier analysis for duodenal adenocarcinoma showed a significant effect of TNM stage (P < 0.01). In univariate analysis of primary deaths from duodenal adenocarcinoma, TNM stage II or higher, undifferentiated, KRAS mutations, gastric phenotype, intestinal phenotype, and PD-L1 status were significant factors. In multivariate analysis, TNM stage II or higher (hazard ratio: 1.63 × 1010, 95% confidence interval: 18.66-6.69 × 1036) and KRAS mutation (hazard ratio: 3.49, confidence interval: 1.52-7.91) were significant factors.
DISCUSSION
Only KRAS mutation was a significant prognostic factor in primary sporadic nonampullary duodenal adenocarcinoma in cases in which TNM stage was considered.
Topics: Adenocarcinoma; Adult; Aged; Aged, 80 and over; B7-H1 Antigen; Duodenal Neoplasms; Female; Fusobacterium nucleatum; Gastric Mucosa; Humans; Male; Middle Aged; Mutation; Neoplasm Staging; Phenotype; Proto-Oncogene Proteins B-raf; Proto-Oncogene Proteins p21(ras)
PubMed: 34797780
DOI: 10.14309/ctg.0000000000000424 -
Journal of Surgical Oncology Dec 2019While sub-2 cm pancreatic neuroendocrine tumors (NETs) are often observed, small bowel-NETs undergo resection and lymphadenectomy regardless of size. Aim was to define...
BACKGROUND
While sub-2 cm pancreatic neuroendocrine tumors (NETs) are often observed, small bowel-NETs undergo resection and lymphadenectomy regardless of size. Aim was to define the natural history of duodenal (D-NETs), determine the role of resection, and define the factors associated with overall survival (OS) after resection.
METHODS
National Cancer Database (2004-2014) was queried for the patients with nonmetastatic/nonfunctional D-NETs. Local resection (LR): local excision/polypectomy/excisional biopsy. Anatomic resection (AR): radical surgery. Tumor size was divided into less than 1 cm, 1 to 2 cm, and ≥2 cm. Propensity score weighting was used to create balanced resection and no-resection cohorts. The primary endpoint was OS.
RESULTS
Among 5502 patient, the median age was 65 years. The median follow-up was 49 months. The median tumor size was 0.8 cm. Resection was performed in 72% (n = 3954; LR: 61%, AR: 39%). Lymph node (LN) resection was performed in 26% (43% had metastasis). A total of 74% had negative margins. Resection and no-resection cohorts were propensity score weighted for age/sex/race/Charlson-Deyo score/tumor grade (all independently associated with OS on multivariable analysis). Resection was associated with improved median OS compared to no resection in all sizes (<1 cm: median not reached vs 194 months; 1-2 cm: median not reached vs 56 months; >2 cm: median not reached vs 90 months; all P < .01). Subset analysis of each resection size cohort demonstrated that neither type of resection, LN retrieval, LN positivity, or margin status was associated with OS (all P > .05).
CONCLUSION
Patients with nonmetastatic and nonfunctional D-NETS should be considered for resection regardless of tumor size. Given the lack of prognostic value, the resection type and extent of LN retrieval should be tailored to each patient's clinical picture and safety profile.
Topics: Aged; Duodenal Neoplasms; Female; Follow-Up Studies; Humans; Lymph Node Excision; Male; Margins of Excision; Middle Aged; Multivariate Analysis; Neuroendocrine Tumors; Prognosis; Registries
PubMed: 31621090
DOI: 10.1002/jso.25731 -
Revista Espanola de Enfermedades... Jul 2019Multiple myeloma (MM) is typical of uncontrolled and clonal growth of malignant plasma cells in the bone marrow, then leads to primary symptoms related to bone narrow...
Multiple myeloma (MM) is typical of uncontrolled and clonal growth of malignant plasma cells in the bone marrow, then leads to primary symptoms related to bone narrow infiltration and destruction bone lesion. The term of extramedullary plasmacytoma is used to defined malignant plasma cells are found out of the bone marrow. In this study, we reported a rare duodenum plasmacytoma accompanied by gastrointestinal symptoms.
Topics: Aged; Duodenal Neoplasms; Female; Humans; Plasmacytoma
PubMed: 31215213
DOI: 10.17235/reed.2019.6090/2018 -
World Journal of Gastroenterology Feb 2019It is widely recognized that endoscopic resection (ER) of superficial non-ampullary duodenal epithelial tumors (SNADETs) is technically challenging and may carry high...
BACKGROUND
It is widely recognized that endoscopic resection (ER) of superficial non-ampullary duodenal epithelial tumors (SNADETs) is technically challenging and may carry high risks of intraoperative and delayed bleeding and perforation. These adverse events could be more critical than those occurring in other levels of the gastrointestinal tract. Because of the low prevalence of the disease and the high risks of severe adverse events, the curability including short- and long-term outcomes have not been standardized yet.
AIM
To investigate the curability including short- and long-term outcomes of ER for SNADETs in a large case series.
METHODS
This retrospective study included cases that underwent ER for SNADETs at our university hospital between March 2004 and July 2017. Short-term outcomes of ER were measured based on and R0 resection rates as well as adverse events. Long-term outcomes included local recurrence detected on endoscopic surveillance and disease-specific mortality in patients followed up for ≥ 12 mo after ER.
RESULTS
In the study, 131 patients with 147 SNADETs were analyzed. The 147 ERs consisted of 136 endoscopic mucosal resections (EMRs) (93%) and 11 endoscopic submucosal dissections (ESDs) (7%). The median tumor diameter was 10 mm. The pathology diagnosis was adenocarcinoma (56/147, 38%), high-grade intraepithelial neoplasia (44/147, 30%), or low-grade intraepithelial neoplasia (47/147, 32%). The R0 resection rate was 68% (93/136) in the EMR group and 73% (8/11) in the ESD group, respectively. Cap-assisted EMR (known as EMR-C) showed a higher rate of R0 resection compared to the conventional method of EMR using a snare (78% 62%, = 0.06). No adverse event was observed in the EMR group, whereas delayed bleeding, intraoperative perforation, and delayed perforation in 3, 3, and 5 patients occurred in the ESD group, respectively. One patient with perforation required emergency surgery. In the 43 mo median follow-up period, local recurrence was found in four EMR cases and all cases were treated endoscopically. No patient died due to tumor recurrence.
CONCLUSION
Our findings suggest that ER provides good long-term outcomes in the patients with SNADETs. EMR is likely to become the safe and reliable treatment for small SNADETs.
Topics: Adenocarcinoma; Aged; Carcinoma in Situ; Duodenal Neoplasms; Duodenoscopy; Endoscopic Mucosal Resection; Female; Humans; Intestinal Mucosa; Male; Middle Aged; Neoplasm Recurrence, Local; Postoperative Complications; Retrospective Studies; Treatment Outcome
PubMed: 30783374
DOI: 10.3748/wjg.v25.i6.707 -
Neuroendocrinology 2006
Topics: Carcinoma; Duodenal Neoplasms; Humans; Pancreatic Neoplasms; Stomach Neoplasms
PubMed: 17312381
DOI: 10.1159/000098013 -
Scientific Reports Jul 2019Non-ampullary duodenal adenocarcinoma (NADC) is extremely rare. Little is known about its clinicopathological and molecular features or its management. Herein we...
Non-ampullary duodenal adenocarcinoma (NADC) is extremely rare. Little is known about its clinicopathological and molecular features or its management. Herein we retrospectively analyzed the cases of 32 NADC patients, focusing on microsatellite instability (MSI), genetic mutations, CpG island methylator phenotype (CIMP), and immunostaining including mucin phenotype and PD-L1 expression. The incidence of MSI, KRAS/BRAF/GNAS mutations and CIMP was 51.6%, 34.4%/3.1%/6.5% and 28.1%, respectively. PD-L1 expression was seen in 34.4% of patients. No significant associations between clinicopathological features and KRAS/BRAF/GNAS genetic mutations or CIMP were found. Histologically non-well-differentiated-type NADCs and those in the 1st portion of the duodenum were significantly associated with later stages (stages III-IV) (P = 0.006 and P = 0.003, respectively). Gastric-phenotype NADCs were frequently observed in the 1st portion and in late-stage patients; their cancer cells more frequently expressed PD-L1. Histologically, the non-well-differentiated type was an independent predictor of PD-L1 expression in cancer cells (OR 25.05, P = 0.04) and immune cells (OR 44.14, P = 0.02). Only late-stage disease (HR 12.23, P = 0.01) was a prognostic factor for worse overall survival in a Cox proportional hazards regression model. Our observation of high proportions of MSI and PD-L1 expression may prompt the consideration of immune checkpoint inhibitors as a new treatment option for NADCs.
Topics: Adenocarcinoma; Aged; B7-H1 Antigen; Chromogranins; CpG Islands; DNA Methylation; DNA, Neoplasm; Duodenal Neoplasms; Female; GTP-Binding Protein alpha Subunits, Gs; Genes, Neoplasm; Genes, ras; Humans; Kaplan-Meier Estimate; Male; Microsatellite Instability; Middle Aged; Mutation; Neoplasm Proteins; Phenotype; Prognosis; Proportional Hazards Models; Proto-Oncogene Proteins B-raf; Retrospective Studies
PubMed: 31324814
DOI: 10.1038/s41598-019-46167-y -
Medicine Jun 2019Duodenal neuroendocrine tumors (NETs) are rare, and risk factors associated with lymph node (LN) metastasis are still not well defined. The aim of this study was to... (Observational Study)
Observational Study
Duodenal neuroendocrine tumors (NETs) are rare, and risk factors associated with lymph node (LN) metastasis are still not well defined. The aim of this study was to investigate risk factors of LN metastasis in duodenal NETs based on the final histopathologic results and clinical follow-up data.This study included a total of 44 duodenal NETs in 38 patients who underwent endoscopic or surgical resection between January 2008 and December 2015. Diagnosis of duodenal NETs was confirmed based on immunohistochemical staining of chromogranin A, synaptophysin, and CD56; the clinicopathologic records were collected at the time of the initial diagnosis of duodenal NETs.Most duodenal NETs were small (≤1 cm in 33 tumors), World Health Organization (WHO) grade G1 (in 32 tumors), limited to the mucosa and/or submucosa (in 40 tumors), and located at the duodenal bulb (in 32 tumors). Of 44 tumors, lymphovascular invasion was present in 4 (9.1%), and among 38 patients, LN metastasis was detected in 4 (10.5%). LN metastases were significantly associated with the non-bulb location, tumor size >10 mm, tumor invasion into the muscularis propria or deeper, WHO grade G2, and lymphovascular invasion. During the mean follow-up period of 54.5 months (range, 24-123 months), recurrence occurred in 1 patient.Non-bulb location, tumor size >10 mm, invasion beyond the submucosa, WHO grade G2, and lymphovascular invasion are risk factors of LN metastasis in duodenal NETs. These findings can help clinicians choose the appropriate therapeutic modality for duodenal NETs.
Topics: Adult; Aged; Duodenal Neoplasms; Female; Humans; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Grading; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Neuroendocrine Tumors; Retrospective Studies; Risk Factors; Tumor Burden
PubMed: 31169696
DOI: 10.1097/MD.0000000000015885 -
International Journal of Clinical and... 2015Defined as a family of scarce mesenchymal neoplasm which distinctively co-express melanocytic markers and muscle markers, perivascular epithelioid cell tumors (PEComas)... (Review)
Review
Defined as a family of scarce mesenchymal neoplasm which distinctively co-express melanocytic markers and muscle markers, perivascular epithelioid cell tumors (PEComas) have been reported almost everybody site. Perivascular epithelioid cell tumors-not otherwise specified (PEComas-NOS) arising in the gastrointestinal (GI) tract are still restricted into sporadic case reports. Herein we present a case of GI PEComas-NOS which occurs in the duodenum of a 27-year-old male. Our initial diagnosis tended to gastrointestinal stromal tumor or smooth muscle tumor till the correct diagnosis of perivascular epithelioid cell tumor (PEComa) was established by postoperative pathological examination. We also make a literature review of GI PEComas-NOS and highlight the challenge it brings to the differential diagnosis.
Topics: Adult; Biomarkers, Tumor; Biopsy; Diagnosis, Differential; Duodenal Neoplasms; Duodenoscopy; Humans; Immunohistochemistry; Male; Perivascular Epithelioid Cell Neoplasms; Predictive Value of Tests; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 26339433
DOI: No ID Found