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Alsalman J, Alqourain A, Alyousef M, Aldandan O, Alzahrani I. Obstructive Jaundice Caused by Metastatic Neuroendocrine Tumor of the Ampulla of Vater in a Young Adult: A Case Report. Case Rep Gastroenterol 2024; 18:204-213. [PMID: 38590835 PMCID: PMC11001288 DOI: 10.1159/000538260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 02/29/2024] [Indexed: 04/10/2024] Open
Abstract
Introduction Ampullary neuroendocrine tumors (NETs) are usually diagnosed in the 5th-6th decades of life, and no cases were reported in <20 years of age. We report a rare case, presenting at a very young age, of well-differentiated NET involving the ampulla of Vater with lymph node metastasis. Case Presentation An 18-year-old man presented with a 3-month history of upper abdominal pain and jaundice. Abdominal ultrasound showed a dilated common bile duct, and endoscopic retrograde cholangiopancreatography revealed two duodenal polypoid lesions, one of them overlying the ampulla of Vater, with an erythematous and ulcerated surface. Histopathological examination confirmed the diagnosis of NET grade 1. Octreotide scan revealed 2 para-aortic lymph nodes with intense radiotracer uptake. The patient had undergone Whipple surgery with para-aortic lymph node dissection. Histopathological examination of the surgical specimens was confirmatory of NET grade 2 and paraganglioma in a few of the dissected lymph nodes. Postoperatively, the patient was kept on monthly intramuscular octreotide. Follow-up gallium-68 DOTATATE is unremarkable apart from an avid left para-aortic lymph node which is showing stability over 12 months of follow-up. Conclusion This case demonstrates that NETs of the ampulla of Vater can present at a very young age. Radical surgical excision with extended lymph node dissection and postoperative octreotide is associated with better patient outcomes and survival.
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Affiliation(s)
- Jaafar Alsalman
- Department of Internal Medicine, Division of Gastroenterology, Dammam Medial Complex, Dammam, Saudi Arabia
| | - Abdulaziz Alqourain
- Department of Internal Medicine, Division of Gastroenterology, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mohammed Alyousef
- Department of Pathology, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Omran Aldandan
- Department of Radiology, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ibrahim Alzahrani
- Department of Internal Medicine, Division of Gastroenterology, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Tuan HX, Lieu DQ, Anh TN, Tuan HQ, Ly TTH, Kha VV, Duc NM. A rare case of duodenal adenocarcinoma. Radiol Case Rep 2023; 18:4400-4403. [PMID: 37829165 PMCID: PMC10565683 DOI: 10.1016/j.radcr.2023.09.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 09/12/2023] [Accepted: 09/14/2023] [Indexed: 10/14/2023] Open
Abstract
Duodenal adenocarcinoma is very rare. Its clinical picture is nonspecific and the diagnosis is often accidental. The factors that affect survival are difficult to determine because the number of patients is not high. The common site of duodenal tumors and surgical removal are also debatable. The treatment guidelines published so far have mostly been evaluated in retrospective studies conducted over a 20-year period with relatively small sample sizes. The author presents a case of duodenal adenocarcinoma in a 62-year-old male patient with a clinical manifestation of melena. Duodeno-cephalo-pancreatectomy was the surgical option.
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Affiliation(s)
- Ho Xuan Tuan
- Department of Medical Imaging, Da Nang University of Medical Technology and Pharmacy, Da Nang, Viet Nam
| | - Dau Quang Lieu
- Department of Internal Medicine, Hanoi Medical University Hospital, Hanoi, Viet Nam
| | - Tran Ngoc Anh
- Department of Internal Medicine, Hanoi Medical University Hospital, Hanoi, Viet Nam
- Department of Internal Medicine, Hanoi Medical University, Hanoi, Viet Nam
| | - Hang Quoc Tuan
- Director Board, Kien Giang Oncology Hospital, Kien Giang, Viet Nam
| | - Tran-Thi Huong Ly
- Department of General Planning, Can Tho Oncology Hospital, Can Tho, Viet Nam
| | - Vo-Van Kha
- Director Board, Can Tho Oncology Hospital, Can Tho, Viet Nam
| | - Nguyen Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Viet Nam
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Muacevic A, Adler JR, Owais M, Haseeb M, Kharal F. Schwannoma of the Ascending Colon in a 22-Year-Old Male: A Case Report. Cureus 2022; 14:e31946. [PMID: 36582566 PMCID: PMC9795079 DOI: 10.7759/cureus.31946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2022] [Indexed: 11/29/2022] Open
Abstract
Schwannoma of the ascending colon is an extremely rare neoplasm that is often discovered incidentally in the asymptomatic older population on surveillance colonoscopy. We present the case of a symptomatic 22-year-old male presenting with one month of discomfort in the right lower abdominal quadrant, abdominal bloating, and hematochezia. A sessile polyp measuring 0.5 cm was identified in the ascending colon on the colonoscopy. The polyp was completely resected using cold snare polypectomy. Histological examination of the resected polyp with hematoxylin-eosin staining revealed small nodules of bland spindle cells with focal nuclear condensation. The lesional cells tested positive for S-100 and SOX-10 on immunohistochemical analysis, establishing the diagnosis of benign schwannoma. Since this lesion was submucosal, its diagnosis required an endoscopic biopsy that could only be performed on the mucosa. It was difficult to distinguish it from other mesenchymal tumors (gastrointestinal stromal tumor or leiomyoma), and this makes the differential diagnosis exceedingly challenging. If the immunohistochemistry is positive for S-100 and negative for C-KIT, CD-34, actin, and desmin, it aids in diagnosis. These tumors have non-specific radiological features and are asymptomatic.
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Cherouaqi Y, Belabbes FZ, Delsa H, Nadi A, Rouibaa F. Massive Digestive Hemorrhagia Revealing a Gastro-Intestinal Stromal Tumor of the Jejunum. Cureus 2021; 13:e17316. [PMID: 34567868 PMCID: PMC8451536 DOI: 10.7759/cureus.17316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2021] [Indexed: 11/05/2022] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors that originate from Cajal cells located in different sites of the digestive system. They may occur in the entire gastrointestinal tract. They are diagnosed on the basis of the identification of c-kit-positive cells. We report a case of a stromal tumor of the jejunum revealed by a massive digestive hemorrhagia. Surgical resection is the basis of the treatment of GISTs. Imatinib, a tyrosine kinase inhibitor, is a beneficial treatment after surgical resection of high-risk GISTs.
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Affiliation(s)
- Yasmine Cherouaqi
- Gastroenterology and Proctology, Faculty of Medicine, Mohammed VI University of Health Sciences (UM6SS) Cheikh Khalifa International University Hospital, Casablanca, MAR
| | - Fatima Zahra Belabbes
- Gastroenterology and Proctology, Faculty of Medicine, Mohammed VI University of Health Sciences (UM6SS) Cheikh Khalifa International University Hospital, Casablanca, MAR
| | - Hanane Delsa
- Gastroenterology and Proctology, Faculty of Medicine, Mohammed VI University of Health Sciences (UM6SS) Cheikh Khalifa International University Hospital, Casablanca, MAR
| | - Anass Nadi
- Gastroenterology and Proctology, Faculty of Medicine, Mohammed VI University of Health Sciences (UM6SS) Cheikh Khalifa International University Hospital, Casablanca, MAR
| | - Fedoua Rouibaa
- Gastroenterology and Proctology, Faculty of Medicine, Mohammed VI University of Health Sciences (UM6SS) Cheikh Khalifa International University Hospital, Casablanca, MAR
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5
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Zhou YW, Xia RL, Chen YY, Ma XL, Liu JY. Clinical features, treatment, and prognosis of different histological types of primary small bowel adenocarcinoma: A propensity score matching analysis based on the SEER database. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2021; 47:2108-2118. [PMID: 33849741 DOI: 10.1016/j.ejso.2021.03.260] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/19/2021] [Accepted: 03/28/2021] [Indexed: 02/08/2023]
Abstract
PURPOSE This aim of this study was to provide a comprehensive understanding of the clinical characteristics, treatment, and prognosis of patients with small bowel adenocarcinoma (SBA), mucinous small bowel adenocarcinoma (MSBA), and signet ring cell carcinoma of the small bowel (SRCSB). METHODS Information on patients with SBA, MSBA, and SRCSB (2004-2015) was obtained from the Surveillance, Epidemiology and End Results (SEER) database. Cox proportional hazards models and Kaplan-Meier curves were used for the survival analyses. Propensity-score matching (PSM) was implemented to determine the differences among these tumors. RESULTS In all, 3697 patients with SBA (n = 3196), MSBA (n = 325) and SRCSB (n = 176) were ultimately eligible for this study. Poor differentiation, local invasion, and lymph node metastasis were more likely to be observed in SRCSB than in SBA and MSBA. Surgery was the most common treatment modality in all groups. The prognosis of SBA was similar to that of MSBA, but better than that of SRCSB in both unmatched and matched cohorts. M stage, surgery, and chemotherapy were identified as independent predictors of survival in all patients. Surgery and chemotherapy could significantly improve outcomes in all groups before and after PSM. Radiotherapy was associated with a survival benefit in patients with SBA, but this trend was not maintained after PSM. Survival advantages of SBA and MSBA were remarkable in the stratified analysis of surgery after PSM. CONCLUSION Patients with SRCSB had the worst prognosis among all histological types examined. However, surgery and chemotherapy could improve patients survival, regardless of histological type.
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Affiliation(s)
- Yu-Wen Zhou
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China; West China School of Medicine, Sichuan University, Chengdu, China
| | - Ruo-Lan Xia
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China; West China School of Medicine, Sichuan University, Chengdu, China
| | - Yue-Yun Chen
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China; West China School of Medicine, Sichuan University, Chengdu, China
| | - Xue-Lei Ma
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China.
| | - Ji-Yan Liu
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China.
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Zhao J, Huang C, Zhu J, Zhu J, Yuan R, Zhu Z. Efficacy and safety of Seprafilm for preventing intestinal obstruction after gastrointestinal neoplasms surgery: a systematic review and meta-analysis. Acta Chir Belg 2021; 121:1-15. [PMID: 33459577 DOI: 10.1080/00015458.2020.1871286] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE It was controversial that hyaluronate-carboxy-methylcellulose-based membrane (Seprafilm) could prevent intestinal obstruction after gastrointestinal neoplasms operation. This study aimed to evaluate the efficacy and safety of Seprafilm in preventing postoperative intestinal obstruction of gastrointestinal neoplasms patients. METHODS A systematic research of multiple databases was performed to identify relevant studies, and the studies satisfying the inclusion criteria were included. Risk ratio (RR), weighted mean difference (WMD), and 95% confidence intervals were calculated using RevMan 5.3. RESULTS 2937 patients from 10 studies who were enrolled in this meta-analysis were divided into the Seprafilm group (n = 1334) and the control group (n = 1603). The Seprafilm group had lower incidence of intestinal obstruction (RR, 0.52; 95% CI, 0.38-0.70; p < .0001), reoperation rates due to intestinal obstruction (RR, 0.48; 95% CI, 0.28 - 0.80; p = .005), incidence of overall complications (RR, 0.77; 95% CI, 0.61-0.97; p = .03) and higher serum creatinine on postoperative day 5 (WMD, 0.15; 95% CI, 0.05-0.25; p = .003). There were no differences regarding time to intestinal obstruction after operation, aspartate aminotransferase, alanine aminotransferase, blood urea nitrogen, white blood cell count results on day 5 and 7, serum creatinine on day 7, hospital stay, and incidence of intra-abdominal infection, wound infection, anastomotic leakage between the 2 groups. CONCLUSIONS This meta-analysis provided valuable evidence-based support for the efficacy and safety of Seprafilm in preventing postoperative intestinal obstruction of gastrointestinal neoplasms patients. However, more multicenter randomized controlled trials from different countries are needed.
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Affiliation(s)
- Jiefeng Zhao
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Chao Huang
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jisheng Zhu
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jinfeng Zhu
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Rongfa Yuan
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zhengming Zhu
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
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Role of Primary Tumor Resection for Metastatic Small Bowel Neuroendocrine Tumors. World J Surg 2020; 45:213-218. [PMID: 32797281 DOI: 10.1007/s00268-020-05727-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2020] [Indexed: 12/21/2022]
Abstract
While small bowel resection is well established as standard of care for curative-intent management of localized and loco-regional small bowel neuroendocrine tumors (SB-NETs), resection of the primary tumor in the setting of metastatic disease is debated. This review addresses the role of primary tumor resection for stage IV well-differentiated grade 1 and 2 SB-NETs. While survival benefits have been reported for primary tumor resection in the setting of metastatic disease, these studies are limited by selection bias and thus controversial. The main clinical benefits of primary tumor resection for stage IV disease involve the prevention of potentially debilitating complications associated with mesenteric fibrosis, including intestinal obstruction, mesenteric ischemia and angina, venous congestion, malabsorption, and malnutrition. Patients with metastases undergoing initial resection of the primary SB-NETs appear to have fewer episodes of care and re-intervention for loco-regional complications than those who do not undergo resection. As recommended by the NANETS and ENETS guidelines, resection of the primary tumor for stage IV SB-NETs should be strongly considered to avoid future loco-regional complications and potentially to improve survival. All patients with stage IV SB-NETs should be assessed by a surgeon experienced in the management of NETs to consider surgical therapies, including resection of the primary tumor despite metastatic disease.
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8
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Extent of Lymph Node Dissection for Small Bowel Neuroendocrine Tumors. World J Surg 2020; 45:197-202. [PMID: 32737557 DOI: 10.1007/s00268-020-05710-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2020] [Indexed: 12/22/2022]
Abstract
The management of nodal disease remains controversial for small bowel neuroendocrine tumors (SB-NETs). Debates remain regarding the therapeutic role and extent of routine lymph node dissection (LND) for localized SB-NETs, as well as the need for aggressive resection of advanced loco-regional SB-NETs with mesenteric nodal masses. This review will address these questions regarding lymph node dissection for well-differentiated WHO grade 1 and 2 SB-NETs. In general, the aggressiveness and radicality of resection should be balanced against the length of bowel resected and post-operative functional outcomes. In localized SB-NETs with clinically negative lymph nodes, a nodal harvest of ≥ 8 lymph nodes provides accurate staging, but has not been shown to confer survival benefit. For loco-regional SB-NETs with clinically positive lymph nodes identified on imaging, 4 stages of nodal extent have been described: stage 1 nodes are located near to the intestinal border, stage 2 on arterial branches close to the origin of the SMA, stage 3 along the SMA itself, and stage 4 extend in the retroperitoneum under the pancreatic neck. In SB-NETs, every attempt should be made at resection of the primary tumor and the nodal mesenteric mass for curative-intent management and to prevent debilitating complications from mesenteric fibrosis. A mesenteric-sparing approach is favored to allow for resection for complex proximal nodal masses while preserving intestinal length and function. All patients with SB-NETs with nodal mesenteric mass should be assessed by a surgeon for resection; if deemed unresectable, consideration should be given to assessment in high-volume NETs centres to confirm proximal mesenteric-sparing resection is not feasible.
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Kleinschmidt TK, Christein J. Neuroendocrine carcinoma of the ampulla of Vater: a case report, review and recommendations. J Surg Case Rep 2020; 2020:rjaa119. [PMID: 32537123 PMCID: PMC7276669 DOI: 10.1093/jscr/rjaa119] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 04/10/2020] [Indexed: 01/05/2023] Open
Abstract
Neuroendocrine tumor (NET) of the ampulla of Vater is a rare presentation of biliary obstruction. Here, we present a case of NET and discuss the current recommendations that necessitate different management and surgical treatment than other sites. A 56-year-old Caucasian female presented with 2 years of right upper quadrant pain. Workup revealed a well-differentiated 2.2 cm NET at the ampulla with 0 MF/10 HPF, Stage 1A T2NOMO. Whipple procedure performed with 2.2 cm ampullary NET with 1 of the 15 lymph node metastases and <2 mitoses in 10 HPF. TNM classification: Stage IV T2N1MO. Regardless of tumor size, NETs metastasize in half of cases. Local excisions including endoscopic and laparoscopic ampullectomy were recommended only for poor surgical candidates. Ampullary NETs behave more aggressively than nonampullary NETs and their biological behaviors are irrespective of size. For patients of acceptable surgical risk, we recommend radical resection utilizing Whipple procedure.
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Affiliation(s)
- Thomas K Kleinschmidt
- Department of Medical Education, Brookwood Baptist Health Systems, Birmingham, AL, USA.,Department of Hepatobiliary and Pancreatic Surgery, Grandview Medical Center, Birmingham, AL, USA
| | - John Christein
- Department of Hepatobiliary and Pancreatic Surgery, Grandview Medical Center, Birmingham, AL, USA
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Mazzotta E, Lauricella S, Carannante F, Mascianà G, Caricato M, Capolupo GT. Ileo-ileal intussusception caused by small bowel leiomyosarcoma: A rare case report. Int J Surg Case Rep 2020; 72:52-55. [PMID: 32506030 PMCID: PMC7283087 DOI: 10.1016/j.ijscr.2020.05.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/20/2020] [Accepted: 05/20/2020] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Intussusception is the telescoping of one segment of the bowel into an adjacent bowel segment, causing venous congestion, edema, and blood supply reduction. We present a case of ileo-ileal intussusception in an adult patient with intestinal obstruction caused by a rare mesenchymal malignant lesion of the distal ileum: Leiomyosarcoma (LMS). PRESENTATION OF CASE A 90-year-old Caucasian man presented to the hospital with a two-day history of abdominal pain, nausea, and bowel occlusion. Preoperative Computer Tomography (CT) showed a solid mass with stratified walls in the lumen of the cecum with the classics "bulls-eye" appearance with concentric rings, suggestive of intussusception. The patient underwent emergency laparotomy with evidence of a small bowel wall tumor driving ileo-ileal intussusception with ischemic damage. Ileocecal resection was performed without postoperative complications. Histopathological examination showed a tumor on the muscular layer of the small bowel. The definitive diagnosis was LMS. DISCUSSION Adult intussusception is a rare condition, with an incidence of 2/1 000 000 cases per year worldwide. About 60% of patients suffering from this disease require surgery. Clinical presentation can be non-specific because of its no characteristic signs and symptoms. The most common presenting symptom is abdominal pain with bowel obstruction sings. Intussusception can occur anywhere along the small and large intestine and it is typically associated with a Lead Point (LP). The LP may be benign or malignant conditions. Infrequent malignant causes include LMS. CONCLUSION Diagnosis of intussusception is relatively challenging because of its non-specific symptoms. CT scan is the examimation of choice for the diagnosis because of its peculiar images. In adults, surgical treatment is recommended with laparoscopic or open approach according to surgeon expertise, sometimes in an emergency setting.
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Affiliation(s)
- Erica Mazzotta
- Colorectal Surgery Unit, Università Campus Bio-Medico, Rome, Italy.
| | - Sara Lauricella
- Colorectal Surgery Unit, Università Campus Bio-Medico, Rome, Italy
| | | | | | - Marco Caricato
- Colorectal Surgery Unit, Università Campus Bio-Medico, Rome, Italy
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Li Q, Chen T, Cui H, Xiao X, Chen C, Shen Z, Ji F, Yin L. Misdiagnosis of multiple synchronous small bowel adenocarcinomas as intestinal tuberculosis: a case report. BMC Gastroenterol 2020; 20:112. [PMID: 32299377 PMCID: PMC7164229 DOI: 10.1186/s12876-020-01271-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 04/07/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Small bowel adenocarcinoma (SBA) is a rare malignancy that primarily occurs in the duodenum. Multiple synchronous SBA is unique rare and difficult to diagnose due to non-specific disease presentation. Protocols to identify multiple synchronous SBA during early disease stages are urgently required. CASE PRESENTATION An elderly man experienced left lower abdominal pain and melena for 3 months. Abdominal CT showed thickening of the multiple segmental small intestinal walls. As the patient had pulmonary tuberculosis simultaneously, he was misdiagnosis as intestinal tuberculosis and received anti-spasm therapy. The treatment delayed radical resection surgery and the patient underwent palliative segmental resection of the jejunum after 4 months due to intestinal obstruction. Resected specimens showed multiple synchronous SBA (five tumors). The patient accepted chemotherapy postoperatively. Six months postoperatively, the patient died of brain metastasis. CONCLUSIONS We highlight how multiple synchronous SBA is rare and easily misdiagnosed. We should rule out multiple synchronous SBA when diagnosing intestinal diseases (e.g. inflammatory bowel disease, IBS). Intestinal tuberculosis may also be one of the risk factors for multiple synchronous SBA. High-risk patients should be assessed for known tumor makers, and receive gastroscopy, enteroscopy or capsule endoscopy. Doctors should obtain the pathology under endoscopy to the greatest possible degree. For suspected patients, laparotomy should be performed.
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Affiliation(s)
- Qiwei Li
- Department of General Surgery, South Campus, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200112, China
| | - Tao Chen
- Department of General Surgery, South Campus, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200112, China
| | - Hexi Cui
- Department of Nursing, South Campus, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200112, China
| | - Xiao Xiao
- Department of Tuberculosis Control, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, 200336, China
| | - Chunqiu Chen
- Department of Abdominal Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Zhenyu Shen
- Department of Abdominal Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Fu Ji
- Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China.
| | - Lu Yin
- Department of Abdominal Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China.
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12
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Complications of surgery for gastro-entero-pancreatic neuroendocrine neoplasias. Langenbecks Arch Surg 2020; 405:137-143. [PMID: 32291468 PMCID: PMC7239819 DOI: 10.1007/s00423-020-01869-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 03/22/2020] [Indexed: 12/14/2022]
Abstract
Purpose Surgery is recommended for most patients with gastro-entero-pancreatic neuroendocrine neoplasias (GEP-NENs). Rates of complications and perioperative mortality have been reported in few mostly retrospective single-center series, but there has been no detailed analysis on risk factors for perioperative complications and mortality to date. Methods Data of patients with GEP-NENs operated between January 2015 and September 2018 were retrieved from EUROCRINE©, a European online endocrine surgical quality registry, and analyzed regarding rate and risk factors of surgical complications. Risk factors were assessed by logistic regression. Results Some 376 patients (211 female, 167 male; age median 63, range 15–89 years) were included. Most NENs were located in the small intestine (SI) (n = 132) or pancreas (n = 111), the rest in the stomach (n = 34), duodenum (n = 30), appendix (n = 30), colon, and rectum (n = 22), or with unknown primary (n = 15). Of the tumors, 320 (85.1%) were well or moderately differentiated, and 147 (39.1%) of the patients had distant metastases at the time of operation. Severe complications (Dindo-Clavien ≥ 3) occurred in 56 (14.9%) patients, and 4 (1.1%) patients died perioperatively. Severe complications were more frequent in surgery for duodenopancreatic NENs (n = 31; 22.0%) compared with SI-NENs (n = 15; 11.4%) (p = 0.014), in patients with lymph node metastases operated with curative aim of surgery (n = 24; 21.4%) versus non-metastasized tumors or palliative surgery (n = 32; 12.1%) (p = 0.020), and in functioning tumors (n = 20; 23.0%) versus non-functioning tumors (n = 30; 13.5%) (p = 0.042). Complication rates were not significantly associated with tumor stage or grade. Conclusions Severe complications are frequent in GEP-NEN surgery. Besides duodenopancreatic tumor location, curative resection of nodal metastases and functioning tumors are risk factors for complications.
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Štor Z, Hanžel J. Ileal leiomyosarcoma presenting with intussusception. J Surg Case Rep 2019; 2019:rjz052. [PMID: 30800281 PMCID: PMC6380073 DOI: 10.1093/jscr/rjz052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 01/31/2019] [Indexed: 01/06/2023] Open
Abstract
Intussusception is a rare cause of small bowel obstruction in adults, up to 30% of cases are caused by small bowel malignancy. Intestinal leiomyosarcoma is an extremely rare malignant mesenchymal tumour. An 80-year-old male presented with small bowel obstruction. Abdominal ultrasonography and a subsequent CT scan showed small bowel obstruction due to ileo-ileal intussusception. The patient underwent an emergency exploratory laparotomy, which confirmed prior findings on imaging. The affected segment of the ileum was resected and a primary entero-enteral anastomosis was created. Histopathological analysis revealed a 4.8 cm leiomyosarcoma. The patient remains without evidence of disease 12 months after initial presentation. Radical surgical resection remains the treatment of choice for leiomyosarcoma, with no convincing evidence supporting adjuvant treatment. Tumours smaller than 5 cm appear to have a more favourable prognosis.
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Affiliation(s)
- Zdravko Štor
- Department of Abdominal Surgery, University Medical Centre Ljubljana, Zaloška 7, SI-1525 Ljubljana, Slovenia
| | - Jurij Hanžel
- Department of Abdominal Surgery, University Medical Centre Ljubljana, Zaloška 7, SI-1525 Ljubljana, Slovenia
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Dhaduk VR, Johri V, Majesty SRH, Mushtaque N, Jain N, Reddy PK. Laparoscopic resection of duodenal carcinoid: A feasible method: Single institute case series. J Minim Access Surg 2018; 16:24-29. [PMID: 30106022 PMCID: PMC6945343 DOI: 10.4103/jmas.jmas_131_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Duodenal carcinoids (neuroendocrine tumour) are rare tumour, but recently, increase in incidence has been noted. Various techniques for excision of tumour have been described in literature, but very few case reports and case series have mentioned about laparoscopic management of carcinoid tumour. We describe a case series of seven cases of duodenal non-periampullary carcinoids which was managed by laparoscopic method. Aims The aim of the study was to check feasibility of laparoscopic management of duodenal carcinoid and technique of surgery. Settings and Design This study design was a case series and prospective data were retrospectively collected. Materials and Methods A total of 7 patients were operated for carcinoid tumour of duodenum mainly involving first part by laparoscopic method from February 2016 to January 2017. All patients were followed up for minimum 1-year period and various pre-operative, intra-operative findings and post-operative outcome were noted. Results Out of seven patients, 6 patient were managed by laparoscopic duodenotomy and transduodenal excision whereas one patient required duodenectomy of first part. Mean operative time was 99 min, mean intraoperative blood loss was 55.7, mean hospital stay was 99.7 and no recurrence in a 1-year follow-up. Conclusions Laparoscopic excision of carcinoid tumour is safe, technically reproducible and feasible method.
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Affiliation(s)
- Vimalkumar R Dhaduk
- Department of Surgical Gastroenterology and Minimal Access and Bariatric Surgery, Apollo Hospital Chennai, India
| | - Vishwas Johri
- Department of Surgical Gastroenterology and Minimal Access and Bariatric Surgery, Apollo Hospital Chennai, India
| | - S R Harshavardan Majesty
- Department of Surgical Gastroenterology and Minimal Access and Bariatric Surgery, Apollo Hospital Chennai, India
| | - Nadeem Mushtaque
- Department of Surgical Gastroenterology and Minimal Access and Bariatric Surgery, Apollo Hospital Chennai, India
| | - Nikunj Jain
- Department of Surgical Gastroenterology and Minimal Access and Bariatric Surgery, Apollo Hospital Chennai, India
| | - Prasanna Kumar Reddy
- Department of Surgical Gastroenterology and Minimal Access and Bariatric Surgery, Apollo Hospital Chennai, India
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15
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Meta-analysis of postoperative adjuvant therapy for small bowel adenocarcinoma. PLoS One 2018; 13:e0200204. [PMID: 30096150 PMCID: PMC6086425 DOI: 10.1371/journal.pone.0200204] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 06/21/2018] [Indexed: 12/31/2022] Open
Abstract
Objective The role of adjuvant therapy in small bowel adenocarcinoma (SBA), a rare malignancy with a poor prognosis, is controversial. The purpose of this article is to investigate the impact of adjuvant therapy on the survival of patients with SBA in a meta-analysis. Methods We performed a comprehensive search of PubMed, EMBASE and the Cochrane Library database between 2010 and 2017. Hazard ratios (HR) with 95% confidence intervals (95%CI) were used to assess the effect of adjuvant chemotherapy and/or radiation treatment after curative surgery in patients with SBA. Moreover, impact of age, sex, stage, differentiation, lymph node involvement, and margin status was also evaluated. Results We included 15 studies to evaluate the effect of adjuvant therapy on the survival of patients with SBA. The pooled HR of overall survival (OS) involving 5986 patients showed that adjuvant therapy did not have a statistically significant effect on the survival of patients with SBA (pooled HR = 0.89, 95% CI = 0.73–1.09, p = 0.25). Further, 607 patients with duodenal adenocarcinoma (DA) had similar results (pooled HR = 0.96, 95% CI = 0.75–1.23, p = 0.77). Similarly, adjuvant treatment vs. non-adjuvant treatment in terms of disease-free survival (DFS) or relapse-free survival (RFS) showed the same results (pooled HR = 0.89, 95% CI = 0.64–1.23, p = 0.48). However, we found that adjuvant therapy resulted in favorable postoperative survival in Europe according to the subgroup analysis (pooled HR = 0.63, 95% CI = 0.5–0.8, p = 0.0002). In addition, the pooled HR shows that stage, differentiation, lymph node involvement, and margin status were related to the OS of patients with SBA. Conclusion Patients with SBA who received adjuvant therapy after surgery did not receive a significant survival benefit. Adjuvant therapy may be more useful in advanced cancer or metastatic patients.
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16
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Xie X, Zhou Z, Song Y, Dang C, Zhang H. Surgical Management and Prognostic Prediction of Adenocarcinoma of Jejunum and Ileum. Sci Rep 2017; 7:15163. [PMID: 29123252 PMCID: PMC5680303 DOI: 10.1038/s41598-017-15633-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 10/31/2017] [Indexed: 02/07/2023] Open
Abstract
We conducted a retrospective study based on the Surveillance, Epidemiology, and End Results Program (SEER) database to establish a novel nomogram prognostic prediction system and to estimate the association between overall survival and prognostic factors, as well as to explore surgical treatment strategies for adenocarcinoma of the jejunum and ileum. A total of 883 patients from the SEER database were included in this study. Eight potential prognostic factors were included in a nomogram model and discriminatory power and accuracy were examined using the Harrell's C-index and Akaike Information Criterion (AIC) index. In comparison with the AJCC TNM staging system, the nomogram prediction system was more accurate and homogeneous (Harrell's C-index, 0.731 vs. 0.667; AIC index, 4852.9 vs. 4913.723). For surgical management, resection of more than 12 local lymph nodes could improve the likelihood of survival. This study demonstrates that our nomogram model is more accurate and homogeneous than the traditional AJCC TNM staging system, and proper surgical strategies for mesenteric lymphadenectomy improve overall survival.
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Affiliation(s)
- Xin Xie
- Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, China
| | - Zhangjian Zhou
- Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, China
| | - Yongchun Song
- Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, China
| | - Chengxue Dang
- Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, China.
| | - Hao Zhang
- Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, China.
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17
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[Mid gut neuroendocrine tumors: News on medical treatment]. Presse Med 2017; 46:4-10. [PMID: 28089247 DOI: 10.1016/j.lpm.2016.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 07/21/2016] [Accepted: 09/01/2016] [Indexed: 11/23/2022] Open
Abstract
CONTEXT Mid gut neuroendocrine tumors (NET) are rare tumors whose incidence is increasing. Curative surgery remains the gold standard for the treatment of NETs of the small intestine. Surgery should be considered as soon as possible even if a metastatic stage is diagnosed. The management of unresectable well-differentiated metastatic NETs of the small intestine recently changed with the publication of trials demonstrating the benefit of targeted therapies and metabolic radiotherapy, leading to a change of practices and update of French and international recommendations. OBJECTIVE The objective of this review is to present the recent data consisting of three phase III studies, which modify the management of well-differentiated metastatic midgut NETs and make an inventory of the available treatment options. DOCUMENTARY SOURCES The documentary sources used were gathered through the PubMed website using keyword searching (neurendocrine tumor, mid gut, treatment). We also referred to recommendations of the European Society of neuroendocrine tumors (ENETS) trials presented at ESMO Congress 2015 (European Society for Medical Oncology). STUDY SELECTION We excluded studies of exclusive extra-digestive NETs, poorly differentiated NETs, surgical treatments and phase I studies. RESULTS We discussed three randomized phase III trials: CLARINET, RADIANT and NETTER studies. These studies demonstrated the efficacy of respectively somatostatin analogues, mTOR inhibitors and metabolic radiotherapy. CONCLUSION This review highlights the validation by randomized studies of an mTOR inhibitor and metabolic radiotherapy in metastatic non-pancreatic digestive NETs unresectable well-differentiated grade of G1/2 in progression under somatostatin analogues.
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Yamamoto M, Yamamoto K, Taketomi H, Yamamoto F, Yamamoto H. Obscure Gastrointestinal Bleeding Due to a Small Intestinal Gastrointestinal Stromal Tumor in a Young Adult. Case Rep Gastroenterol 2016; 10:668-673. [PMID: 27920659 PMCID: PMC5126590 DOI: 10.1159/000452207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 10/03/2016] [Indexed: 12/18/2022] Open
Abstract
The source of most cases of gastrointestinal bleeding is the upper gastrointestinal tract. Since bleeding from the small intestine is very rare and difficult to diagnose, time is required to identify the source. Among small intestine bleeds, vascular abnormalities account for 70-80%, followed by small intestine tumors that account for 5-10%. The reported peak age of the onset of small intestinal tumors is about 50 years. Furthermore, rare small bowel tumors account for only 1-2% of all gastrointestinal tumors. We describe a 29-year-old man who presented with obscure anemia due to gastrointestinal bleeding and underwent laparotomy. Surgical findings revealed a well-circumscribed lesion measuring 45 × 40 mm in the jejunum that initially appeared similar to diverticulosis with an abscess. However, the postoperative pathological diagnosis was a gastrointestinal stromal tumor with extramural growth.
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Affiliation(s)
- Mami Yamamoto
- Department of Surgery, Yamamoto Memorial Hospital, Imari, Japan
| | | | | | - Fumio Yamamoto
- Department of Surgery, Yamamoto Memorial Hospital, Imari, Japan
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Niederle B, Pape UF, Costa F, Gross D, Kelestimur F, Knigge U, Öberg K, Pavel M, Perren A, Toumpanakis C, O'Connor J, O'Toole D, Krenning E, Reed N, Kianmanesh R. ENETS Consensus Guidelines Update for Neuroendocrine Neoplasms of the Jejunum and Ileum. Neuroendocrinology 2016; 103:125-38. [PMID: 26758972 DOI: 10.1159/000443170] [Citation(s) in RCA: 291] [Impact Index Per Article: 36.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- B Niederle
- Department of Surgery, Medical University of Vienna, Vienna, Austria
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20
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Lachhab I, Traoré BZ, Saoud O, Khedid YZAA, Zouaidia F, Echarrab M, Chkoff MR. Small bowel volvulus with intussusception: an unusual revelation of neuroendocrine tumor. Pan Afr Med J 2015; 22:6. [PMID: 26600906 PMCID: PMC4643153 DOI: 10.11604/pamj.2015.22.6.7132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 06/07/2015] [Indexed: 11/20/2022] Open
Abstract
The primary malignant tumors of the small bowel are rare, representing 1 to 1.4% of all gastrointestinal tumors. We report a case of a 33 year-old women, admitted to our emergency department of visceral surgery for acute abdomen. The clinical examination revealed diffuse abdominal distension, defenseless, the hernia orifices were free and the rectal examination was normal. The biological test showed no hydro electrolytic disorders with normal hemoglobin and normal renal function. The abdominal CT-Scan showed signs of bowel obstruction due to a volvulus with intussusception without ischemia. The patient was operated urgently; the exploration has revealed a small bowel obstruction in the ileum with volvulus, an intussusceptum associated with a retractile mesenteritis, and the hepatic exploration found no metastases. The patient underwent a bowel resection taking away the intussusceptum with the infiltrated mesentery. The postoperative course was uneventful. The pathological result has proved a well-differentiated neuroendocrine tumor with five free nodes. Through this observation, we aim to highlight that an obstruction of small bowel with volvulus and intussusception could be exceptionally due to a neuroendocrine tumor, this complication has enabled a relatively early diagnosis in the absence of metastases and a 6-month follow-up without recurrence is a demonstration.
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Affiliation(s)
- Imad Lachhab
- Departement of Visceral Surgical Emergency, IBN Sina University Hospital, Rabat, Morocco
| | - Boubacar Zan Traoré
- Departement of Visceral Surgical Emergency, IBN Sina University Hospital, Rabat, Morocco
| | - Omar Saoud
- Departement of Visceral Surgical Emergency, IBN Sina University Hospital, Rabat, Morocco
| | | | - Fouad Zouaidia
- Department of Pathology, IBN Sina University Hospital, Rabat, Morocco
| | - Mahjoub Echarrab
- Departement of Visceral Surgical Emergency, IBN Sina University Hospital, Rabat, Morocco
| | - Mohamed Rachid Chkoff
- Departement of Visceral Surgical Emergency, IBN Sina University Hospital, Rabat, Morocco
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Kervarrec T, Lecointre C, Kerdraon R, Bens G, Piquard A, Michenet P. [Gastro-intestinal neuroectodermal tumor (GNET): A case report of a small intestine tumor with hepatic metastases]. Ann Pathol 2015; 35:506-10. [PMID: 26586017 DOI: 10.1016/j.annpat.2015.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2014] [Revised: 08/02/2015] [Accepted: 09/30/2015] [Indexed: 11/18/2022]
Abstract
The gastro-intestinal neuroectodermal tumor (GNET) is a rare sarcoma of the digestive tract, which was recently recognised. The knowledge of the morphological, immunohistochemical and molecular diagnostic criteria is necessary to not mistake it for the metastasis of a melanoma or for another sarcoma of the digestive tract as the gastro-intestinal clear cells sarcoma or the malignant peripheral nervous system tumor (MPNST). We report the case of a 41-year-old patient with a GNET of the small intestine with hepatic metastasis. The histological examination showed a diffuse proliferation of epithelioid cells, which only express PS100. The presence EWSR1-ATF1 gene fusions with any melanocytic differentiation leads to the diagnosis of GNET.
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Affiliation(s)
- Thibault Kervarrec
- Service d'anatomie pathologique, hôpital de la Source, 14, avenue de l'Hôpital, 45067 Orléans, France.
| | - Claire Lecointre
- Service d'anatomie pathologique, hôpital de la Source, 14, avenue de l'Hôpital, 45067 Orléans, France
| | - Rémy Kerdraon
- Service d'anatomie pathologique, hôpital de la Source, 14, avenue de l'Hôpital, 45067 Orléans, France
| | - Guido Bens
- Service de dermatologie, hôpital Porte-Madeleine, 1, rue Porte-Madeleine, 45000 Orléans, France
| | - Arnaud Piquard
- Service de chirurgie viscérale, hôpital de la Source, 14, avenue de l'Hôpital, 45067 Orléans, France
| | - Patrick Michenet
- Service d'anatomie pathologique, hôpital de la Source, 14, avenue de l'Hôpital, 45067 Orléans, France
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Primary small-bowel malignancy: update in tumor biology, markers, and management strategies. J Gastrointest Cancer 2015; 45:421-30. [PMID: 25339426 DOI: 10.1007/s12029-014-9658-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE Primary small-bowel malignancies (SBM) are rare tumors but their incidence is rising. An estimated 9160 new cases and 1210 deaths due to SBM may occur in the USA in 2014. We review advances made in tumor biology, immunohistochemistry, and discuss treatment strategies for these malignancies. METHODS Relevant articles from PubMed/Medline and Embase searches were collected using the phrases "small-bowel adenocarcinoma, gastrointestinal carcinoids, gastrointestinal stromal tumors, small-bowel leiomyosarcoma, and small-bowel lymphoma". RESULTS Advances in imaging techniques such as wireless capsule endoscopy, CT and MRI enterography, and endoscopy (balloon enteroscopy) along with discovery of molecular markers such as c-kit and PDGFRA for GIST tumors have improved our ability to diagnose, localize, and treat these patients. Early detection and surgical resection offers the best chance for long-term survival in all tumors except bowel lymphoma where chemotherapy plays the main role. Adjuvant therapy with imatinib has improved overall survival for GIST tumors, somatostatin analogs have improved symptoms and also inhibited tumor growth and stabilized metastatic disease in carcinoid disease, but chemotherapy has not improved survival for adenocarcinoma. CONCLUSIONS Recent advances in molecular characterization holds promise in novel targeted therapies. Currently ongoing trials are exploring efficacy of targeted therapies and role of adjuvant therapy for adenocarcinoma and results are awaited. Early detection and aggressive surgical therapy for all localized tumors and lymph node sampling particularly for adenocarcinoma remains the main treatment modality.
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23
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Carcinoid Tumors. Surg Oncol 2015. [DOI: 10.1007/978-1-4939-1423-4_26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Xie YB, Liu H, Cui L, Xing GS, Yang L, Sun YM, Bai XF, Zhao DB, Wang CF, Tian YT. Tumors of the angle of Treitz: A single-center experience. World J Gastroenterol 2014; 20:3628-3634. [PMID: 24707147 PMCID: PMC3974531 DOI: 10.3748/wjg.v20.i13.3628] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 02/10/2014] [Accepted: 03/10/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To explore the feasibility and oncologic outcomes of segmental jejunal resection on the left side of the mesenteric vessels in patients with tumors of the angle of Treitz using data from a single center.
METHODS: Thirteen patients with tumors of the angle of Treitz who underwent surgery at our institution were prospectively followed. A segmental jejunal resection on the left side of the mesenteric vessels was performed in all patients. Formalin-fixed and paraffin-embedded tumor samples were examined. The primary end point of this analysis was disease-free survival.
RESULTS: In this study, there were 8 males and 5 females (mean age, 50.1 years; range, 36-74 years). The mean tumor size was 8.1 cm (range, 3.2-15 cm). Histologic examination showed 11 gastrointestinal stromal tumors (GISTs) and 2 adenocarcinomas. Five of the GIST patients presented with potential low risk, and 6 presented with intermediate and high risk, according to the National Institutes of Health criteria. One potentially high-risk patient showed tumor progression at 46 mo and died 52 mo after surgery. One patient with locally advanced adenocarcinoma received neoadjuvant chemotherapy and adjuvant radiotherapy, but the disease progressed, and the patient died 9 mo after surgery. One GIST patient without progression died 16 mo after surgery because of a postoperative intestinal obstruction. The median overall survival rate was 84.6 mo, and the median disease-free survival rate was 94.5 mo.
CONCLUSION: The overall survival of patients with tumors of the angle of Treitz was encouraging even when the tumor size was relatively large. A segmental resection on the left side of the mesenteric vessels is considered to be a reliable and curative option for tumors of the angle of Treitz.
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Jabbour SK, Mulvihill D. Defining the role of adjuvant therapy: ampullary and duodenal adenocarcinoma. Semin Radiat Oncol 2014; 24:85-93. [PMID: 24635865 DOI: 10.1016/j.semradonc.2013.11.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Adenocarcinomas of the ampulla of Vater and duodenum are more rare than pancreatic cancer and have a better prognosis. However, studies conducted on the management of these cancers, such as adjuvant chemotherapy and radiation therapy, are limited by small sample sizes and series that are retrospective. This review evaluates ampullary and duodenal adenocarcinomas with regard to incidence, anatomy, prognostic features, patterns of failure, and the available literature studying adjuvant therapy.
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Affiliation(s)
- Salma K Jabbour
- Department of Radiation Oncology, Robert Wood Johnson Medical School, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ.
| | - David Mulvihill
- Department of Radiation Oncology, Robert Wood Johnson Medical School, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ
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Guo X, Mao Z, Su D, Jiang Z, Bai L. The clinical pathological features, diagnosis, treatment and prognosis of small intestine primary malignant tumors. Med Oncol 2014; 31:913. [PMID: 24639284 DOI: 10.1007/s12032-014-0913-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Accepted: 03/06/2014] [Indexed: 02/06/2023]
Abstract
The aim of the study was to describe and analyze the clinicopathological features and diagnosis of Chinese patients with small intestine primary malignant tumors and to explore the best therapy to small bowel adenocarcinoma (SBA). More than 26,000 patients with digestive tract malignant tumors received treatment in PLA hospital from 2000 to 2011, and among them, there were 887 patients who had small intestine primary malignant tumors, and 666 of 887 patients had the completed basic clinical documents. We retrospectively analyzed the correlation between clinical and pathological features of the 666 patients and analyzed the survival and prognosis of 173 SBA patients with follow-up data. Both the number of patients with primary malignant tumors of the small intestine and the number of patients who received chemotherapy showed an increasing trend. The ratio of male to female was 1.58:1. The male patients significantly exceed the female patients with tumors of non-ampullary duodenum, jejunum and duodenal ampulla; and most of the patients are over 60 years of age. For patients burdened with either of the pathological types of tumors, the males exceeded the females, but there was no significant difference. Abdominal pain was the main clinical manifestation for patients with tumors of non-ampullary duodenum, jejunum and ileum, and the most common clinical manifestations were jaundice and abdominal pain for patients with ampullary duodenal tumors, adenocarcinoma, neuroendocrine tumors and sarcoma. In addition, patients with stromal tumors were prone to gastrointestinal bleeding. Gastrointestinal endoscopy was the most common examinational procedure. Patients under 60 years of age were prone to surgery and chemotherapy after surgery, and patients over 60 years of age were prone to supportive treatment and chemotherapy without surgery. The medium overall survival of patients who received surgery without chemotherapy, chemotherapy after surgery, chemotherapy without surgery and supportive treatment were 40.0, 35.0, 9.0 and 7.5 months, respectively. For the 173 SBA patients with follow-up data, treatment, age and distant metastasis were important prognostic factors; 149 of 173 SBA patients received only surgery, and the depth of tumor invasion, lymph node metastasis and surgical approach were important prognostic factors. Adjuvant chemotherapy had not provided significant benefit to prolong OS in patients with adenocarcinoma. The incidence of small intestine primary malignant tumors is very low, and it is difficult to diagnose. The patients should be aggressively treated and regularly followed up with related clinical and pathological features. Currently, surgery is the most effective treatment, and the role of chemotherapy needs further large-scale clinical studies.
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Affiliation(s)
- Xiaochuan Guo
- Department of Oncology, PLA General Hospital, Beijing, 100853, People's Republic of China
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Abstract
A 45-year-old female who presented with nausea, vomiting, abdominal pain, and anemia was found to have an 8 × 5 × 5 cm ileal tumor on CT imaging. Laparoscopic evaluation and small bowel resection was performed with clear margins with a diagnosis of low-grade leiomyosarcoma. Small intestine leiomyosarcoma is very rare, and there are no prior reports of laparoscopic resection.
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28
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Arrue I, Arregui M, Catón B, Soloeta R. Neuroendocrine TumorWith an Atypical Clinical Course: A Description of 2 Cases. ACTAS DERMO-SIFILIOGRAFICAS 2014. [DOI: 10.1016/j.adengl.2012.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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29
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Tumor neuroendocrino: descripción de 2 casos de evolución atípica. ACTAS DERMO-SIFILIOGRAFICAS 2014; 105:94-6. [DOI: 10.1016/j.ad.2012.10.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 10/22/2012] [Accepted: 10/23/2012] [Indexed: 11/19/2022] Open
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Waisberg J, Joppert-Netto G, Vasconcellos C, Sartini GH, Miranda LSVD, Franco MIF. Carcinoid tumor of the duodenum: a rare tumor at an unusual site. Case series from a single institution. ARQUIVOS DE GASTROENTEROLOGIA 2013; 50:3-9. [PMID: 23657299 DOI: 10.1590/s0004-28032013000100002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 01/16/2013] [Indexed: 12/15/2022]
Abstract
CONTEXT Duodenal carcinoids are extremely rare, and their characteristics and biological behavior have not been fully elucidated. OBJECTIVE To analyze the clinicopathological characteristics of patients with resected duodenal carcinoids. METHODS Twenty patients (12 females and 8 males) were investigated. Their average age was 66.4 ± 5.8 years old (43 to 88 years old). The data corresponding to the clinical picture, diagnosis, treatment, and prognosis of patients with duodenal carcinoid tumors subjected to resection over a period of 18 years (1993-2011) were analyzed. RESULTS The most common symptoms were dyspepsia (50%) and epigastric pain (45%) followed by weight loss (10%) and vomiting (5%). Carcinoid syndrome was not observed in any patient. The lesion was located on the first part of the duodenum in 15 (75%) patients, the second part in 4 (20%) patients, and the third part in 1 (5%) patient. The diagnosis of a carcinoid tumor was established through an endoscopic excision biopsy in 19 (95%) patients and an histopathological examination of the surgical specimen in 1 (5%) patient. The average tumor size was 1.1 cm ± 0.4 cm (0.3 cm to 6.0 cm). Nineteen (95%) patients were initially treated by endoscopic resection of the duodenal lesion. One patient (5%), whose tumor was on the third part of the duodenum underwent a duodenectomy of the third and fourth duodenal parts and duodenojejunal anastomosis. The duodenal carcinoid resection margin was involved in four (20%) patients. Four (20%) patients were subjected to a partial gastrectomy to fully remove the lesion. The tumor was restricted to the submucosal layer in 16 (80%) cases, and it penetrated into the muscular layer in 4 (20%) cases. All patients exhibited positive chromogranin A, neuron-specific enolase, and/or synaptophysin immunostaining. The average duration of the follow-up period was 39.6 months (3 to 96 months). Twelve (60%) of the 20 cases in this series are alive without any evidence of active disease. Only one (5%) patient died due to liver metastases of the duodenal carcinoid. CONCLUSIONS Duodenal carcinoids are rare and indolent tumors usually associated with a benign progression. Duodenoscopy, computerized tomography, and endoscopic ultrasound should be performed to evaluate the tumor size, the level of wall invasion, and the presence of regional or distant lymphatic metastases. Endoscopic removal of tumors smaller than 1.0 cm without periampullary localization or evidence of muscular propria layer invasion assessed by histology and/or endoscopic ultrasound is recommended. The endoscopic resection with a carcinoid tumor size between 1.0 cm and 2.0 cm can be incomplete and require new endoscopic resection or even surgical removal. Duodenal carcinoid larger than 2.0 cm require full-thickness resection and concomitant lymphadenectomy.
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Affiliation(s)
- Jaques Waisberg
- Hospital do Servidor Público Estadual (IAMSPE), São Paulo, Brazil.
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Les adénocarcinomes primitifs du duodénum. JOURNAL AFRICAIN D'HÉPATO-GASTROENTÉROLOGIE 2013. [DOI: 10.1007/s12157-013-0457-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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GRIERSON C, UPPONI S. Patterns of tumour recurrence after luminal tumour resection. IMAGING 2013. [DOI: 10.1259/imaging/73678953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Huang YY, Pratt JJ, Dabner M, Tjhin W. Challenging diagnosis of a jejunal adenocarcinoma with ovarian metastasis: report of an unusual case. BMJ Case Rep 2013; 2013:bcr-2013-008842. [PMID: 23580681 DOI: 10.1136/bcr-2013-008842] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
We report the first documented case of ovarian metastasis from a jejunal primary adenocarcinoma in an Australian patient. The presentation was unusual, initially a suspicious abdominal nodule in the epigastric area, which turned out to be an adenocarcinoma of possible intestinal origin. Gastroscopy and colonoscopy were performed with no suspicious lesion identified. Abdominal and pelvic ultrasound imaging showed a complex pelvic mass suspicious of ovarian cancer. Laparoscopy was performed to exclude possibility of ovarian cancer and small bowel cancer. The ovarian mass showed similar features from the epigastric nodule, again suggestive of intestinal primary. Definitive diagnosis was obtained when the patient represented 2 months later with malignant bowel obstruction requiring palliative resection of the proximal jejunum. This case demonstrates the difficulty in diagnosing ovarian metastasis from a small bowel primary, which has the potential to mimic an ovarian primary tumour clinically, and a large bowel or ovarian primary pathologically.
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Yoshida H, Tanaka N, Suzuki Y. Primary Adenocarcinoma of the Jejunum with Intramural Metastasis: Is This a Rare Event? J Gastrointest Cancer 2012; 43 Suppl 1:S276-9. [PMID: 22752454 DOI: 10.1007/s12029-012-9411-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Hiroshi Yoshida
- Department of Pathology, Asahi General Hospital, i-1326, Asahi, Chiba, 289-2511, Japan.
| | - Noriyuki Tanaka
- Department of Pathology, Asahi General Hospital, i-1326, Asahi, Chiba, 289-2511, Japan
| | - Yoshio Suzuki
- Department of Pathology, Asahi General Hospital, i-1326, Asahi, Chiba, 289-2511, Japan
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Umman P, Adiyodi V, Narayan C. Small bowel adenocarcinoma - report of two cases and review of literature. Indian J Surg 2012; 75:123-7. [PMID: 24426406 DOI: 10.1007/s12262-012-0598-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Accepted: 06/05/2012] [Indexed: 12/29/2022] Open
Abstract
Although accounting for 90 % of the intestinal surface area, small bowel adenocarcinomas are not common. The majority of these lesions are incidentally detected during laparotomy for intestinal obstruction or perforation. The symptoms associated with these lesions are not very specific and preoperative diagnosis is rare. We report two cases of jejunal adenocarcinomas detected in patients undergoing laparotomy for acute abdomen and review the literature for small bowel adenocarcinomas.
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Affiliation(s)
- Philip Umman
- Department of General Surgery, Govt. T D Medical College, Alappuzha, Kerala India
| | - Vineeth Adiyodi
- Department of General Surgery, Govt. T D Medical College, Alappuzha, Kerala India
| | - Chanchal Narayan
- Department of General Surgery, Govt. T D Medical College, Alappuzha, Kerala India
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An unusual presentation of neuroendocrine tumor of the small bowel. Updates Surg 2012; 65:321-3. [PMID: 22678987 DOI: 10.1007/s13304-012-0161-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2012] [Accepted: 02/28/2012] [Indexed: 10/28/2022]
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Sista F, Santis GD, Giuliani A, Cecilia EM, Piccione F, Lancione L, Leardi S, Amicucci G. Adenocarcinoma of the third duodenal portion: Case report and review of literature. World J Gastrointest Surg 2012; 4:23-6. [PMID: 22347539 PMCID: PMC3277878 DOI: 10.4240/wjgs.v4.i1.23] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2011] [Revised: 11/13/2011] [Accepted: 11/20/2011] [Indexed: 02/06/2023] Open
Abstract
We focus on the diagnostic and therapeutic problems of duodenal adenocarcinoma, reporting a case and reviewing the literature. A 65-year old man with adenocarcinoma in the third duodenal portion was successfully treated with a segmental resection of the third part of the duodenum, avoiding a duodeno-cephalo-pancreatectomy. This tumor is very rare and frequently affects the III and IV duodenal portion. A precocious diagnosis and the exact localization of this neoplasia are crucial factors in order to decide the surgical strategy. Given a non-specificity of symptoms, endoscopy with biopsy is the diagnostic gold standard. Duodeno-cephalo-pancreatectomy (DCP) and segmental resection of the duodenum (SRD) are the two surgical options, with overlapping morbidity (27% vs 18%) and post operative mortality (3% vs 1%). The average incidence of postoperative long-term survival is 100%, 73.3% and 31.6% of cases after 1, 3 and 5 years from surgery, respectively. Long-term survival is made worse by two factors: the presence of metastatic lymph nodes and tumor localization in the proximal duodenum. The two surgical options are radical: DCP should be used only for proximal localizations while SRD should be chosen for distal localizations.
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Affiliation(s)
- Federico Sista
- Federico Sista, Giuseppe De Santis, Antonio Giuliani, Emanuela Marina Cecilia, Federica Piccione, Laura Lancione, Sergio Leardi, Gianfranco Amicucci, General Surgery, Department of Surgery, University of L'Aquila, 67100 L'Aquila, Italy
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Pape UF, Perren A, Niederle B, Gross D, Gress T, Costa F, Arnold R, Denecke T, Plöckinger U, Salazar R, Grossman A. ENETS Consensus Guidelines for the management of patients with neuroendocrine neoplasms from the jejuno-ileum and the appendix including goblet cell carcinomas. Neuroendocrinology 2012; 95:135-56. [PMID: 22262080 DOI: 10.1159/000335629] [Citation(s) in RCA: 269] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Ulrich-Frank Pape
- Division of Hepatology and Gastroenterology, Department of Internal Medicine, Campus Virchow-Klinikum, Berlin, Germany.
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Abahssain H, Mokrim M, Lalya I, M’rabti H, Errihani H. [Primary malignant tumors of the small intestine: clinical and therapeutic aspects of 27 patients]. Pan Afr Med J 2011; 8:18. [PMID: 22121427 PMCID: PMC3201583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Accepted: 02/27/2011] [Indexed: 11/10/2022] Open
Abstract
Les tumeurs malignes de l’intestin grêle (TMPIG) sont des tumeurs rares. Elles représentent 1 à 5% de toutes les tumeurs du tube digestif. Elles sont caractérisées par une hétérogénéité anatomopathologique et une symptomatologie pauvre et non spécifique entrainant ainsi un retard diagnostic, des difficultés Thérapeutiques et donc un mauvais pronostic. Nous rapportant les caractéristiques épidémiologiques, diagnostiques et thérapeutiques ainsi que la survie des patients atteints des TMIG au sein de l’institut national d’oncologie de Rabat. Il s’agit d’une analyse rétrospective des dossiers cliniques des 27 patients ayant le diagnostic de tumeurs malignes de l’intestin grêle admis dans notre institut entre 1998 et 2002. L’âge médian était de 46 ans (15-70 ans). Le délai médian de diagnostic était de 6 mois (0-96 mois). La douleur abdominale était le symptôme le plus fréquent (77.8%). L’étude anatomopathologique a montré 63% de lymphome non Hodgkinien, 14.8% d’adénocarcinome, 7.4% de tumeur stromale, 7.4% de carcinome neuroendocrine et 7.4% de sarcome intestinal. Vingt patients (76. 9%) ont eu une résection chirurgicale et 14 patients (53. 8%) ont eu une chimiothérapie en fonction du stade de la maladie et du type histologique. Après un recul médian de 11.6 mois, la survie globale après 12 mois était de 44.4% et la médiane de survie était de 11.6 mois. Les tumeurs malignes de l’intestin grêle sont rares. Leur diagnostic est tardif limitant ainsi la prise en charge thérapeutique curative. Les cliniciens doivent être avertis des symptômes gastro-intestinaux non spécifiques.
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Affiliation(s)
- Halima Abahssain
- Service d’oncologie médicale, Institut national d’oncologie, Rabat, Maroc,Corresponding author: Service de radiothérapie, Institut national d’oncologie, Rabat, Maroc
| | - Maha Mokrim
- Service d’oncologie médicale, Institut national d’oncologie, Rabat, Maroc
| | - Issam Lalya
- Service de radiothérapie, Institut national d’oncologie, Rabat, Maroc
| | - Hind M’rabti
- Service d’oncologie médicale, Institut national d’oncologie, Rabat, Maroc
| | - Hassan Errihani
- Service d’oncologie médicale, Institut national d’oncologie, Rabat, Maroc
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