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Dahiya DS, Shah YR, Canakis A, Parikh C, Chandan S, Ali H, Gangwani MK, Pinnam BSM, Singh S, Sohail AH, Patel R, Ramai D, Al-Haddad M, Baron T, Rastogi A. Groove pancreatitis: From enigma to future directions-A comprehensive review. J Gastroenterol Hepatol 2024. [PMID: 39004833 DOI: 10.1111/jgh.16683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 06/23/2024] [Accepted: 07/02/2024] [Indexed: 07/16/2024]
Abstract
Groove pancreatitis (GP) is a rare and clinically distinct form of chronic pancreatitis affecting the pancreaticoduodenal groove comprising the head of the pancreas, duodenum, and the common bile duct. It is more prevalent in individuals in their 4-5th decade of life and disproportionately affects men compared with women. Excessive alcohol consumption, tobacco smoking, pancreatic ductal stones, pancreatic divisum, annular pancreas, ectopic pancreas, duodenal wall thickening, and peptic ulcers are significant risk factors implicated in the development of GP. The usual presenting symptoms include severe abdominal pain, nausea, vomiting, diarrhea, weight loss, and jaundice. Establishing a diagnosis of GP is often challenging due to significant clinical and radiological overlap with numerous benign and malignant conditions affecting the same anatomical location. This can lead to a delay in initiation of treatment leading to increasing morbidity, mortality, and complication rates. Promising research in artificial intelligence (AI) has garnered immense interest in recent years. Due to its widespread application in diagnostic imaging with a high degree of sensitivity and specificity, AI has the potential of becoming a vital tool in differentiating GP from pancreatic malignancies, thereby preventing a missed or delayed diagnosis. In this article, we provide a comprehensive review of GP, covering the etiology, pathogenesis, clinical presentation, radiological and endoscopic evaluation, management strategies, and future directions. This article also aims to increase awareness about this lesser known and often-misdiagnosed clinical entity amongst clinicians to ultimately improve patient outcomes.
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Affiliation(s)
- Dushyant S Dahiya
- Division of Gastroenterology, Hepatology and Motility, The University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Yash R Shah
- Department of Internal Medicine, Trinity Health Oakland/Wayne State University, Pontiac, Michigan, USA
| | - Andrew Canakis
- Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Charmy Parikh
- Department of Internal Medicine, Carle BroMenn Medical Center, Normal, Illinois, USA
| | - Saurabh Chandan
- Division of Gastroenterology and Hepatology, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Hassam Ali
- Division of Gastroenterology, Hepatology and Nutrition, East Carolina University/Brody School of Medicine, Greenville, North Carolina, USA
| | - Manesh K Gangwani
- Department of Gastroenterology and Hepatology, University of Arkansas For Medical Sciences, Little Rock, Arkansas, USA
| | - Bhanu S M Pinnam
- Department of Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois, USA
| | - Sahib Singh
- Department of Internal Medicine, Sinai Hospital, Baltimore, Maryland, USA
| | - Amir H Sohail
- Complex Surgical Oncology, Department of Surgery, University of New Mexico, Albuquerque, New Mexico, USA
| | - Raj Patel
- Department of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Daryl Ramai
- Department of Internal Medicine, St. Mary's Medical Center, Langhorne, Pennsylvania, USA
| | - Mohammad Al-Haddad
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Todd Baron
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Amit Rastogi
- Division of Gastroenterology, Hepatology and Motility, The University of Kansas School of Medicine, Kansas City, Kansas, USA
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Kurata Y, Hirose T, Kakushima N, Nakaguro M, Okumura Y, Tanaka H, Fujishiro M, Kawashima H. Endoscopic Diagnosis of Epithelial Subtypes of Superficial Non-Ampullary Duodenal Epithelial Tumors using Magnifying Narrow-Band Imaging. Dig Dis 2024:1-8. [PMID: 38749404 DOI: 10.1159/000539308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 05/09/2024] [Indexed: 06/20/2024]
Abstract
INTRODUCTION Superficial non-ampullary duodenal epithelial tumors (SNADETs) include low-grade adenoma (LGA) and high-grade adenoma or carcinoma (HGA/Ca) and are classified into two different epithelial subtypes, gastric-type (G-type) and intestinal-type (I-type). We attempted to distinguish them by endoscopic characteristics including magnifying endoscopy with narrow-band imaging (M-NBI). METHODS Various endoscopic and M-NBI findings of 286 SNADETs were retrospectively reviewed and compared between G- and I-types and histological grades. M-NBI findings were divided into four patterns based on the following vascular patterns; absent, network, intrastructural vascular (ISV), and unclassified. Lesions displaying a single pattern were classified as mono-pattern and those displaying multiple patterns as mixed-pattern. Lesions showing CDX2 positivity were categorized as I-types and those showing MUC5AC or MUC6 positivity were categorized as G-types based on immunohistochemistry. RESULTS Among 286 lesions, 23 (8%) were G-type and 243 (85%) were I-type. More G-type lesions were located oral to papilla (91.3 vs. 45.6%, p < 0.001), and had protruding morphology compared to those of I-types (65.2 vs. 14.4%, p < 0.001). The major M-NBI pattern was ISV in G-type (78.2 vs. 26.3%, p < 0.001), and absent for I-type (0 vs. 34.5%, p = 0.003). Three endoscopic characteristics; location oral to papilla, protruding morphology, and major M-NBI pattern (ISV) were independent predictors for G-type. Mixed-pattern was more common in HGA/Ca than LGA for I-type (77.0 vs. 58.8%, p = 0.01); however, there was no difference for those in G-type. CONCLUSION Endoscopic findings including M-NBI are useful to differentiate epithelial subtypes.
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Affiliation(s)
- Yoshiyuki Kurata
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takashi Hirose
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naomi Kakushima
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masato Nakaguro
- Department of Pathology and Laboratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuki Okumura
- Department of Pathology and Laboratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hitoshi Tanaka
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroki Kawashima
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Sugai T, Uesugi N, Suzuki M, Suzuki N, Honda M, Abe T, Yanagawa N. A rare case of neuroendocrine cell tumor mixed with a mucinous component in the ampulla of Vater. Diagn Pathol 2024; 19:64. [PMID: 38678248 PMCID: PMC11055287 DOI: 10.1186/s13000-024-01488-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 04/16/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND A rare case of neuroendocrine cell tumor (NET) having both conventional and mucinous components was reported. Mucinous NET is rarely encountered in the pathological diagnosis of gastrointestinal (GI) tumors. Here we examined the mechanism for transformation of conventional NETs into mucinous NETs. CASE PRESENTATION Macroscopic examination revealed a tumor with ulceration in the ampulla of Vater that measured 1.7 cm in its largest diameter. Histologically, the tumor comprised two components: a tubular/ribbon-like feature and small nests floating in a mucinous lake. The tumor nests showed sheet, nest and ribbon-like structures of small cells having eosinophilic cytoplasm as well as small-sized nuclei with dense hyperchromatin. Immunohistochemical analysis showed tumor cells positive for pan-endocrine markers (synaptophysin, CD56, INSM1 and chromogranin). Based on the histological findings, the solid and mucinous components were diagnosed as conventional and mucinous NETs, respectively. Grading was NET G2 based on 12.8% and 13.2% Ki-67-positive cells in the solid and mucinous components, respectively. Immunohistochemically, the mucin phenotype of this tumor was gastric and intestinal. Only the mucinous NET component had cytoplasmic CD10 expression. Examination using a customized gene panel detected only a DPC4 mutation, which was limited to the mucinous component. CONCLUSIONS Coexistence of conventional and mucinous NETs could provide important insight into evaluating the NET subtype histogenesis. Moreover, molecular alterations including cytoplasmic expression of CD10 and the DPC4 mutation can contribute to interpretation of tumor pathogenesis.
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Affiliation(s)
- Tamotus Sugai
- Diagnostic Pathology Center, Southern Tohoku General Hospital, 7-115, Yatsuyamada, Kooriyama City, Fukushima, 963-8563, Japan.
- Department of Molecular Diagnostic Pathology, School of Medicine, Iwate Medical University, 2-1-1, Shiwagun, Yahabachou, 028-3695, Japan.
| | - Noriyuki Uesugi
- Diagnostic Pathology Center, Southern Tohoku General Hospital, 7-115, Yatsuyamada, Kooriyama City, Fukushima, 963-8563, Japan
- Department of Molecular Diagnostic Pathology, School of Medicine, Iwate Medical University, 2-1-1, Shiwagun, Yahabachou, 028-3695, Japan
| | - Masamichi Suzuki
- Diagnostic Pathology Center, Southern Tohoku General Hospital, 7-115, Yatsuyamada, Kooriyama City, Fukushima, 963-8563, Japan
| | - Nobuyasu Suzuki
- Department of Surgery, Southern Tohoku General Hospital, 7-115, Yatsuyamada, Koriyama City, Fukushima, 963-8563, Japan
| | - Michitaka Honda
- Department of Surgery, Southern Tohoku General Hospital, 7-115, Yatsuyamada, Koriyama City, Fukushima, 963-8563, Japan
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, 1 Hikarigaoka Fukushima, Fukushima, 960-1295, Japan
| | - Tsuyoshi Abe
- Department of Surgery, Southern Tohoku General Hospital, 7-115, Yatsuyamada, Koriyama City, Fukushima, 963-8563, Japan
| | - Naoki Yanagawa
- Department of Molecular Diagnostic Pathology, School of Medicine, Iwate Medical University, 2-1-1, Shiwagun, Yahabachou, 028-3695, Japan
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Chung C, Stovall S, Biehl SR, Rocha F, Wancata L, Helton S, Biehl T. Pancreas preserving duodenectomy (PPrD). Am J Surg 2024:S0002-9610(24)00234-4. [PMID: 38641448 DOI: 10.1016/j.amjsurg.2024.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 04/02/2024] [Accepted: 04/13/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND Pancreaticoduodenectomy has been the standard of care for managing duodenal neoplasms, but recent studies show similar overall and disease-specific survival after pancreas-preserving duodenectomy (PPrD) with potentially less morbidity. METHODS Retrospective cohort of all adult (age >18) patients who underwent PPrD with curative intent of a neoplasm in or invading into the duodenum at our institution from 2011 to 2022 (n = 29), excluding tumors involving the Ampulla of Vater or the pancreas. Statistical analyses were performed using STATA. RESULTS R0 resection was achieved in 93 % patients. Ten (34.4 %) experienced postoperative complications (13.7 % within Clavien-Dindo III-V). PPrD patients had lower rates of pancreatic leak, delayed gastric emptying, and deep surgical site infection. CONCLUSIONS In this case series, we demonstrate PPrD is safe and effective, with a high rate of complete resection and lower complication rate than that seen in pancreaticoduodenectomy.
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Affiliation(s)
- Christine Chung
- Virginia Mason Franciscan Health (VMFH), 1100 9th Ave, Seattle, WA, 98101, USA.
| | - Stephanie Stovall
- Virginia Mason Franciscan Health (VMFH), 1100 9th Ave, Seattle, WA, 98101, USA.
| | - Stella R Biehl
- Colorado College, 14 E Cache La Poudre St, Colorado Springs, CO, 80903, USA.
| | - Flavio Rocha
- Oregon Health & Science University Hospital (OHSU), 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA.
| | - Lauren Wancata
- Virginia Mason Franciscan Health (VMFH), 1100 9th Ave, Seattle, WA, 98101, USA.
| | - Scott Helton
- Virginia Mason Franciscan Health (VMFH), 1100 9th Ave, Seattle, WA, 98101, USA.
| | - Thomas Biehl
- Virginia Mason Franciscan Health (VMFH), 1100 9th Ave, Seattle, WA, 98101, USA.
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Koseki M, Nishimura M, Nammour T, Chin K, Nagao S, Beauvais JC, Schattner MA. Safety of Duodenal Endoscopic Submucosal Dissection for Superficial Non-Ampullary Duodenal Epithelial Tumor: A Single-Center Study in the United States. J Clin Med 2023; 13:143. [PMID: 38202150 PMCID: PMC10780121 DOI: 10.3390/jcm13010143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/15/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
Endoscopic submucosal dissection (ESD) of superficial non-ampullary duodenal epithelial tumors (SNADETs) is associated with a high rate of en bloc resection and low rate of recurrence. However, in the United States, SNADETs are predominantly managed using endoscopic mucosal resection (EMR) or surgery because the feasibility and safety of duodenal ESD have not yet been established. In this study, we analyzed the outcomes of duodenal ESD for SNADETs. This single-center retrospective study reviewed the data of patients who underwent ESD for SNADETs between June 2018 and August 2023. Baseline patient characteristics, histopathology of the resected lesions, adverse events, and recurrence rates were evaluated. The primary outcome measures were en bloc resection, complications, and recurrence rate. Thirty ESD procedures were performed on 24 patients. All 30 lesions were adenomas, with no cancerous lesions. The en bloc resection rate and R0 resection rates were both 53%. There were no cases of procedure-associated perforation. Post-ESD bleeding was observed in six cases. No ESD-related mortality was observed. The recurrence rate was 14% in 1 year follow up, and 28% the during all follow-up period. ESD is a safe option for SNADET in the United States; however further comparative studies are necessary to determine the optimal procedure for North American populations.
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Affiliation(s)
- Mako Koseki
- Gastroenterology, Hepatology, and Nutrition Service, Memorial Slone Kettering Cancer Center, New York, NY 10022, USA (M.A.S.)
- Internal Medicine, Mount Sinai Beth Israel, New York, NY 10003, USA
| | - Makoto Nishimura
- Gastroenterology, Hepatology, and Nutrition Service, Memorial Slone Kettering Cancer Center, New York, NY 10022, USA (M.A.S.)
| | - Tarek Nammour
- Gastroenterology, Hepatology, and Nutrition Service, Memorial Slone Kettering Cancer Center, New York, NY 10022, USA (M.A.S.)
| | - Kana Chin
- Gastroenterology, Hepatology, and Nutrition Service, Memorial Slone Kettering Cancer Center, New York, NY 10022, USA (M.A.S.)
| | - Sayaka Nagao
- Gastroenterology, Hepatology, and Nutrition Service, Memorial Slone Kettering Cancer Center, New York, NY 10022, USA (M.A.S.)
| | - Jacques C. Beauvais
- Gastroenterology, Hepatology, and Nutrition Service, Memorial Slone Kettering Cancer Center, New York, NY 10022, USA (M.A.S.)
| | - Mark A. Schattner
- Gastroenterology, Hepatology, and Nutrition Service, Memorial Slone Kettering Cancer Center, New York, NY 10022, USA (M.A.S.)
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Hirota S, Naganuma A, Kobayashi R, Suzuki Y, Hoshino T, Yasuoka H, Tanaka Y, Uraoka T, Kakizaki S. An autopsy case of alpha-fetoprotein-producing large duodenal adenocarcinoma. Clin J Gastroenterol 2023; 16:829-835. [PMID: 37594614 DOI: 10.1007/s12328-023-01843-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 08/03/2023] [Indexed: 08/19/2023]
Abstract
We report an autopsy case of a large duodenal adenocarcinoma that produced alpha-fetoprotein (AFP). The patient was a man in his 70s with diabetes mellitus. He presented with epigastralgia and was referred to our hospital. Upper gastrointestinal endoscopy and abdominal computed tomography revealed a large tumor of 11 cm in diameter in the descending limb of the duodenum. A tumor biopsy showed poorly differentiated adenocarcinoma. Although his carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) levels were within the normal range, his AFP levels were significantly elevated (42,078.4 ng/mL). Due to vascular invasion, curative resection was not feasible, and chemotherapy was chosen as the treatment option. After gastrojejunostomy was performed to enable oral intake, one cycle of modified leucovorin/5-fluorouracil/oxaliplatin (mFOLFOX6) therapy was administered. However, it proved ineffective, and the patient's anorexia gradually worsened. Ultimately, he succumbed to the progression of cancer cachexia. Autopsy findings revealed a 14-cm-long duodenal carcinoma primarily located in the duodenal bulb, with direct invasion into the stomach, pancreas, and liver. A pathological examination confirmed a diagnosis of poorly differentiated adenocarcinoma with AFP production. Duodenal cancer is rare, and AFP-producing duodenal cancer is even rarer, with only 21 reported cases, including our own. We present this autopsy case of AFP-producing duodenal adenocarcinoma and review the cases reported in the relevant literature.
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Affiliation(s)
- Sumire Hirota
- Department of Gastroenterology, National Hospital Organization Takasaki General Medical Center, Takasaki, Gunma, 370-0829, Japan
| | - Atsushi Naganuma
- Department of Gastroenterology, National Hospital Organization Takasaki General Medical Center, Takasaki, Gunma, 370-0829, Japan
| | - Rintaro Kobayashi
- Department of Gastroenterology, National Hospital Organization Takasaki General Medical Center, Takasaki, Gunma, 370-0829, Japan
| | - Yuhei Suzuki
- Department of Gastroenterology, National Hospital Organization Takasaki General Medical Center, Takasaki, Gunma, 370-0829, Japan
| | - Takashi Hoshino
- Department of Gastroenterology, National Hospital Organization Takasaki General Medical Center, Takasaki, Gunma, 370-0829, Japan
| | - Hidetoshi Yasuoka
- Department of Gastroenterology, National Hospital Organization Takasaki General Medical Center, Takasaki, Gunma, 370-0829, Japan
| | - Yuko Tanaka
- Department of Pathology, National Hospital Organization Takasaki General Medical Center, Takasaki, Gunma, 370-0829, Japan
| | - Toshio Uraoka
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, 3-39-22 Showa-Machi, Maebashi, Gunma, 371-8511, Japan
| | - Satoru Kakizaki
- Department of Gastroenterology, National Hospital Organization Takasaki General Medical Center, Takasaki, Gunma, 370-0829, Japan.
- Department of Clinical Research, National Hospital Organization Takasaki General Medical Center, 36 Takamatsu-Cho, Takasaki, Gunma, 370-0829, Japan.
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7
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Hayashi H, Miyamoto H, Nakagawa S, Matsuno K, Miyata T, Tsukamoto M, Mima K, Nitta H, Tanaka Y, Baba H. Distinct approaches (antecolic and retrocolic) according to tumor location in laparoscopic and endoscopic cooperative surgery for non-ampullary duodenum tumors. Surg Endosc 2023; 37:6718-6726. [PMID: 37217687 DOI: 10.1007/s00464-023-10114-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/03/2023] [Indexed: 05/24/2023]
Abstract
AIM Laparoscopic and endoscopic cooperative surgery for early non-ampullary duodenum tumors (D-LECS) is now noted because of its safety and lower invasiveness. Here, we introduce two distinct approaches (antecolic and retrocolic) according to the tumor location during D-LECS. METHODS From October 2018 to March 2022, 24 patients (25 lesions) underwent D-LECS. Two (8%), two (8%), 16 (64%), and five (20%) lesions were located in the first portion, in the second portion to Vater's papilla, around the inferior duodenum flexure, and in the third portion of the duodenum, respectively. The median preoperative tumor diameter was 22.5 mm. RESULTS Antecolic and retrocolic approaches were employed in 16 (67%) and 8 (33%) cases, respectively. LECS procedures, such as two-layer suturing after full-thickness dissection and laparoscopic reinforcement by seromuscular suturing after endoscopic submucosal dissection (ESD), were performed in five and 19 cases, respectively. Median operative time and blood loss were 303 min and 5 g, respectively. Intraoperative duodenal perforations occurred in three of 19 cases during ESD; however, they were successfully laparoscopically repaired. Median times until start diet and postoperative hospital stay were 4.5 and 8 days, respectively. Histological examination of the tumors revealed nine adenomas, 12 adenocarcinomas, and four GISTs. Curative resection (R0) was achieved in 21 cases (87.5%). In a comparison of the surgical short outcomes between antecolic and retrocolic approaches, there was no significant difference. CONCLUSION D-LECS can be a safe and minimally invasive treatment option for non-ampullary early duodenal tumors, and two distinct approaches according to the tumor location are feasible.
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Affiliation(s)
- Hiromitsu Hayashi
- Department of Gastroenterological Surgery, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
| | - Hideaki Miyamoto
- Department of Gastroenterology, Kumamoto University, Kumamoto, Japan
| | - Shigeki Nakagawa
- Department of Gastroenterological Surgery, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Kenshi Matsuno
- Department of Gastroenterology, Kumamoto University, Kumamoto, Japan
| | - Tatsunori Miyata
- Department of Gastroenterological Surgery, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Masayo Tsukamoto
- Department of Gastroenterological Surgery, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Kosuke Mima
- Department of Gastroenterological Surgery, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Hidetoshi Nitta
- Department of Gastroenterological Surgery, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Yasuhito Tanaka
- Department of Gastroenterology, Kumamoto University, Kumamoto, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
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8
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Tang S, Li X, Wu A. Poorly cohesive duodenal carcinoma mixed with signet ring cell carcinoma with systemic metastasis: a case report and literature review. Front Oncol 2023; 13:1240013. [PMID: 37692856 PMCID: PMC10492232 DOI: 10.3389/fonc.2023.1240013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/01/2023] [Indexed: 09/12/2023] Open
Abstract
Poorly cohesive duodenal carcinoma mixed with signet ring cell carcinoma is very rare, and no cases have been reported. When distant metastasis occurs, it is very easy to be misdiagnosed. We report the first case of a 52-year-old man with poorly cohesive carcinoma of the duodenum mixed with signet ring cell carcinoma with systemic metastasis. The process of its diagnosis and differential diagnosis is highlighted.
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Affiliation(s)
- Song Tang
- Department of Oncological Surgery, Guangzhou Royallee Cancer Center, Guangzhou, China
| | - Xinjun Li
- Department of Oncological Surgery, Guangzhou Royallee Cancer Center, Guangzhou, China
| | - Aiguo Wu
- Department of General Surgery, Zhujiang Hospital of Southern Medical University, Guangzhou, China
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9
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Trifonov AV, Gazizov AS, Tapalova AS, Kibardina LK, Appazov NO, Voloshina AD, Sapunova AS, Luybina AP, Abyzbekova GM, Dobrynin AB, Litvinov IA, Tauekel AK, Yespenbetova SO, Burilov AR, Pudovik MA. Synthesis and Anticancer Evaluation of Novel 7-Aza-Coumarine-3-Carboxamides. Int J Mol Sci 2023; 24:9927. [PMID: 37373075 DOI: 10.3390/ijms24129927] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/04/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
Herein, we report the design and synthesis of novel 7-aza-coumarine-3-carboxamides via scaffold-hopping strategy and evaluation of their in vitro anticancer activity. Additionally, the improved non-catalytic synthesis of 7-azacoumarin-3-carboxylic acid is reported, which features water as the reaction medium and provides a convenient alternative to the known methods. The anticancer activity of the most potent 7-aza-coumarine-3-carboxamides against the HuTu 80 cell line is equal to that of reference Doxorubicin, while the selectivity towards the normal cell line is 9-14 fold higher.
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Affiliation(s)
- Alexey V Trifonov
- Arbuzov Institute of Organic and Physical Chemistry, FRC Kazan Scientific Center, Russian Academy of Science, Arbuzova Str., 8, Kazan 420088, Russia
| | - Almir S Gazizov
- Arbuzov Institute of Organic and Physical Chemistry, FRC Kazan Scientific Center, Russian Academy of Science, Arbuzova Str., 8, Kazan 420088, Russia
| | - Anipa S Tapalova
- Korkyt Ata Kyzylorda University, Aiteke Bi Street, 29A, Kyzylorda 120014, Kazakhstan
| | - Lyudmila K Kibardina
- Arbuzov Institute of Organic and Physical Chemistry, FRC Kazan Scientific Center, Russian Academy of Science, Arbuzova Str., 8, Kazan 420088, Russia
| | - Nurbol O Appazov
- Korkyt Ata Kyzylorda University, Aiteke Bi Street, 29A, Kyzylorda 120014, Kazakhstan
| | - Alexandra D Voloshina
- Arbuzov Institute of Organic and Physical Chemistry, FRC Kazan Scientific Center, Russian Academy of Science, Arbuzova Str., 8, Kazan 420088, Russia
| | - Anastasiia S Sapunova
- Arbuzov Institute of Organic and Physical Chemistry, FRC Kazan Scientific Center, Russian Academy of Science, Arbuzova Str., 8, Kazan 420088, Russia
| | - Anna P Luybina
- Arbuzov Institute of Organic and Physical Chemistry, FRC Kazan Scientific Center, Russian Academy of Science, Arbuzova Str., 8, Kazan 420088, Russia
| | - Gulmira M Abyzbekova
- Korkyt Ata Kyzylorda University, Aiteke Bi Street, 29A, Kyzylorda 120014, Kazakhstan
| | - Alexey B Dobrynin
- Arbuzov Institute of Organic and Physical Chemistry, FRC Kazan Scientific Center, Russian Academy of Science, Arbuzova Str., 8, Kazan 420088, Russia
| | - Igor A Litvinov
- Arbuzov Institute of Organic and Physical Chemistry, FRC Kazan Scientific Center, Russian Academy of Science, Arbuzova Str., 8, Kazan 420088, Russia
| | - Akerke K Tauekel
- Department of Oil, Chemistry and Nanotechnology, Kazan National Research Technological University, Karl Marx Str., 68, Kazan 420015, Russia
| | | | - Alexander R Burilov
- Arbuzov Institute of Organic and Physical Chemistry, FRC Kazan Scientific Center, Russian Academy of Science, Arbuzova Str., 8, Kazan 420088, Russia
| | - Michail A Pudovik
- Arbuzov Institute of Organic and Physical Chemistry, FRC Kazan Scientific Center, Russian Academy of Science, Arbuzova Str., 8, Kazan 420088, Russia
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10
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Altshuler E, Richhart R, King W, Aryan M, Mathavan A, Mathavan A, Hones K, Leech D, Pucci L, Riklan J, Haley P, Sahin I, Ramnaraign B, Rogers S, Nassour I, Hughes S, George TJ, Fabregas J. Importance of carbohydrate antigen (CA 19-9) and carcinoembrionic antigen (CEA) in the prognosis of patients with duodenal adenocarcinoma: a retrospective single-institution cohort study. Oncotarget 2023; 14:351-357. [PMID: 37068159 PMCID: PMC10109526 DOI: 10.18632/oncotarget.28406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND Duodenal adenocarcinoma (DA) is a rare malignancy without validated tumor markers. In practice, carcinoembryonic antigen (CEA) and carbohydrate antigen (CA 19-9) are often used in the management of DA, though their prognostic value is unknown. MATERIALS AND METHODS A single-institution retrospective review included patients diagnosed with biopsy-confirmed adenocarcinoma of the duodenum between 2006 and 2021. Peri-ampullary tumors were excluded. Levels of CA 19-9 and CEA were collected as continuous variables and were analyzed as binary variables: normal vs. high, using the maximum normal value as a cut-off (normal Ca 19-9 <35 U/ml; CEA <3 ng/ml). Survival analysis was conducted using Kaplan Meier curves, log-rank test and Cox proportional hazards model. RESULTS There were 68 patients included in the final analysis. Median age was 67 years old and median follow-up time was 22.2 months. CA 19-9 and CEA were elevated in 36.8% and 48.5% of patients, respectively. A concomitant elevation of both tumor markers was associated with worsened OS (HR 2.140, 95% CI: 1.114-4.112; p = 0.019). After controlling for age and sex on multivariate analysis, elevation in both CA 19-9 ≥35 and CEA ≥3.0 remained significantly associated with increased mortality (HR 2.278, 95% CI: 1.162-4.466; p = 0.016). CONCLUSIONS In summary, CA 19-9 and, to a lesser extent, CEA, show promise as prognostic markers in DA. Larger studies are needed to validate their use and to evaluate their performance as markers of recurrence.
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Affiliation(s)
- Ellery Altshuler
- Department of Internal Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Raymond Richhart
- Department of Internal Medicine, University of Florida, Gainesville, FL 32610, USA
| | - William King
- Department of Internal Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Mahmoud Aryan
- Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Akash Mathavan
- University of Florida College of Medicine, Gainesville, FL 32610, USA
| | - Akshay Mathavan
- University of Florida College of Medicine, Gainesville, FL 32610, USA
| | - Keegan Hones
- University of Florida College of Medicine, Gainesville, FL 32610, USA
| | - Daniel Leech
- University of Florida College of Medicine, Gainesville, FL 32610, USA
| | - Logan Pucci
- Department of Internal Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Joshua Riklan
- Department of Internal Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Pat Haley
- Department of Internal Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Ilyas Sahin
- Division of Hematology and Oncology, Department of Medicine, University of Florida, Gainesville, FL 32610, USA
- University of Florida Health Cancer Center, Gainesville, FL 32610, USA
| | - Brian Ramnaraign
- Division of Hematology and Oncology, Department of Medicine, University of Florida, Gainesville, FL 32610, USA
- University of Florida Health Cancer Center, Gainesville, FL 32610, USA
| | - Sherise Rogers
- Division of Hematology and Oncology, Department of Medicine, University of Florida, Gainesville, FL 32610, USA
- University of Florida Health Cancer Center, Gainesville, FL 32610, USA
| | - Ibrahim Nassour
- Division of Surgical Oncology, Department of Surgery, University of Florida, Gainesville, FL 32610, USA
| | - Steven Hughes
- Division of Surgical Oncology, Department of Surgery, University of Florida, Gainesville, FL 32610, USA
| | - Thomas J George
- Division of Hematology and Oncology, Department of Medicine, University of Florida, Gainesville, FL 32610, USA
- University of Florida Health Cancer Center, Gainesville, FL 32610, USA
| | - Jesus Fabregas
- Division of Hematology and Oncology, Department of Medicine, University of Florida, Gainesville, FL 32610, USA
- University of Florida Health Cancer Center, Gainesville, FL 32610, USA
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11
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Mohamed I, Haji M, Hassan N, Qasim H, Rajab R, Rajab R, Ibrahim A, Zulqarnain M, Sadeddin EZ, Ghoz H, Mohammed S. A Rare Case of Primary Duodenal Plasmacytoma: An Incidental Finding. Cureus 2023; 15:e37342. [PMID: 37182040 PMCID: PMC10169253 DOI: 10.7759/cureus.37342] [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: 04/09/2023] [Indexed: 05/16/2023] Open
Abstract
Solitary extramedullary plasmacytoma (SEP) is a rare tumor due to the monoclonal proliferation of plasma cells without bone marrow involvement. Plasmacytomas are frequently encountered in bone or soft tissue but rarely occur in the gastrointestinal (GI) tract. They can present with a multitude of symptoms depending on their site. This report describes a case of SEP diagnosed as a duodenal ulcer (DU) during esophagogastroduodenoscopy (EGD) for iron deficiency anemia.
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Affiliation(s)
- Islam Mohamed
- Internal Medicine, University of Missouri Kansas City School of Medicine, Kansas City, USA
| | - Mariam Haji
- Internal Medicine, University of Missouri Kansas City School of Medicine, Kansas City, USA
| | - Noor Hassan
- Internal Medicine, University of Missouri Kansas City School of Medicine, Kansas City, USA
| | - Hana Qasim
- Internal Medicine, University of Missouri Kansas City School of Medicine, Kansas City, USA
| | - Rawan Rajab
- Internal Medicine, University of Missouri Kansas City School of Medicine, Kansas City, USA
| | - Rami Rajab
- Biology, Saint Louis University, Saint Louis, USA
| | - Ali Ibrahim
- Internal Medicine, University of Missouri Kansas City School of Medicine, Kansas City, USA
| | - Mir Zulqarnain
- Gastroenterology and Hepatology, University of Missouri Kansas City School of Medicine, Kansas City, USA
| | - Esmat Z Sadeddin
- Gastroenterology and Hepatology, University of Missouri Kansas City School of Medicine, Kansas City, USA
| | - Hassan Ghoz
- Gastroenterology and Hepatology, University of Missouri Kansas City School of Medicine, Kansas City, USA
| | - Sobrina Mohammed
- Internal Medicine, University of Missouri Kansas City School of Medicine, Kansas City, USA
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12
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Seo D, Park BG, Jung D, Hwang HK, Kim SH, Hong SS, Kang CM. Pancreatoduodenectomy following neoadjuvant chemotherapy in duodenal adenocarcinoma. Ann Hepatobiliary Pancreat Surg 2023; 27:114-119. [PMID: 36536505 PMCID: PMC9947377 DOI: 10.14701/ahbps.22-069] [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: 08/22/2022] [Revised: 10/05/2022] [Accepted: 10/12/2022] [Indexed: 12/24/2022] Open
Abstract
A 51-year-old male patient had four times of massive hematochezia episode three days before arrival. Carbohydrate antigen (CA) 19-9 level was extremely elevated. Computed tomography, magnetic resonance imaging, and positron emission tomography-computed tomography identified 5.7 cm sized periampullary duodenal cancer with regional metastatic lymph nodes and vascular invasion to aberrant right hepatic artery, main portal vein, and superior mesenteric vein. Diagnosed as duodenal adenocarcinoma through endoscopic biopsy, 16 times of FOLFIRI (5-fluorouracil, leucovorin, irinotecan) was conducted. The regimen changed to XELOX (capecitabine, oxaliplatine), four times of administration was done, and the CA19-9 level dramatically decreased. The tumor decreased to 2.1 cm. After R0 laparoscopic pylorus preserving pancreatoduodenectomy, no adjuvant therapy was given. No sign of recurrence or metastasis was reported, and the patient reached complete remission after five years. We reported a case where neoadjuvant chemotherapy for locally advanced duodenal adenocarcinoma was shown to be effective.
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Affiliation(s)
- Dongjin Seo
- Yonsei University College of Medicine, Seoul, Korea
| | | | - Dawn Jung
- Yonsei University College of Medicine, Seoul, Korea,Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Ho Kyoung Hwang
- Yonsei University College of Medicine, Seoul, Korea,Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea,Pancreatobiliary Cancer Center, Yonsei Cancer Center, Severance Hospital, Seoul, Korea
| | - Sung Hyun Kim
- Yonsei University College of Medicine, Seoul, Korea,Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea,Pancreatobiliary Cancer Center, Yonsei Cancer Center, Severance Hospital, Seoul, Korea
| | - Seung Soo Hong
- Yonsei University College of Medicine, Seoul, Korea,Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea,Pancreatobiliary Cancer Center, Yonsei Cancer Center, Severance Hospital, Seoul, Korea
| | - Chang Moo Kang
- Yonsei University College of Medicine, Seoul, Korea,Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea,Pancreatobiliary Cancer Center, Yonsei Cancer Center, Severance Hospital, Seoul, Korea,Corresponding author: Chang Moo Kang, MD, PhD Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea Tel: +82-2-2228-2135, 2100, Fax: +82-2-313-8289, E-mail: ORCID: https://orcid.org/0000-0002-5382-4658
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13
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Sseruwagi T, Musinzi J, Mutumba WM, Lewis C. Duodenal Mucinous Adenocarcinoma in a Patient With Immunodeficiency: A Case Report. Cureus 2023; 15:e34509. [PMID: 36874331 PMCID: PMC9984185 DOI: 10.7759/cureus.34509] [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: 01/28/2023] [Indexed: 02/04/2023] Open
Abstract
Duodenal mucinous adenocarcinoma is a rare type of small bowel carcinoma. It is not commonly encountered; hence little knowledge exists about its presentation, diagnosis, and management. The diagnosis is mostly made by either esophagogastroduodenoscopy (EGD) or intra-operatively. Some of the main symptoms are abdominal pain, nausea, vomiting, weight loss, or signs and symptoms of upper gastrointestinal bleeding. Therefore, this is a serious condition that healthcare providers and patients should be aware of to reduce its severity and improve prognosis. We present a case of duodenal mucinous adenocarcinoma in a patient with immunodeficiency virus.
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Affiliation(s)
- Timon Sseruwagi
- General Surgery, Kampala International University, Ishaka, UGA
| | - Joel Musinzi
- Internal Medicine, St. Joseph's Hospital Kitovu, Masaka, UGA
| | | | - Catherine Lewis
- General Surgery, East Tennessee State University, Johnson City, USA.,General Surgery, St. Joseph's Hospital Kitovu, Masaka, UGA
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14
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Mitrovic N, Stevanovic D, Jasarovic D, Lazic A. Adenocarcinoma of the duodenojejunal flexure: our recent experience. Eur Surg 2023. [DOI: 10.1007/s10353-022-00792-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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15
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Lim SY, Chung DI, Jeong HJ, Jeon HJ, Yoon SJ, Kim H, Han IW, Heo JS, Shin SH. Clinical Outcome of Resected Non-Ampullary Duodenal Adenocarcinoma: A Single Center Experience. J Clin Med 2022; 12:jcm12010210. [PMID: 36615011 PMCID: PMC9821070 DOI: 10.3390/jcm12010210] [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] [Received: 11/24/2022] [Revised: 12/21/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022] Open
Abstract
(1) Background: This study identified the clinical outcome and prognostic factors of resected non-ampullary duodenal adenocarcinoma (NADA) in a single tertiary cancer center. (2) Methods: The medical records of 109 patients with NADA who underwent curative surgery between 2000 and 2018 were reviewed retrospectively. (3) Results: The mean age was 62.4 years with a male predominance (70.6%). The majority of tumors were located at the 2nd portion (58.7%). Fifty-seven patients (52.3%) had symptoms at diagnosis. CA19-9 was elevated in 32 patients (29.4%). Of this cohort, most patients were diagnosed as stage III (64.2%). The median overall survival was 92.9 months, and the 1-, 3-, and 5-year survival rates were 84.4%, 71.6%, and 53.7%, respectively. In univariate and multivariate analysis, age, symptoms, CA19-9, and margin status were associated with overall survival and symptoms, CA19-9 and margin status were also associated with recurrence. When correlating symptoms with stages, patients with symptoms at diagnosis had more advanced stages (all p < 0.001). (4) Conclusion: Old age, elevated CA19-9, symptoms, and margin status were independent prognostic factors of NADA, and the patients with symptoms at diagnosis tend to have more advanced stages and a poor prognosis.
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Affiliation(s)
- Soo Yeun Lim
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Dong Il Chung
- Department of Medicine, Sungkyunkwan University School of Medicine, Suwon 16419, Republic of Korea
| | - Hye Jeong Jeong
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Hyun Jeong Jeon
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - So Jeong Yoon
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Hongbeom Kim
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - In Woong Han
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Jin Seok Heo
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Sang Hyun Shin
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
- Correspondence: ; Tel.: +82-2-3410-6980
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16
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Liang J, Jiang Y, Abboud Y, Gaddam S. Role of Endoscopy in Management of Upper Gastrointestinal Cancers. Diseases 2022; 11:diseases11010003. [PMID: 36648868 PMCID: PMC9844461 DOI: 10.3390/diseases11010003] [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] [Received: 09/21/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022] Open
Abstract
Upper gastrointestinal (GI) malignancy is a leading cause of cancer-related morbidity and mortality. Upper endoscopy has an established role in diagnosing and staging upper GI cancers, screening for pre-malignant lesions, and providing palliation in cases of advanced malignancy. New advances in endoscopic techniques and technology have improved diagnostic accuracy and increased the therapeutic potential of upper endoscopy. We aim to describe the different types of endoscopic technology used in cancer diagnosis, summarize the current guidelines for endoscopic diagnosis and treatment of malignant and pre-malignant lesions, and explore new potential roles for endoscopy in cancer therapy.
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17
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Tesarikova J, Skalicky P, Kurfurstova D, Svebisova H, Urban O, Falt P, Zapletalova J, Klos D, Lovecek M. Surgical treatment of duodenal adenocarcinoma: ampullary vs. non-ampullary, short- and long-term outcomes. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2022; 166:290-296. [PMID: 34012147 DOI: 10.5507/bp.2021.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 04/23/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate symptoms, diagnostic methods, short- and long-term outcomes of surgical treatment in patients with duodenal adenocarcinoma. PATIENTS AND METHODS A single center, retrospective, observational study of 52 consecutive patients with duodenal adenocarcinoma operated on with curative intent between 2006 - 2019. Duodenectomy as part of a hemipancreatoduodenectomy or total pancreatectomy procedure was performed for ADAC (ampullary duodenal/intestinal adenocarcinoma) or NADAC (non-ampullary duodenal adenocarcinoma). RESULTS Prevailing symptoms were obstructive jaundice in the ADAC group (P<0.0001) and bleeding in the NADAC group (P=0.005), with larger tumor size in patients with NADAC (P=0.001). Complication rate, morbidity and mortality were comparable. Primary total pancreatoduodenectomy predominated in the NADAC group, 16.6% vs. 2.9%, and salvage completion pancreatectomy in the ADAC group, 6% vs. 0%. Significant prognostic factors for OS were perineural invasion (P=0.006) and adjuvant chemotherapy (P=0.045) in the ADAC group, and for DFS the total number of resected lymph nodes (P=0.042) and lymph node ratio (P=0.031) in the NADAC group. Median OS is 21 months and 5-year survival 27.3% in the NADAC group and 41.5 months and 52% in the ADAC group. CONCLUSION Ampullary duodenal/intestinal adenocarcinomas are smaller than non-ampullary at diagnosis, with a higher rate of lymph node metastases, but with a better prognosis and long-term outcome in the presented cohort. Oral localisation of NADAC prevailed in the present cohort. Perineural invasion and postoperative oncological therapy are significant prognostic factors for OS in ADAC, but the total number of lymph nodes and lymph node ratio are significant prognostic factors for DFS in NADAC.
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Affiliation(s)
- Jana Tesarikova
- Department of Surgery I, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
| | - Pavel Skalicky
- Department of Surgery I, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
| | - Daniela Kurfurstova
- Department of Clinical and Molecular Pathology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
| | - Hana Svebisova
- Department of Oncology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
| | - Ondrej Urban
- Department of Internal Medicine II - Gastroenterology and Geriatrics, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
| | - Premysl Falt
- Department of Internal Medicine II - Gastroenterology and Geriatrics, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
| | - Jana Zapletalova
- Department of Medical Biophysics, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Dusan Klos
- Department of Surgery I, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
| | - Martin Lovecek
- Department of Surgery I, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
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18
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Segmental resection with partial mesopancreatic and mesojejunal excision (pMME) for duodenal carcinoma of the third or fourth portion. Langenbecks Arch Surg 2022; 407:2143-2150. [DOI: 10.1007/s00423-022-02569-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 05/22/2022] [Indexed: 11/28/2022]
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19
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Ye N, Bao X, Zhao X, Wang B. Signet-ring cell carcinoma of the duodenal bulb presenting with gastrointestinal hemorrhage: a case report and literature review. BMC Gastroenterol 2022; 22:226. [PMID: 35534806 PMCID: PMC9087945 DOI: 10.1186/s12876-022-02267-0] [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: 07/09/2021] [Accepted: 03/24/2022] [Indexed: 11/18/2022] Open
Abstract
Background Primary duodenal cancer (PDC) is rare, especially signet-ring cell carcinoma (SRCC) of the duodenal bulb, and it is commonly misdiagnosed as an ulceration. Here, we report a rare case of SRCC of the duodenal bulb presenting with gastrointestinal hemorrhage in an 82-year-old man. Case presentation An 82-year-old man was admitted for gastrointestinal hemorrhage. Physical examination revealed upper abdominal tenderness and pale appearance, but was otherwise unrevealing. Laboratory workup was significant for anemia. Imaging showed no abnormalities. Two endoscopic evaluations along with interventional embolization were attempted and, unfortunately, adequate hemostasis was not achieved, resulting in distal subtotal gastrectomy, including the duodenal bulb. SRCC of the duodenal bulb was diagnosed based on pathology after surgery. Post-operatively, the patient experienced persistent gastrointestinal bleeding. Family declined further intervention and the patient eventually died one month post-resection. Conclusions SRCC in the duodenal bulb is difficult to diagnose. For those with high-risk factors, endoscopic examination and biopsy are recommended. For patients who can receive radical tumor resection, pancreaticoduodenectomy (PD) is considered a first-line option. Early diagnosis and resection have been shown to improve prognosis.
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Affiliation(s)
- Nan Ye
- Department of Hepatobiliary Surgery, Dongyang People's Hospital, Zhejiang Province, Jinhua, 322100, China
| | - Xiaoxiao Bao
- Department of Pathology, Dongyang People's Hospital, Zhejiang Province, Jinhua, 322100, China
| | - Xiaokang Zhao
- Department of Gastrointestinal Surgery, Dongyang People's Hospital, Zhejiang Province, Jinhua, 322100, China
| | - Bin Wang
- Department of Hepatobiliary Surgery, Dongyang People's Hospital, Zhejiang Province, Jinhua, 322100, China.
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20
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Patel PH, Likos-Corbett M, Doyle J, Kumar S, Bhogal RH. Node negative duodenal adenocarcinoma is associated with long-term patient survival following pancreaticoduodenal resection. ANZ J Surg 2022; 92:1105-1109. [PMID: 35403794 DOI: 10.1111/ans.17694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/22/2022] [Accepted: 03/28/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Duodenal adenocarcinoma (DA) is a rare gastrointestinal malignancy. There is limited data reporting patient outcomes following radical pancreatic resection for DA. We assessed the disease-free (DFS) and overall survival (OS) in patients undergoing pancreaticoduodenectomy for DA in our institution. METHODS We retrospectively analysed all patients undergoing pancreatic resection of DA at our institution between January 2009 and March 2020 inclusive. RESULTS Ninteen patients underwent pancreatic resection at our institution for DA during the study period. The overall postoperative morbidity and mortality was 37% and 5%, respectively. Nine patients (47%) had no nodal involvement. Median follow up was 25 months (range 1-108 months). Median DFS for our whole cohort was 17 months but was significantly higher in patients with no nodal metastasis [p < 0.001]. Median OS was 9.5 months for the whole cohort but was significantly higher in the patients with no nodal metastasis (60 months) compared to those with nodal metastasis (17.5 months) [p < 0.003]. CONCLUSION Improved DFS and OS for patients undergoing pancreaticoduodenectomy for DAs is associated with lymph node negative disease.
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Affiliation(s)
- Pranav Harshad Patel
- Department of Academic Surgery, The Royal Marsden Hospital Foundation Trust, London, UK
| | - Marinna Likos-Corbett
- Department of Academic Surgery, The Royal Marsden Hospital Foundation Trust, London, UK
| | - Joseph Doyle
- Department of Academic Surgery, The Royal Marsden Hospital Foundation Trust, London, UK
| | - Sacheen Kumar
- Department of Academic Surgery, The Royal Marsden Hospital Foundation Trust, London, UK.,Division of Radiotherapy and Imaging, The Institute for Cancer Research, South Kensington, London, UK
| | - Ricky Harminder Bhogal
- Department of Academic Surgery, The Royal Marsden Hospital Foundation Trust, London, UK.,Division of Radiotherapy and Imaging, The Institute for Cancer Research, South Kensington, London, UK
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21
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Jensen KK, Storkholm JH, Chen I, Burgdorf SK, Hansen CP. Long-term results after resection of primary duodenal adenocarcinoma: A retrospective cohort study. Int J Surg 2022; 100:106599. [DOI: 10.1016/j.ijsu.2022.106599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/16/2022] [Accepted: 03/02/2022] [Indexed: 10/18/2022]
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22
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Khosla D, Dey T, Madan R, Gupta R, Goyal S, Kumar N, Kapoor R. Small bowel adenocarcinoma: An overview. World J Gastrointest Oncol 2022; 14:413-422. [PMID: 35317322 PMCID: PMC8918997 DOI: 10.4251/wjgo.v14.i2.413] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 08/09/2021] [Accepted: 01/23/2022] [Indexed: 02/06/2023] Open
Abstract
Small bowel adenocarcinoma (SBA) is a rare malignancy of the gastrointestinal tract. However, these tumors are among those with worst prognosis. Vague clinical signs and symptoms and radiological diagnostic challenges often delay treatment, which negatively impacts the prognosis of the patients. However, recent advances in imaging technology, like multidetector computed tomography, magnetic resonance imaging, and capsule endoscopy, have made earlier and accurate diagnosis possible. Surgery is the treatment of choice followed by adjuvant therapy. However, there are no strict treatment guidelines available for the management of SBA. Most of the available evidence from colorectal and gastric carcinoma has been extrapolated to adequately manage SBA. Prognosis for SBA is better than gastric carcinoma but worse than colorectal carcinoma. Currently, there is not enough information on the molecular characteristics and tumor pathogenesis. Because the incidence of SBA is very low, there is a need for further studies to evaluate the possible application of newer investigative agents and strategies to obtain a better outcome within the framework of international collaborations.
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Affiliation(s)
- Divya Khosla
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Treshita Dey
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Renu Madan
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Rahul Gupta
- Department of Gastroenterology, Shalby Multispeciality Hospital, Mohali 160062, Punjab, India
| | - Shikha Goyal
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Narendra Kumar
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Rakesh Kapoor
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
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Sakaguchi T, Satoi S, Hashimoto D, Yamamoto T, Yamaki S, Hirooka S, Ishida M, Ikeura T, Inoue K, Naganuma M, Ishikawa H, Sekimoto M. High tumor budding predicts a poor prognosis in resected duodenal adenocarcinoma. Surg Today 2022; 52:931-940. [PMID: 34988677 DOI: 10.1007/s00595-021-02433-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/28/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Tumor budding is a histological characteristic defined as the presence of small clusters of cancer cells at the invasion front. Its significance in duodenal adenocarcinoma (DA) has not been fully described. METHODS A single-center, retrospective study was conducted. Patients who underwent curative surgery for histologically diagnosed DA from January 2006 to December 2018 at Kansai Medical University Hospital were included. Tumor budding was counted per 0.785 mm2 and classified as low (0-4 buds), intermediate (5-9 buds), or high (≥ 10 buds). RESULTS In total, 47 patients were included. The 5-year overall survival and relapse-free survival rates were 77% and 72%, respectively. High tumor budding was seen in 15 patients (32%). Excluding patients with superficial type (pT1) DA (n = 22), high tumor budding [hazard ratio (HR) 13.4, p = 0.028], regional lymph node metastasis (HR 19.9, p = 0.039), and adjuvant chemotherapy (HR 0.056, p = 0.036) were independent factors related to the overall survival in multivariate analyses. Distant metastases occurred significantly more often in patients who had high tumor budding than in others (p = 0.039). CONCLUSION The data suggest that high tumor budding is a predictor of a poor prognosis in resected DA.
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Affiliation(s)
- Tatsuma Sakaguchi
- Department of Surgery, Kansai Medical University, 2-5-1 Shin-machi, Hirakata-city, Osaka, 573-1010, Japan
| | - Sohei Satoi
- Department of Surgery, Kansai Medical University, 2-5-1 Shin-machi, Hirakata-city, Osaka, 573-1010, Japan.
| | - Daisuke Hashimoto
- Department of Surgery, Kansai Medical University, 2-5-1 Shin-machi, Hirakata-city, Osaka, 573-1010, Japan
| | - Tomohisa Yamamoto
- Department of Surgery, Kansai Medical University, 2-5-1 Shin-machi, Hirakata-city, Osaka, 573-1010, Japan
| | - So Yamaki
- Department of Surgery, Kansai Medical University, 2-5-1 Shin-machi, Hirakata-city, Osaka, 573-1010, Japan
| | - Satoshi Hirooka
- Department of Surgery, Kansai Medical University, 2-5-1 Shin-machi, Hirakata-city, Osaka, 573-1010, Japan
| | - Mitsuaki Ishida
- Department of Pathology and Clinical Laboratory, Kansai Medical University, Osaka, Japan
| | - Tsukasa Ikeura
- The Third Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Kentaro Inoue
- Department of Surgery, Kansai Medical University, 2-5-1 Shin-machi, Hirakata-city, Osaka, 573-1010, Japan
| | - Makoto Naganuma
- The Third Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Hideki Ishikawa
- Department of Molecular-Targeting Cancer Prevention, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Mitsugu Sekimoto
- Department of Surgery, Kansai Medical University, 2-5-1 Shin-machi, Hirakata-city, Osaka, 573-1010, Japan
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AlQatari AA, Fallatah RZ, AlQattan AS, Al Abdrabalnabi AA, Mashhour M, AlShahrni AA. Transduodenal resection of periampullary neuroendocrine tumor: A case report. Ann Med Surg (Lond) 2022; 73:103126. [PMID: 35070273 PMCID: PMC8767234 DOI: 10.1016/j.amsu.2021.103126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 11/26/2021] [Accepted: 11/30/2021] [Indexed: 02/07/2023] Open
Abstract
Introduction and importance Periampullary tumors are characterized as tumors that emerge nearby to the major papilla in the duodenum. They are rare lesions with an incidence rate of 0.4–0.48 per 100,000. Neuroendocrine tumors (NETs) constitute only 3% of all duodenal tumors. Their proximity to the major and minor papillae along with the gastric outlet raises a surgical challenge. Case presentation Our patient is a 40-year-old, male, medically free. He presented with history of a testicular mass. A CT scan of the abdomen and pelvis was done and showed a large retroperitoneal lymph node. A biopsy of the epididymal mass showed no evidence of malignancy. Excision of the left para-aortic mass revealed a metastatic lymph node of a well-differentiated neuroendocrine tumor. Further evaluation by gallium-68 PET-CT scan showed a periampullary neuroendocrine tumor. The decision to operate was concluded in a multidisciplinary team meeting, and intraoperatively the duodenum showed a well-defined mass between the first and second part of the duodenum which was excised via a trans-duodenal submucosal approach. A frozen section confirmed a negative margin. The final histopathology report showed a grade 2 metastatic well-differentiated neuroendocrine tumor. The latest follow-up was 3 years post-op via fluorine-18 fluorodeoxyglucose PET-CT and it showed no FDG avid disease at the duodenum or pancreases with no FDG avid lymphadenopathy or distant metastasis. Conclusion Periampullary tumors that fall under certain parameters could be resected via transduodenal local resection. This procedure yields equivalent results to more invasive surgeries, such as a Whipple's procedure, with less morbidity. Ampullary neuroendocrine tumors (NETs) are rare in compare to duodenal NETs, as they are highly metastatic and aggressive regardless of the size. These tumors present a diagnostic challenge in addition to being a topic of contention regarding surgical resection options. The controversy resides in main surgical options; the first being a pancreaticoduodenectomy (PD), and the second is a transduodenal local resection. Certain conditions must be met to achieve a satisfactory outcome for transduodenal local resection in case of periampullary NETs. For patients who have met the criteria, transduodenal local resection is believed to be a less invasive, safe, and useful alternative for PD.
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Routine contrast-enhanced CT is insufficient for TNM-staging of duodenal adenocarcinoma. Abdom Radiol (NY) 2022; 47:3436-3445. [PMID: 35864264 PMCID: PMC9463261 DOI: 10.1007/s00261-022-03589-z] [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: 04/06/2022] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE Adequate TNM-staging is important to determine prognosis and treatment planning of duodenal adenocarcinoma. Although current guidelines advise contrast-enhanced CT (CECT) for staging of duodenal adenocarcinoma, literature about diagnostic tests is sparse. METHODS In this retrospective single-center cohort study, we analyzed the real life performance of routine CECT for TNM-staging and the assessment of resectability of duodenal adenocarcinoma. Intraoperative findings and pathological staging served as reference standard for resectability, T-, and N-staging. Biopsies, 18FDG-PET-CT, and follow-up were used as the reference standard for M-staging. RESULTS Fifty-two consecutive patients with duodenal adenocarcinoma were included, 26 patients underwent resection. Half of the tumors were isodense to normal duodenum on CECT. The tumor was initially missed in 7/52 patients (13%) on CECT. The correct T-stage was assigned with CECT in 14/26 patients (54%), N-stage in 11/26 (42%), and the M-stage in 42/52 (81%). T-stage was underestimated in (27%). The sensitivity for detecting lymph node metastases was only 24%, specificity was 78%. Seventeen percent of patients had indeterminate liver or lung lesions on CECT. Surgery with curative intent was started in 32 patients, but six patients (19%) could not be resected due to unexpected local invasion or metastases. CONCLUSION Radiologists and clinicians have to be aware that routine CECT is insufficient for staging and determining resectability in patients with duodenal adenocarcinoma. CECT underestimates T-stage and N-stage, and M-stage is often unclear, resulting in futile surgery in 19% of patients. Alternative strategies are required to improve staging of duodenal adenocarcinoma. We propose to combine multiphase hypotonic duodenography CT with MRI.
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Hanan S, Luvsannyam E, Jain MS, Laller S, Cheema T, Mellon C, Teed D, Somagutta M, Ahmad LN, Tiesenga FM. A Rare Case of Three Distinct Gastrointestinal Neoplasms Occurring Simultaneously in an Elderly Patient. J Med Cases 2021; 12:419-423. [PMID: 34691340 PMCID: PMC8510667 DOI: 10.14740/jmc3765] [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: 08/18/2021] [Accepted: 09/01/2021] [Indexed: 12/09/2022] Open
Abstract
Duodenal adenocarcinoma (DA), gastrointestinal stromal tumor (GIST), and pancreatic neuroendocrine tumor (PNET) are a set of rare gastrointestinal (GI) cancers characterized by nonspecific symptoms such as anemia, weight loss, and abdominal pain. We report an interesting case of DA, GIST, and PNET in a 79-year-old African American male who presented to the emergency department with syncope. The patient was tachycardic and found to have severe anemia. Further computed tomography (CT) of the abdomen and pelvis with contrast revealed a mass within the duodenal bulb along with a pancreatic cystic lesion. The patient underwent gastroduodenectomy and distal pancreatectomy with incidental findings of GIST in the posterior gastric wall. The patient after surgical removal of all tumors no longer experienced abdominal pain and had hematocrit and hemoglobin (H&H) level of 9.1/31.7 postoperation day (POD) 14. The case unfolds a rare presentation of three neoplasms that were moderate to well-differentiated with no metastases. It highlights the importance of assessment of rare GI neoplasms concurrently with colorectal cancer when geriatric patients present with nonspecific GI symptoms.
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Affiliation(s)
- Saad Hanan
- Saint James School of Medicine, Chicago, IL, USA
| | | | - Molly S Jain
- Saint James School of Medicine, Chicago, IL, USA
| | | | | | - Cory Mellon
- West Suburban Medical Centre, Oak Park, IL, USA
| | - Don Teed
- West Suburban Medical Centre, Oak Park, IL, USA
| | - Manoj Somagutta
- California Institute of Behavioral and Neurosciences and Psychology, Fairfield, CA, USA
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Busquets J, Lopez-Dominguez J, Gonzalez-Castillo A, Vila M, Pelaez N, Secanella L, Ramos E, Fabregat J. Pancreas sparing duodenectomy in the treatment of primary duodenal neoplasms and other situations with duodenal involvement. Hepatobiliary Pancreat Dis Int 2021; 20:485-492. [PMID: 33753002 DOI: 10.1016/j.hbpd.2021.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 02/26/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND There are no clearly defined indications for pancreas-preserving duodenectomy. The present study aimed to analyze postoperative morbidity and the outcomes of patients undergoing pancreas-preserving duodenectomy. METHODS Patients undergoing pancreas-preserving duodenectomy from April 2008 to May 2020 were included. We divided the series according to indication: scenario 1, primary duodenal tumors; scenario 2, tumors of another origin with duodenal involvement; and scenario 3, emergency duodenectomy. RESULTS We included 35 patients. Total duodenectomy was performed in 1 patient of adenomatous duodenal polyposis, limited duodenectomy in 7, and third + fourth duodenal portion resection in 27. The indications for scenario 1 were gastrointestinal stromal tumor (n = 13), adenocarcinoma (n = 4), neuroendocrine tumor (n = 3), duodenal adenoma (n = 1), and adenomatous duodenal polyposis (n = 1); scenario 2: retroperitoneal desmoid tumor (n = 2), recurrence of liposarcoma (n = 2), retroperitoneal paraganglioma (n = 1), neuroendocrine tumor in pancreatic uncinate process (n = 1), and duodenal infiltration due to metastatic adenopathies of a germinal tumor with digestive hemorrhage (n = 1); and scenario 3: aortoenteric fistula (n = 3), duodenal trauma (n = 1), erosive duodenitis (n = 1), and biliopancreatic limb ischemia (n = 1). Severe complications (Clavien-Dindo ≥ IIIb) developed in 14% (5/35), and postoperative mortality was 3% (1/35). CONCLUSIONS Pancreas-preserving duodenectomy is useful in the management of primary duodenal tumors, and is a technical option for some tumors with duodenal infiltration or in emergency interventions.
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Affiliation(s)
- Juli Busquets
- Department of Hepatobiliary and Pancreatic Surgery, Hospital Universitari de Bellvitge, Research Group of Hepato-biliary and Pancreatic Diseases, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, Barcelona University, L'Hospitalet de Llobregat, Barcelona 08907, Spain.
| | - Josefina Lopez-Dominguez
- Department of Hepatobiliary and Pancreatic Surgery, Hospital Universitari de Bellvitge, Research Group of Hepato-biliary and Pancreatic Diseases, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, Barcelona University, L'Hospitalet de Llobregat, Barcelona 08907, Spain
| | | | - Marina Vila
- Department of General Surgery, Hospital de Mataró, Barcelona 08907, Spain
| | - Nuria Pelaez
- Department of Hepatobiliary and Pancreatic Surgery, Hospital Universitari de Bellvitge, Research Group of Hepato-biliary and Pancreatic Diseases, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, Barcelona University, L'Hospitalet de Llobregat, Barcelona 08907, Spain
| | - Lluis Secanella
- Department of Hepatobiliary and Pancreatic Surgery, Hospital Universitari de Bellvitge, Research Group of Hepato-biliary and Pancreatic Diseases, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, Barcelona University, L'Hospitalet de Llobregat, Barcelona 08907, Spain
| | - Emilio Ramos
- Department of Hepatobiliary and Pancreatic Surgery, Hospital Universitari de Bellvitge, Research Group of Hepato-biliary and Pancreatic Diseases, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, Barcelona University, L'Hospitalet de Llobregat, Barcelona 08907, Spain
| | - Juan Fabregat
- Department of Hepatobiliary and Pancreatic Surgery, Hospital Universitari de Bellvitge, Research Group of Hepato-biliary and Pancreatic Diseases, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, Barcelona University, L'Hospitalet de Llobregat, Barcelona 08907, Spain
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28
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Manur JG, Jain HM. A case of duodenal adenocarcinoma treated with primary chemoradiation. J Cancer Res Ther 2021; 17:1101-1103. [PMID: 34528570 DOI: 10.4103/jcrt.jcrt_695_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Duodenal adenocarcinoma represents <1% of total gastrointestinal malignancies. Given the rarity of the disease, a definitive treatment guideline is lacking. Surgery plays a major role and radiotherapy was not included in the treatment due to the presence of many critical structures near the vicinity of the duodenum such as the liver, kidneys, and bowel. However, with the advent of newer techniques, adjuvant chemoradiation has shown a promising result with improvement in locoregional control by 20%. We are herewith presenting the details of the radiation planning of a patient treated with chemoradiation who had good long-term outcome.
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Affiliation(s)
| | - Harshitha M Jain
- Department of Radiation Oncology, Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
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29
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Yamamoto N, Washimi K, Murakawa M, Kamiya M, Kamioka Y, Ueno M, Kishida T, Rino Y, Masuda M, Morinaga S. Primary Duodenal Carcinoma with Embryonal Carcinoma Features in a Young Man. Case Rep Gastroenterol 2021; 15:269-275. [PMID: 33790714 PMCID: PMC7989679 DOI: 10.1159/000512421] [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: 07/23/2020] [Accepted: 10/16/2020] [Indexed: 11/19/2022] Open
Abstract
We present the case of a 35-year-old man with intractable nausea, vomiting, and severe anemia. A computed tomography (CT) scan of the chest, abdomen, and pelvis showed a circumferential lesion thickening of up to 3.5 cm at the level of the third portion of the duodenum. No aortocaval, retroperitoneal lymphadenopathy, nor secondary lesion was observed. Esophagogastroduodenoscopy (EGD) revealed a circumferential mass within the third portion of the duodenum. Histopathology of biopsy materials from the duodenal mass showed it most likely to be a poorly differentiated adenocarcinoma. The patient underwent a subtotal stomach-preserving pancreaticoduodenectomy with regional lymph node dissection. Histologically, tumor cells with basophilic cytoplasm and pleomorphic nuclei showed a solid pattern, and expressed CD30 and SALL4 immunohistochemically, leading to a diagnosis of embryonal carcinoma-like tumor. No other primary tumor could be identified, and the location of the tumor, mainly on the mucosal surface, suggested a duodenal origin. The UICC TNM staging was T3N2M0, stage IIB. This is a rare case of primary duodenal carcinoma with features of embryonal carcinoma.
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Affiliation(s)
- Naoto Yamamoto
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Kota Washimi
- Department of Pathology, Kanagawa Cancer Center, Yokohama, Japan
| | - Masaaki Murakawa
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Mariko Kamiya
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Yuto Kamioka
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Makoto Ueno
- Department of Hepatobiliary and Pancreatic Medical Oncology, Kanagawa Cancer Center, Yokohama, Japan
| | - Takeshi Kishida
- Department of Urology, Kanagawa Cancer Center, Yokohama, Japan
| | - Yasushi Rino
- Department of Surgery, Yokohama City University Hospital, Yokohama, Japan
| | - Munetaka Masuda
- Department of Surgery, Yokohama City University Hospital, Yokohama, Japan
| | - Soichiro Morinaga
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
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30
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Linden K, Melillo A, Gaughan J, Obinero C, Kellish A, Wozniak MR, Patel RM, Pandya V, Atabek U, Spitz F, Hong YK. The Role of Neoadjuvant Versus Adjuvant Therapy for Duodenal Adenocarcinoma: A National Cancer Database Propensity Score Matched Analysis. Am Surg 2020; 87:1066-1073. [PMID: 33291951 DOI: 10.1177/0003134820954821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Adjuvant therapy is recommended in duodenal adenocarcinoma (DA), but the role of neoadjuvant therapy remains undefined. We compared the effect of neoadjuvant therapy to adjuvant therapy on overall survival, 30-day, and 90-day mortality following the resection of DA. METHODS A retrospective review of the National Cancer Database was performed on patients with DA who received either adjuvant or neoadjuvant therapy in addition to surgical resection. Propensity score matching was done for patient, socioeconomic, and tumor characteristics. Overall survival, 30-day, and 90-day mortality were compared. RESULTS A total of 112 patients were identified; 55 received adjuvant therapy; 57 received neoadjuvant therapy. There was no difference in 30-day (0% vs. 1.75%; P = 1.00), 90-day mortality (1.82% vs. 7.02%; P = .36), nor overall survival (1 yr: 86% vs. 76; 3 yr: 49% vs. 46%; 5 yr: 42% vs. 39%; P = .28). CONCLUSIONS There was no difference in overall survival after propensity score matched analysis.
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Affiliation(s)
- Kimberly Linden
- Department of Surgery, Cooper University Hospital, Camden, NJ, USA
| | - Atlee Melillo
- Department of Surgery, Cooper University Hospital, Camden, NJ, USA
| | - John Gaughan
- 363994Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Chioma Obinero
- 363994Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Alec Kellish
- 363994Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Marisa R Wozniak
- 363994Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Raj M Patel
- 363994Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Vidish Pandya
- 363994Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Umur Atabek
- Department of Surgery, Cooper University Hospital, Camden, NJ, USA
| | - Francis Spitz
- Department of Surgery, Cooper University Hospital, Camden, NJ, USA
| | - Young K Hong
- Department of Surgery, Cooper University Hospital, Camden, NJ, USA
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Bracale U, Pontecorvi E, Silvestri V, Cuccurullo D, D'Ambra M, Lionetti R, Coppola A, Carannante F, Pirozzi F, Peltrini R, Sciuto A, Corcione F. Laparoscopic segmental resection for tumours of the Angle of Treitz: a challenging but feasible surgical option. Results from a retrospective case-series analysis. Updates Surg 2020; 73:179-186. [PMID: 33146889 PMCID: PMC7889543 DOI: 10.1007/s13304-020-00910-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 10/24/2020] [Indexed: 12/22/2022]
Abstract
Tumours of the small intestine are rare and account for about 5% of gastrointestinal tract neoplasms. The angle of Treitz (AT) could be defined as the intestinal loop comprised between the third duodenal portion and the first 10 cm of jejunum. A gold standard surgical treatment for AT neoplasm has not yet been well defined. This paper is focused on a very rare disease and at the best of our knowledge this is the largest case series in the literature about the Laparoscopic Segmental Resection (LSR) of AT tumours. Using a prospectively collected database, all data of consecutive patients, from January 2007 to May 2019, who underwent LSR for AT tumours at two different institutions were analysed. Patients’ demographics, intra and post-operative data, 30-day mortality and overall survival were collected. A total of 16 patients were retrieved from our database. The mean operative time was 206,5 ± 79 min. Conversion to open surgery was needed in two cases due to tumor size and, respectively, invasion of the transverse colon which required a multivisceral resection. The mean distal and proximal resection margins were 7.4 ± 2.2 and 3.9 ± 1.2 cm. The median number of harvested nodes was 9 ± 3. Pathological diagnosis was GIST in 11 cases, adenocarcinoma in 4 and sarcoma in 1 case. In conclusion, in experienced hands, LSR appears to be a safe and effective treatment option for tumours of the AT. Prospective studies are needed to confirm these findings.
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Affiliation(s)
- Umberto Bracale
- Department of General and Oncological Minimally Invasive Surgery, University Federico II of Naples, Via Pansini 5 7th Building, Naples, Italy.
| | - Emanuele Pontecorvi
- Department of General and Oncological Minimally Invasive Surgery, University Federico II of Naples, Via Pansini 5 7th Building, Naples, Italy
| | - Vania Silvestri
- Department of General and Oncological Minimally Invasive Surgery, University Federico II of Naples, Via Pansini 5 7th Building, Naples, Italy
| | - Diego Cuccurullo
- Department of General Surgery, Azienda Ospedaliera Dei Colli, Monaldi Hospital, Naples, Italy
| | - Michele D'Ambra
- Department of General and Oncological Minimally Invasive Surgery, University Federico II of Naples, Via Pansini 5 7th Building, Naples, Italy
| | - Ruggero Lionetti
- Department of General and Oncological Minimally Invasive Surgery, University Federico II of Naples, Via Pansini 5 7th Building, Naples, Italy
| | - Andrea Coppola
- Department of General and Oncological Minimally Invasive Surgery, University Federico II of Naples, Via Pansini 5 7th Building, Naples, Italy
| | - Filippo Carannante
- Department of Geriatric Surgery, Università Campus Bio-Medico, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - Felice Pirozzi
- Department of General Surgery, Santa Maria delle Grazie Hospital, Pozzuoli, Italy
| | - Roberto Peltrini
- Department of General and Oncological Minimally Invasive Surgery, University Federico II of Naples, Via Pansini 5 7th Building, Naples, Italy
| | - Antonio Sciuto
- Department of General Surgery, Santa Maria delle Grazie Hospital, Pozzuoli, Italy
| | - Francesco Corcione
- Department of General and Oncological Minimally Invasive Surgery, University Federico II of Naples, Via Pansini 5 7th Building, Naples, Italy
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32
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Platoff RM, Kellish AS, Hakim A, Gaughan JP, Atabek UM, Spitz FR, Hong YK. Simple Versus Radical Resection for Duodenal Adenocarcinoma: A Propensity Score Matched Analysis of National Cancer Database. Am Surg 2020; 87:266-275. [PMID: 32927979 DOI: 10.1177/0003134820951432] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Duodenal adenocarcinoma treatment consists of either simple or radical surgical resection. Existing evidence suggests similar survival outcomes between the two but is limited by small numbers and single-institution analysis. We aim to compare survival after partial versus radical resection for duodenal adenocarcinoma using the National Cancer Database (NCDB). METHODS Using NCDB results from 2004 to 2014, we compared patients with duodenal adenocarcinoma undergoing partial resection (n = 1247) and radical resection (n = 1240) by age, sex, facility type, facility location, cancer stage, cancer grade, lymph node sampling, node status, tumor size, margin status, neoadjuvant therapy, and adjuvant therapy using chi-square analysis. Survival was compared using propensity matching. RESULTS Patients undergoing partial resection had overall earlier cancer stage, more favorable tumor grade, and were less likely to undergo lymph node sampling and neoadjuvant therapy. When overall survival was compared between the 2 propensity-matched groups, the median survival was 46.7 months after partial resection and 43.2 months after radical resection (P = .329), and overall survival was similar between the 2 groups (P = .894). The use of adjuvant therapy demonstrated improved survival over either surgery alone (P < .0001, P = .0037). CONCLUSION Partial resection did not demonstrate worse survival outcomes than radical resection for duodenal adenocarcinoma. The use of adjuvant therapy in addition to surgery demonstrated improved survival regardless of surgery type and played a larger role in survival than the type of surgery. Our findings provide evidence to support the continued use of both partial and radical surgical resections to treat duodenal malignancy.
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Affiliation(s)
- Rebecca M Platoff
- 2202 Department of Surgery, Cooper University Hospital, Camden, NJ, USA
| | - Alec S Kellish
- 363994 School of Medicine, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Abraham Hakim
- 363994 School of Medicine, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - John P Gaughan
- 2202 Cooper Research Institute, Cooper University Hospital, Camden, NJ, USA
| | - Umur M Atabek
- 2202 Department of Surgery, Cooper University Hospital, Camden, NJ, USA
| | - Francis R Spitz
- 2202 Department of Surgery, Cooper University Hospital, Camden, NJ, USA
| | - Young K Hong
- 2202 Department of Surgery, Cooper University Hospital, Camden, NJ, USA
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33
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Zhao J, Li X, Liu Q, Shi L, Zhang L, Yang H, Zhang Q. Clinical comparative analysis of various duodenal diseases in different age groups. TURKISH JOURNAL OF GASTROENTEROLOGY 2020; 31:489-496. [PMID: 32897221 DOI: 10.5152/tjg.2020.18712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND/AIMS This study aimed to investigate the differences and relevance of various common duodenal diseases in different parts in the aspects of age, gender, helicobacter pylori (H. pylori) infection, application of nonsteroidal anti-inflammatory drugs (NSAIDs), smoking, or alcohol consumption. MATERIALS AND METHODS The medical records of various duodenal diseases were collected and tested for difference using the χ2 test or the Fisher exact probability method. RESULTS 1) The proportions of duodenal ulcer (DU), inflammation, and duodenal bulb diseases in the adult group (A) (47.98%, 36.70%, and 66.63%) were higher than those in the elderly group (E) (41.38%, 29.83%, and 56.82%), but the proportions of duodenal diverticulum (DD) and tumor diseases in the descending and ascending segments (2.95%, 1.43%, 9.14%, and 0.14%) were lower than those in group E (13.73%, 3.69%, 19.41%, and 0.76%) (p<0.001). 2) The positive rate of H. pylori (63.64%) in the duodenal bulb diseases was higher than that in the bulb-descending segment (53.75%), but the application rate of NSAIDs (16.44%) in the duodenal bulb-descending diseases was lower than that in the descending segment (24.81%) (p<0.001). CONCLUSION 1) DU, inflammation, and duodenal bulb diseases are common in adults, but DD and tumor diseases in the descending and ascending segments are more common in the elderly. 2) Compared with the duodenal bulb-descending diseases, the application of NSAIDs has greater impact on the diseases in the descending segment, and the rate of H. pylori infection is higher in duodenal bulb diseases.
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Affiliation(s)
- Jin Zhao
- Department of Gastroenterology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Xuelian Li
- Department of Gastroenterology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Qi Liu
- Department of Gastroenterology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Linyan Shi
- Department of Gastroenterology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Ling Zhang
- Department of Gastroenterology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Hong Yang
- Department of Gastroenterology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Qianqian Zhang
- Department of Gastroenterology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
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Donisi G, Capretti G, Cortese N, Rigamonti A, Gavazzi F, Nappo G, Pulvirenti A, Sollai M, Spaggiari P, Zerbi A, Marchesi F. Immune infiltrating cells in duodenal cancers. J Transl Med 2020; 18:340. [PMID: 32883314 PMCID: PMC7470614 DOI: 10.1186/s12967-020-02508-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 08/26/2020] [Indexed: 12/11/2022] Open
Abstract
Background Duodenal adenocarcinoma (DA) is a rare yet aggressive malignancy, with increasing incidence in the last decades. Its low frequency has hampered a thorough understanding of the pathogenesis of the disease and of its biology, limiting the identification of tailored therapeutic options. A large body of evidence has clearly shown the clinical relevance of immune cells in solid tumors, correlating immune features with post-surgical prognosis. The aim of this study was to analyze the immune contexture in a cohort of duodenal adenocarcinomas surgically resected at our Institution and define its correlation with clinical variables. Methods Tissue slides from paraffin-embedded tumor specimens of 15 consecutive DA and 3 adenomas that underwent a pancreaticoduodenectomy in our center between 2010 to 2018 were immunohistochemically stained. The density (percentage of immune reactive area, IRA%) of immune markers CD45RO, CD8, CD20, IL-17, PD-1, CD68 was quantified by computer-assisted image analysis. Demographic, clinical, histopathological data were collected. Results In our population, median IRA % (IQR) of immune subsets was respectively CD45RO-TILs 2.19 (2.14), CD8-TIL 0.42 (0.81), CD20-TILs 0.22 (0.51), CD20-TLT 2.84 (4.64), CD68-TAM 2.19 (1.56), IL17+ cells 0.39 (0.39), PD1-TILs 0.19 (0.41). The median follow-up was 47.5 (22.4–63.3) months. At statistical analysis, the density of CD8-TILs inversely correlated with lymph node ratio (p = 0.013), number of metastatic lymph nodes (p = 0.019), and was lower in N+ adenocarcinomas compared to N0 (1.07 vs 0.29; p = 0.093), albeit not significantly. Stratifying patients for the N status, the density of CD8-TILs decreased with the increasing of the N stage (p = 0.065) and was lower in patients who experienced recurrence and died for the disease (0.276 vs 0.641; p = 0.044). Notably, also CD68-TAM distribution was different in patients who had recurrence versus patients who did not (1.028 vs 2.276; p = 0.036). Conclusions Immune cells showed variable expression in correlation with common prognostic factors, suggesting T cell infiltration may play a protective role towards lymphatic spread of disease and nodal metastatization. Furthermore, T cell density and macrophage infiltration were associated to a lower risk of recurrence and disease related death. A multicentric approach may be indicated to allow analysis of larger cohorts of patients, potentially increasing the power of our observations.
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Affiliation(s)
- G Donisi
- Section of Pancreatic Surgery, Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, 20089, Rozzano, Milano, Italy
| | - G Capretti
- Section of Pancreatic Surgery, Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, 20089, Rozzano, Milano, Italy. .,Department of Biomedical Sciences, Humanitas University, Rozzano, Italy.
| | - N Cortese
- Department of Immunology and Inflammation, Humanitas Clinical and Research Center-IRCCS, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Rozzano, Milano, Italy
| | - A Rigamonti
- Department of Immunology and Inflammation, Humanitas Clinical and Research Center-IRCCS, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Rozzano, Milano, Italy.,Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
| | - F Gavazzi
- Section of Pancreatic Surgery, Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, 20089, Rozzano, Milano, Italy
| | - G Nappo
- Section of Pancreatic Surgery, Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, 20089, Rozzano, Milano, Italy
| | - A Pulvirenti
- Section of Pancreatic Surgery, Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, 20089, Rozzano, Milano, Italy
| | - M Sollai
- Department of Pathology, Humanitas Clinical and Research Center-IRCCS, Rozzano, Italy
| | - P Spaggiari
- Department of Pathology, Humanitas Clinical and Research Center-IRCCS, Rozzano, Italy
| | - A Zerbi
- Section of Pancreatic Surgery, Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, 20089, Rozzano, Milano, Italy.,Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
| | - F Marchesi
- Department of Immunology and Inflammation, Humanitas Clinical and Research Center-IRCCS, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Rozzano, Milano, Italy. .,Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy.
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35
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Krupka M, Bartusik-Aebisher D, Strzelczyk N, Latos M, Sieroń A, Cieślar G, Aebisher D, Czarnecka M, Kawczyk-Krupka A, Latos W. The role of autofluorescence, photodynamic diagnosis and Photodynamic therapy in malignant tumors of the duodenum. Photodiagnosis Photodyn Ther 2020; 32:101981. [PMID: 32882405 DOI: 10.1016/j.pdpdt.2020.101981] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 07/12/2020] [Accepted: 08/24/2020] [Indexed: 02/07/2023]
Abstract
This article presents the current state of knowledge and a review of the literature in terms of the prevalence, etiopathogenesis, differential diagnosis, management, prognosis, and treatment of malignant tumors of the duodenum. The role of autofluorescence and photodynamic diagnosis as an emerging treatment method for rarely o ccurring duodenal malignant neoplasms .. We selected publications which can be found in databases such as The National Center for Biotechnology Information, U.S. National Library of Medicine (PubMed), The American Chemical Society, The American Association of Pharmaceutical Sciences and The American Society for Photobiology and The Canada Institute for Scientific and Technical Information.
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Affiliation(s)
- Magdalena Krupka
- Department of Internal Diseases, Angiology and Physical Medicine, Center for Laser Diagnostics and Therapy, Medical University of Silesia, Batorego 15, 41-902, Bytom, Poland.
| | - Dorota Bartusik-Aebisher
- Department of Biochemistry and General Chemistry, Faculty of Medicine, University of Rzeszów, Kopisto 2A, 35-310, Rzeszów, Poland.
| | - Natalia Strzelczyk
- Department of Internal Medicine, 11 Listopada 5E, 42-100, Kłobuck, Poland.
| | - Magdalena Latos
- Silesian Centre for Heart Disease in Zabrze, Marii Curie Skłodowskiej 9, 41-800 Zabrze, Poland.
| | - Aleksander Sieroń
- Jan Długosz University in Częstochowa, Waszyngtona 4/8, 42-200, Częstochowa, Poland.
| | - Grzegorz Cieślar
- Department of Internal Diseases, Angiology and Physical Medicine, Center for Laser Diagnostics and Therapy, Medical University of Silesia, Batorego 15, 41-902, Bytom, Poland.
| | - David Aebisher
- Department of Photomedicine and Physical Chemistry, Faculty of Medicine, University of Rzeszów, Kopisto 2A, 35-310, Rzeszów, Poland.
| | - Magdalena Czarnecka
- Department of Internal Diseases, Angiology and Physical Medicine, Center for Laser Diagnostics and Therapy, Medical University of Silesia, Batorego 15, 41-902, Bytom, Poland.
| | - Aleksandra Kawczyk-Krupka
- Department of Internal Diseases, Angiology and Physical Medicine, Center for Laser Diagnostics and Therapy, Medical University of Silesia, Batorego 15, 41-902, Bytom, Poland.
| | - Wojciech Latos
- Department of Internal Diseases, Angiology and Physical Medicine, Center for Laser Diagnostics and Therapy, Medical University of Silesia, Batorego 15, 41-902, Bytom, Poland.
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Khanal S, Joshi U, Bhattarai A, Agrawal V, Sayami G, Bhandari RS. Primary Duodenal Adenocarcinoma: Uncommon Tumor, Uncommon Presentation. A Case Report and Review of the Literature. Int Med Case Rep J 2020; 13:165-169. [PMID: 32523384 PMCID: PMC7237129 DOI: 10.2147/imcrj.s256107] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 05/05/2020] [Indexed: 01/13/2023] Open
Abstract
Introduction The symptoms of primary duodenal adenocarcinoma, which is a rare but aggressive tumor, are vague and nonspecific and often result in a delayed diagnosis or misdiagnosis. This results in a tumor being diagnosed at an advanced stage when it becomes unresectable secondary to local and distant spread. Case Presentation A 64-year-old Nepalese female presented to our hospital with epigastric pain, anorexia, and significant weight loss that developed over two-and-a-half months. Upper gastrointestinal endoscopy showed an ulceroproliferative growth in the first part of the duodenum with no features of duodenal stenosis. Contrast-enhanced computed tomography of the abdomen revealed heterogeneously enhancing, circumferential, asymmetrical thickening in the first part of the duodenum and multiple liver metastases. Biopsy of the mass revealed features suggestive of moderately differentiated adenocarcinoma of the duodenum. She was managed with palliative care during her hospital stay. The unique presentation in our case was that the tumor did not cause stenosis and the patient could consume food till the last day of her life. Conclusion In patients with primary duodenal adenocarcinoma, the non-stenotic lesion is also a possibility. Clinicians should always maintain a high degree of suspicion to avoid the delay in diagnosis or misdiagnosis.
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Affiliation(s)
- Shital Khanal
- Department of GI and General Surgery, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Utsav Joshi
- Department of GI and General Surgery, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Adheesh Bhattarai
- Department of GI and General Surgery, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Vishakha Agrawal
- Department of GI and General Surgery, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Gita Sayami
- Department of Pathology, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Ramesh Singh Bhandari
- Department of GI and General Surgery, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
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Asare O, Osei F, Appau AY, Sarkodie B, Tachi K, Nkansah A, Acheampong T, Nwaokweanwe C, Olayiwola D. Aetiology of Obstructive Jaundice in Ghana: A Retrospective Analysis in a Tertiary Hospital. JOURNAL OF WEST AFRICAN COLLEGE OF SURGEONS 2020; 10:36-39. [PMID: 35720953 PMCID: PMC9202603 DOI: 10.4103/jwas.jwas_46_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 03/15/2022] [Indexed: 11/04/2022]
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Kang S, Zaidi AJ, Shokouh-Amiri M, Wiley E, Venepalli NK. A case report of paraneoplastic syndrome in β-hCG-secreting duodenal adenocarcinoma. J Gastrointest Oncol 2019; 10:1151-1156. [PMID: 31949933 DOI: 10.21037/jgo.2019.09.08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Human chorionic gonadotropin (hCG) is a glycoprotein hormone that is used in clinical practice to detect pregnancy and serves as a sensitive marker for trophoblastic tumors. Other organs besides placental trophoblasts naturally express the hormone at low levels, which can be elevated in nontrophoblastic malignancies. Some studies have suggested that elevated β-hCG levels in nontrophoblastic tumors are a sign of aggressive disease and strongly associated with poor prognosis. We describe a case of a 50-year-old post-menopausal woman with metastatic duodenal adenocarcinoma who presented with a negative pregnancy test that later changed to positive. Biopsy of the primary duodenal mass showed positive immunohistochemical expression of β-hCG. The patient was also found to have multiple brain metastases, which is uncommon in gastrointestinal cancer. This is a rare case of paraneoplastic syndrome in a β-hCG-secreting duodenal adenocarcinoma.
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Affiliation(s)
- Sandra Kang
- Division of Internal Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Ayesha J Zaidi
- Oncology Clinical Trials Office, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Elizabeth Wiley
- Department of Pathology, University of Illinois at Chicago, Chicago, IL, USA
| | - Neeta K Venepalli
- Division of Hematology Oncology, Department of Medicine Oncology, University of Illinois at Chicago, Chicago, IL, USA
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39
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Mochizuki T, Fujikuni N, Nakadoi K, Nakahara M, Tanabe K, Yonehara S, Noriyuki T. Adenocarcinoma of the duodenum arising from Brunner's gland resected by partial duodenectomy: a case report. Surg Case Rep 2019; 5:179. [PMID: 31728658 PMCID: PMC6856237 DOI: 10.1186/s40792-019-0732-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 10/15/2019] [Indexed: 12/12/2022] Open
Abstract
Background Duodenal carcinoma originating in Brunner’s gland is rare. Herein, we report a case of duodenal carcinoma arising from Brunner’s gland in a 63-year-old man. Case presentation On diagnostic imaging, the lesion presented as a non-invasive carcinoma; the patient also had uncontrolled diabetes and liver cirrhosis. Hence, we decided to perform partial duodenectomy to reduce operative stress. Pathological examination revealed that the tumor consisted of tissue from Brunner’s gland. Additionally, the carcinoma cells were strongly positive for Mucin-6 protein, which is an epithelial marker of Brunner’s gland. The patient’s post-operative course was uneventful, and he has been well for 2 years after the surgery. Conclusions This a rare case of an adenocarcinoma arising from Brunner’s gland of the duodenum that was resected by duodenectomy.
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Affiliation(s)
- Tetsuya Mochizuki
- Department of Surgery, Onomichi General Hospital, Onomichi, Hiroshima, Japan
| | - Nobuaki Fujikuni
- Department of Surgery, Onomichi General Hospital, Onomichi, Hiroshima, Japan.
| | - Koichi Nakadoi
- Department of Gastroenterology, Onomichi General Hospital, Onomichi, Hiroshima, Japan
| | - Masahiro Nakahara
- Department of Surgery, Onomichi General Hospital, Onomichi, Hiroshima, Japan
| | - Kazuaki Tanabe
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shuji Yonehara
- Department of Pathology, Onomichi General Hospital, Onomichi, Hiroshima, Japan
| | - Toshio Noriyuki
- Department of Surgery, Onomichi General Hospital, Onomichi, Hiroshima, Japan.,Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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A Rare Case of Duodenal Adenocarcinoma Presenting as a Subepithelial Lesion in a Patient Undergoing Investigation for Iron Deficiency Anaemia. Case Rep Gastrointest Med 2019; 2019:3434620. [PMID: 31687224 PMCID: PMC6800942 DOI: 10.1155/2019/3434620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 08/05/2019] [Accepted: 08/16/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction Adenocarcinomas account for approximately 40% of small bowel cancers. They are typically mucosal lesions with distinctive features on endoscopy. We describe a rare case of duodenal adenocarcinoma presenting as a subepithelial lesion which posed a diagnostic challenge. Case An 85-year-old male patient presented for investigation of iron deficiency anaemia. Initial upper endoscopy found a subepithelial duodenal lesion with central depression but otherwise normal appearing mucosa. Superficial biopsies of the duodenal lesion were unremarkable. Subsequent antegrade single balloon enteroscopy revealed active bleeding from the lesion which was refractory to endoscopic treatment. A complete local excision of the lesion via laparotomy was necessary to achieve haemostasis. Histopathology from the lesion showed a moderately differentiated duodenal adenocarcinoma with invasion into the submucosa but no evidence of lymphovascular spread. Conclusion Duodenal adenocarcinomas are rare gastrointestinal tumours associated with a poor prognosis. This case report outlines a rare presentation of duodenal adenocarcinoma and highlights the importance of judicious assessment of lesions found on endoscopy. Advances in endoscopic diagnostic modalities could facilitate early diagnosis and improve therapeutic outcomes.
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Dave A, Wiseman JT, Cloyd JM. Duodenal adenocarcinoma: neoadjuvant and adjuvant therapy strategies. Expert Opin Orphan Drugs 2019. [DOI: 10.1080/21678707.2019.1684257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Apeksha Dave
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jason T. Wiseman
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jordan M. Cloyd
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Feasibility and Safety of a Novel Laparoscopic and Endoscopic Cooperative Surgery Technique for Superficial Duodenal Tumor Resection: How I Do It. J Gastrointest Surg 2019; 23:2068-2074. [PMID: 30859426 DOI: 10.1007/s11605-019-04176-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 02/21/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pancreatoduodenectomy is considered to be a very invasive treatment for early superficial duodenal tumors (SDTs), which have a lower risk of lymph node metastasis. Partial resection of the duodenum with endoscopic submucosal dissection for SDT resection is an attractive technique but it is associated with a high risk of complications. We describe our technique for SDT resection. METHOD It includes the following elements: freeing the transverse mesocolon, exposing and mobilizing the second part of the duodenum and the head of the pancreas (Kocher maneuver), confirming the location of the ulcer bed for endoscopic submucosal dissection, and laparoscopic suturing by hand in the seromuscular layer of the duodenum. We performed this technique in 10 patients between March 2015 and March 2017. RESULTS The median tumor diameter and resected tissue diameter were 36 (20-54) and 41 (25-60) mm, respectively. Curative resection (R0) with negative margins was achieved for all patients. There were no conversions to open surgery in this series. No postoperative complications were above grade 2 in the Clavien-Dindo classification system. No recurrences were observed during the medium-term follow-up period. CONCLUSION This technique is safe and feasible and can be an option for surgical SDT resection.
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López-Domínguez J, Busquets J, Secanella L, Peláez N, Serrano T, Fabregat J. Duodenal adenocarcinoma: Surgical results of 27 patients treated at a single center. Cir Esp 2019; 97:523-530. [PMID: 31563268 DOI: 10.1016/j.ciresp.2019.06.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 06/10/2019] [Accepted: 06/26/2019] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Duodenal adenocarcinoma is a rare malignancy. Given the rarity of the disease, there is limited data related to resection results. The objective is to analyze results at our hospital after the curative resection of duodenal adenocarcinoma (DA). METHODS The variables were retrospectively collected from patients operated on between 1990 and 2017 at our hospital. RESULTS A total of 27 patients were treated. Twenty-three patients (85%) underwent pancreaticoduodenectomy, and 4 patients (15%) with tumors located in the third and fourth portions of the duodenum underwent segmental duodenal resection. The overall postoperative morbidity was 67% (18 patients). Postoperative mortality was 7% (2 patients); however, postoperative mortality related to surgery was 4% (1 patient). All patients had negative resection margins. A median of 18 lymph nodes (range, 0-38) were retrieved and evaluated, with a median of 1 involved node (range, 0-8). Median follow up was 23 (9-69.7) months. Actuarial overall survival was 62.2 (25.2-99.1) months. Actuarial disease-free survival was 49 (0-133) months. CONCLUSIONS The surgical treatment of duodenal adenocarcinoma is associated with a high morbidity, although it achieves considerable survival. Depending on the tumor location and if there is no pancreatic infiltration, segmental duodenal resection with negative margins is an alternative to cephalic pancreaticoduodenectomy.
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Affiliation(s)
- Josefina López-Domínguez
- Unidad de Cirugía Hepatobiliar y Pancreática, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Juli Busquets
- Unidad de Cirugía Hepatobiliar y Pancreática, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España.
| | - Lluis Secanella
- Unidad de Cirugía Hepatobiliar y Pancreática, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Nuria Peláez
- Unidad de Cirugía Hepatobiliar y Pancreática, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Teresa Serrano
- Servicio de Anatomía Patológica, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Juan Fabregat
- Unidad de Cirugía Hepatobiliar y Pancreática, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
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Molecular alterations and PD-L1 expression in non-ampullary duodenal adenocarcinoma: Associations among clinicopathological, immunophenotypic and molecular features. Sci Rep 2019; 9:10526. [PMID: 31324814 PMCID: PMC6642201 DOI: 10.1038/s41598-019-46167-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 06/24/2019] [Indexed: 02/07/2023] Open
Abstract
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.
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Wang N, Bu Q, Liu Q, Yang J, He H, Liu J, Ren X, Lyu J. Effect of marital status on duodenal adenocarcinoma survival: A Surveillance Epidemiology and End Results population analysis. Oncol Lett 2019; 18:1904-1914. [PMID: 31423260 PMCID: PMC6607043 DOI: 10.3892/ol.2019.10475] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 05/23/2019] [Indexed: 12/15/2022] Open
Abstract
Numerous studies have shown that marital status may be a prognostic factor in various malignancies, but little is known about its effect on duodenal adenocarcinoma. The aim of the present study was to determine the association between marital status and survival in patients with duodenal adenocarcinoma. The Surveillance, Epidemiology and End Results database was utilized to analyze 2,018 patients who had been diagnosed with duodenal adenocarcinoma between January 2004 and December 2015. Kaplan-Meier and Cox regression analyses were also used to determine the impact of marital status on overall survival (OS) and cause-specific survival (CSS). The 5-year OS rate was higher in married patients (32.6%) compared with unmarried (26.8%) patients (P<0.001), as was the 5-year CSS rate (38.8 vs. 33.7%; P<0.001). Multivariate analysis demonstrated that marital status was an independent prognostic factor for duodenal adenocarcinoma, with married patients having improved OS (P<0.001) and CSS (P=0.001) compared with unmarried patients. Subgroup analysis showed that marital status played a role in the survival of patients at American Joint Committee on Cancer Tumor-Node-Metastasis stage I, but not of patients at stages II, III or IV. The survival outcomes for duodenal adenocarcinoma are improved in married patients compared with those in unmarried patients. Therefore, attention should be paid to the impact of social factors and socio-economic factors on unmarried patients, in order to improve their survival outcomes.
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Affiliation(s)
- Na Wang
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China.,School of Nursing and Health, Henan University, Kaifeng, Henan 475001, P.R. China
| | - Qingting Bu
- Department of Genetics, Northwest Women's and Children's Hospital, Xi'an, Shaanxi 710061, P.R. China
| | - Qingqing Liu
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China.,School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi 710061, P.R. China
| | - Jin Yang
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China.,School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi 710061, P.R. China
| | - Hairong He
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Jie Liu
- School of Nursing and Health, Henan University, Kaifeng, Henan 475001, P.R. China
| | - Xuequn Ren
- Center for Evidence-Based Medicine and Clinical Research, Huaihe Hospital of Henan University, Kaifeng, Henan 475000, P.R. China.,Department of General Surgery, Huaihe Hospital of Henan University, Kaifeng, Henan 475000, P.R. China
| | - Jun Lyu
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
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Assumpção P, Khayat A, Araújo T, Barra W, Ishak G, Cruz A, Santos S, Santos Â, Demachki S, Assumpção P, Calcagno D, Santos N, Assumpção M, Moreira F, Santos A, Assumpção C, Riggins G, Burbano R. The Small Bowel Cancer Incidence Enigma. Pathol Oncol Res 2019; 26:635-639. [PMID: 31165996 DOI: 10.1007/s12253-019-00682-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 05/31/2019] [Indexed: 11/30/2022]
Abstract
Although the small bowel is a vast organ with a highly proliferative epithelium, the incidence of small bowel cancers is surprisingly low. Many factors could be involved in this unexpected cancer incidence, including difficult access to the exploration of the small bowel mucosa, which might lead to missed diagnoses of non-obstructive and non-bleeding small tumours. Moreover, possible factors that influence the low incidence include more efficient machinery of DNA replication and DNA repair enzymes, peculiarities in microbiota components, competence of the immune system, and the speed of intestinal transit. Importantly, the answer for the enigmatic risk of driver mutations caused by replication errors may be hidden in the small bowel, which is an obscure part of digestive tract that is usually inaccessible by endoscopic or colonoscopic conventional investigations. These observations warrant the necessity of an urgent exploration of small bowel features, including the evaluation of DNA replication controls and expression of DNA repair genes, in order to shed light on these obscure events.
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Affiliation(s)
- Paulo Assumpção
- Núcleo de Pesquisas em Oncologia, Universidade Federal do Pará, Belém, 66073-000, Brazil. .,Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Pará, Belém, 66075-110, Brazil.
| | - André Khayat
- Núcleo de Pesquisas em Oncologia, Universidade Federal do Pará, Belém, 66073-000, Brazil
| | - Taíssa Araújo
- Núcleo de Pesquisas em Oncologia, Universidade Federal do Pará, Belém, 66073-000, Brazil
| | - Williams Barra
- Núcleo de Pesquisas em Oncologia, Universidade Federal do Pará, Belém, 66073-000, Brazil
| | - Geraldo Ishak
- Núcleo de Pesquisas em Oncologia, Universidade Federal do Pará, Belém, 66073-000, Brazil
| | - Aline Cruz
- Núcleo de Pesquisas em Oncologia, Universidade Federal do Pará, Belém, 66073-000, Brazil
| | - Sidney Santos
- Núcleo de Pesquisas em Oncologia, Universidade Federal do Pará, Belém, 66073-000, Brazil
| | - Ândrea Santos
- Núcleo de Pesquisas em Oncologia, Universidade Federal do Pará, Belém, 66073-000, Brazil
| | - Samia Demachki
- Núcleo de Pesquisas em Oncologia, Universidade Federal do Pará, Belém, 66073-000, Brazil
| | - Paula Assumpção
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Pará, Belém, 66075-110, Brazil
| | - Danielle Calcagno
- Núcleo de Pesquisas em Oncologia, Universidade Federal do Pará, Belém, 66073-000, Brazil
| | - Ney Santos
- Núcleo de Pesquisas em Oncologia, Universidade Federal do Pará, Belém, 66073-000, Brazil
| | - Mônica Assumpção
- Serviço de Endoscopia Digestiva, Hospital Universitário João de Barros Barreto, Belém, 66073-000, Brazil
| | - Fabiano Moreira
- Núcleo de Pesquisas em Oncologia, Universidade Federal do Pará, Belém, 66073-000, Brazil
| | - André Santos
- Programa de Pós-Graduação em Genética e Biologia Molecular, Universidade Federal do Pará, Belém, 66075-110, Brazil
| | - Carolina Assumpção
- Serviço de Cirurgia Oncológica, Hospital Alemão Oswaldo Cruz, São Paulo, 01327-001, Brazil
| | - Gregory Riggins
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, 21287, USA
| | - Rommel Burbano
- Laboratório de Biologia Molecular, Hospital Ophir Loyola, Belém, 66060-281, Brazil
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Mann K, Gilbert T, Cicconi S, Jackson R, Whelan P, Campbell F, Halloran C, Neoptolemos J, Ghaneh P. Tumour stage and resection margin status are independent survival factors following partial pancreatoduodenectomy for duodenal adenocarcinoma. Langenbecks Arch Surg 2019; 404:439-449. [PMID: 30972486 PMCID: PMC6614162 DOI: 10.1007/s00423-019-01779-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 03/20/2019] [Indexed: 01/14/2023]
Abstract
INTRODUCTION There is limited published evidence on duodenal carcinoma due to its rarity. This study aimed to evaluate gastric outlet obstruction and obstructive jaundice along with pathological variables as survival factors in patients with duodenal adenocarcinoma following resection. METHODS Survival factor analysis was undertaken in patients undergoing duodenal cancer surgery from 1997 to 2015 in a single centre. RESULTS There were 57 patients of whom 18 had gastric outlet obstruction and 14 had obstructive jaundice. Fifty-three had a partial pancreatoduodenectomy and four had palliative bypass. Perioperative mortality and morbidity were 4% (2/53) and 47% (25/53) respectively in resected patients. With a median (95% confidence interval, CI) follow-up of 72 (57-86) months, median overall and recurrence-free survival was 38 months (95% CI 28-113) and 27 months (95% CI 18-83) respectively. The 1 and 3-year overall survival rates were 84% (95% CI 74-95) and 52% (95% CI 39-69) respectively. Median overall survival was 19 months in patients with gastric outlet obstruction vs 53 months in those without (p = 0.026) and 28 months in patients with obstructive jaundice vs 38 months in those without (p = 0.611). Univariate analysis revealed that tumour stage, resection margin status, pre-operative albumin status, gastric outlet obstruction and age were associated with poorer overall and recurrence-free survival but multivariate analysis confirmed only tumour stage and resection margin status to be significant. CONCLUSION Whereas gastric outlet obstruction in duodenal cancer appeared to be an important survival factor following partial pancreatoduodenectomy, multivariate analysis showed that only tumour stage and resection margin status were the key independent survival factors. Further multicentre studies are required to elucidate further characteristics of duodenal carcinoma and develop neoadjuvant/adjuvant management strategies.
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Affiliation(s)
- Kulbir Mann
- Department of Molecular and Clinical Cancer Medicine, Institution of Translational Medicine, University of Liverpool, 2nd Floor Sherrington Building, Ashton Street, Liverpool, L69 3GE, UK.
| | - T Gilbert
- Department of Molecular and Clinical Cancer Medicine, Institution of Translational Medicine, University of Liverpool, 2nd Floor Sherrington Building, Ashton Street, Liverpool, L69 3GE, UK
| | - S Cicconi
- Statistics and Bioinformatics Unit, Cancer Research UK Liverpool Cancer Trials Unit, University of Liverpool, Block C, Waterhouse Building, 1-3 Brownlow Street, Liverpool, L69 3GL, UK
| | - R Jackson
- Statistics and Bioinformatics Unit, Cancer Research UK Liverpool Cancer Trials Unit, University of Liverpool, Block C, Waterhouse Building, 1-3 Brownlow Street, Liverpool, L69 3GL, UK
| | - P Whelan
- Department of Surgery, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK
| | - F Campbell
- Department of Pathology, Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK
| | - C Halloran
- Department of Molecular and Clinical Cancer Medicine, Institution of Translational Medicine, University of Liverpool, 2nd Floor Sherrington Building, Ashton Street, Liverpool, L69 3GE, UK
| | - J Neoptolemos
- Department of Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - P Ghaneh
- Department of Molecular and Clinical Cancer Medicine, Institution of Translational Medicine, University of Liverpool, 2nd Floor Sherrington Building, Ashton Street, Liverpool, L69 3GE, UK
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Cumberledge JD, Anaka I, Kupec JT. Rare case of small intestine bleeding. BMJ Case Rep 2019; 12:12/1/e227184. [PMID: 30700455 DOI: 10.1136/bcr-2018-227184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present a case of a healthy 59-year-old woman who presented for a capsule endoscopy to evaluate melaena and iron deficiency anaemia. She had previously underwent an oesophagogastroduodenoscopy and colonoscopy at an outside institution which were unremarkable. Capsule endoscopy showed an ulcerated, bleeding lesion likely in the duodenum. Differential diagnosis included adenocarcinoma, carcinoid tumour, lymphoma, gastrointestinal stromal tumour and metastatic disease. A push enteroscopy was performed after which showed an ulcerated mass in the third portion of the duodenum. Biopsies confirmed adenocarcinoma. Computed tomography of the abdomen showed no signs of distant metastasis and the patient was referred to surgery for evaluation. The patient underwent a pancreaticoduodenectomy, with resection of the mass and negative lymph nodes in all nine that were removed (T3N0). The patient was classified as stage II duodenal adenocarcinoma. Duodenal adenocarcinoma is a rare but clinically significant cause of small bowel bleeding.
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Affiliation(s)
- Jeremy D Cumberledge
- Department of Medicine, Section of Digestive Diseases, West Virginia University Hospitals, Morgantown, West Virginia, USA
| | - Ikenna Anaka
- Department of Medicine, Section of Digestive Diseases, West Virginia University Hospitals, Morgantown, West Virginia, USA
| | - Justin T Kupec
- Department of Medicine, Section of Digestive Diseases, West Virginia University Hospitals, Morgantown, West Virginia, USA
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Abstract
Small bowel adenocarcinoma is a clinically and anatomically distinct gastrointestinal cancer that lacks prospective data to support its optimal management. Patients with inflammatory bowel disease and inherited conditions that cause gastrointestinal polyps are at especially high risk. Due to a lack of effective surveillance programs resulting in missed or delayed diagnoses only when symptoms develop, this disease is generally discovered at an advanced stage. Surgical resection is the only treatment modality with a chance of cure. Currently accepted treatment considerations are often generalized from large bowel and pancreatic-biliary cancers, due to some anatomic and clinical parallels. Additional research, however, is desperately needed to characterize the unique molecular differences of this disease to better prognosticate patients and establish rational clinical trials that would improve their outcomes.
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Affiliation(s)
- Emerson Y Chen
- Division of Hematology and Medical Oncology, Department of Medicine, Knight Cancer Institute, Oregon Health & Sciences University, Portland, Oregon
| | - Gina M Vaccaro
- Division of Hematology and Medical Oncology, Department of Medicine, Knight Cancer Institute, Oregon Health & Sciences University, Portland, Oregon
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50
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Chang ES, Lin DSC, Hou MC, Chen CY. Incidental endoscopic findings of a rare gastric neuroendocrine carcinoma concurrent with an uncommon primary duodenal adenocarcinoma: A case report. ADVANCES IN DIGESTIVE MEDICINE 2018. [DOI: 10.1002/aid2.13088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- En-Su Chang
- Division of Gastroenterology and Hepatology, Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- Faculty of Medicine; National Yang-Ming University School of Medicine; Taipei Taiwan
| | - Diego S.-C. Lin
- Department of Pathology and Laboratory Medicine; Taipei Veterans General Hospital; Taipei Taiwan
| | - Ming-Chih Hou
- Division of Gastroenterology and Hepatology, Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- Faculty of Medicine; National Yang-Ming University School of Medicine; Taipei Taiwan
| | - Chih-Yen Chen
- Division of Gastroenterology and Hepatology, Department of Medicine; Taipei Veterans General Hospital; Taipei Taiwan
- Faculty of Medicine; National Yang-Ming University School of Medicine; Taipei Taiwan
- Taiwan Association for the Study of Small Intestinal Diseases; Taoyuan Taiwan
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