1
|
García García MD, Galván Fernández MD, Mouhtar El Halabi SA, Machuca Aguado J, Argüelles-Arias F. Unusual presentation of jejunal adenocarcinoma and ovarian metastasis. Rev Esp Enferm Dig 2024; 116:225-226. [PMID: 37170586 DOI: 10.17235/reed.2023.9658/2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
It is rare to find a small bowel tumour presenting as intestinal obstruction. This type of cancer is an extremely unusual condition often misdiagnosed until late stages. We report the case of a patient with persistent vomiting secondary to an obstructing jejunal adenocarcinoma not related to intestinal bowel disease. After resection and chemotherapy treatment a huge mass was detected in the left ovary. The anatomopathological findings confirmed a metastatic cancer consequent to the jejunal adenocarcinoma previously resected. This case illustrates a successful outcome of a jejunal adenocarcinoma with very poor prognosis after a extremely unusual ovarian metastasis. It is highly important to suspect other causes than intestinal bowel disease when doing a differential diagnosis in a young patient presenting with clinical symptoms of intestinal obstruction.
Collapse
|
2
|
Gonçalves M, Silva JS, Rebelo A. Germ cell tumor with duodenal involvement: a rare case of gastrointestinal bleeding. Rev Esp Enferm Dig 2024; 116:118-119. [PMID: 36412989 DOI: 10.17235/reed.2022.9327/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
A 19-year-old male presented to the emergency department with a 7-day history of melena, anorexia and asthenia. Blood tests revealed a hemoglobin of 5.8 g/dL. Upper endoscopy showed a large ulcerated and stenosing lesion in the duodenum. The histologic examination of the biopsy specimen showed a neoplasia with epithelioid cells, accentuated atypia and pleomorphism, expressing MNF 116 cytokeratin, CD30, glypican 3 and alpha-fetoprotein on immunohistochemistry, suggesting of a germ cell tumor metastasis.
Collapse
|
3
|
Duan J, Wang X, Xu C, Guo R. The Brunner adenoma of the duodenum with positive fecal occult blood and anemia: A case report. Medicine (Baltimore) 2024; 103:e36737. [PMID: 38181268 PMCID: PMC10766290 DOI: 10.1097/md.0000000000036737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/30/2023] [Indexed: 01/07/2024] Open
Abstract
RATIONALE Brunner gland adenoma (BGA) is a rare benign duodenal tumor that is an adenomatoid lesion in nature rather than an actual tumor. Patients with different adenoma sizes have various clinical manifestations with nonspecific clinical symptoms. Here, We report a case of BGA with black stool and anemia as the primary manifestations. PATIENT CONCERNS A young female patient was admitted to the hospital because of black stool and anemia. Endoscopic surgery was performed to a definitive diagnosis, and endoscopic tumor-like lesions were resected. DIAGNOSIS The patient was diagnosed with duodenal Brunner adenoma and received related treatment. OUTCOMES After treatment, the patient symptoms improved, and he was discharged. LESSONS Brunner adenoma of the duodenum is a rare benign duodenum tumor. This report paper describes a case of BGA with black stool and anemia as the primary manifestations, followed by endoscopic resection and treatment. The literature on Brunner adenoma of the duodenum has been analyzed and discussed. Clinicians should pay attention to differentiating the disease based on atypical symptoms.
Collapse
Affiliation(s)
- Junwei Duan
- Changchun University of Chinese Medicine Changchun, Changchun, Jilin, China
| | - Xiaoyan Wang
- The First Clinical Hospital of Jilin Academy of Chinese Medicine, Changchun, Jilin, China
| | - Chenxi Xu
- The First Clinical Hospital of Jilin Academy of Chinese Medicine, Changchun, Jilin, China
| | - Rongxin Guo
- Changchun University of Chinese Medicine Changchun, Changchun, Jilin, China
| |
Collapse
|
4
|
Kinoshita U, Kawase T, Yanagimoto Y, Odagiri K, Yamashita M, Takeyama H, Suzuki Y, Ikenaga M, Shimizu J, Imamura H, Tomita N, Dono K. [A Case Report of SOX Therapy for an Elderly Patient with Hemorrhagic Primary Duodenal Carcinoma]. Gan To Kagaku Ryoho 2023; 50:1777-1779. [PMID: 38303204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
BACKGROUND Although pancreatoduodenectomy is recommended as a radical surgery for duodenal carcinoma, it has been reported that pancreatoduodenectomy in elderly patients has a high risk of surgical complications. CASE PRESENTATION A man in his 80's was diagnosed with advanced duodenal carcinoma, presenting with anemia(Hb 5.4 g/dL). Computed tomography scanning showed wall thickening in the descending leg of the duodenum, pancreatic invasion was suspected, and clinical diagnosis was Stage ⅡB(cT4N0M0). Although radical surgery was possible, the patient refused surgery considering the risks of surgical complications. The gastroduodenal bypass surgery was performed to control bleeding, and the patient was treated with S-1 plus oxaliplatin(SOX; S-1 100 mg/body, days 1-14; oxaliplatin 100 mg/m2, day 1 q21 days). After 6 courses of the SOX regimen, the wall thickening of duodenum disappeared, and SOX was switched to S-1 monotherapy (S-1 100 mg/body, days 1-28, q42 days)according to Grade 2 thrombocytopenia and decreased performance status. After 11 courses of S-1, upper gastrointestinal endoscopy showed that the tumor had disappeared, the biopsy of duodenum showed no evidence of malignancy, and chemotherapy was terminated. The patient has been followed up for 7 months without recurrence. CONCLUSIONS SOX for elderly patient showed efficacy against hemorrhagic duodenal carcinoma.
Collapse
|
5
|
Moreta Rodríguez M, Fernández Prada SJ, Maroto Martin C, Martínez Ortega A, Madrigal Rubiales B, de la Serna Higuera C. Biliary obstruction secondary to duodenal follicular lymphoma with papillary involvement. Rev Esp Enferm Dig 2023; 115:663-665. [PMID: 37882167 DOI: 10.17235/reed.2023.9929/2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
Duodenal-type follicular lymphoma is a clinical variant of follicular lymphoma located in the intestine, presenting as multiple small polyps. The estimated frequency is 1/7000 people and extraduodenal involvement is rare. It predominantly affects middle-aged women, although some cases of young patients have been published in the literature. They are usually located in the second periampullary portion of the duodenum. It is diagnosed incidentally or after performing an imaging test due to non-specific digestive symptoms (abdominalgia, diarrhea or hyporexia). The prognosis is usually favorable without specific treatment5.
Collapse
|
6
|
Vara-Luiz F, Nunes G, Oliveira C, Mendes I, Dahlstedt-Ferreira C, Currais P, Pinto-Marques P, Fonseca J. Duodenal angiolipoma: a rare tumor causing recurrent upper gastrointestinal bleeding. Rev Esp Enferm Dig 2023; 115:674-675. [PMID: 37314137 DOI: 10.17235/reed.2023.9744/2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Duodenal angiolipoma is a rare adipocytic tumor, with non-specific symptoms precluding an early diagnosis. We present a case of a 67-year-old female admitted due to upper gastrointestinal bleeding. The upper endoscopy and endoscopic ultrasound evaluation showed a subepithelial lesion in the third portion of the duodenum. Endoscopic excision was performed using a standard polypectomy technique after endoloop placement. Histopathology was compatible with duodenal angiolipoma. The authors highlight duodenal angiolipoma as a rare adipocytic tumor potentially causing gastrointestinal bleeding, which can be safely treated with endoscopic excision.
Collapse
Affiliation(s)
| | | | | | - Ivo Mendes
- Gastroentererology, Hospital Garcia de Orta
| | | | - Pedro Currais
- Gastroenterology, Instituto Português de Oncologia de Lisboa Francisco Gentil
| | | | | |
Collapse
|
7
|
Karstensen JG, Bülow S, Højen H, Jelsig AM, Jespersen N, Andersen KK, Wewer MD, Burisch J, Pommergaard HC. Cancer in Patients With Familial Adenomatous Polyposis: A Nationwide Danish Cohort Study With Matched Controls. Gastroenterology 2023; 165:573-581.e3. [PMID: 37201686 DOI: 10.1053/j.gastro.2023.05.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/25/2023] [Accepted: 05/02/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND & AIMS Familial adenomatous polyposis (FAP) is a hereditary disorder that predisposes patients to colorectal cancer (CRC). Prophylactic colectomy has greatly reduced the risk of CRC. However, new associations between FAP and the risk of other cancers have subsequently emerged. In this study, we assessed the risk of specific primary and secondary cancers among patients with FAP compared with matched controls. METHODS All known patients with FAP up until April 2021 were identified in the nationwide Danish Polyposis Register and paired with 4 unique controls matched by birth year, sex, and postal code. The risk of overall cancers, specific cancer types, and risk of a second primary cancer was assessed and compared with controls. RESULTS The analysis included 565 patients with FAP and 1890 controls. The overall risk of cancer was significantly higher for patients with FAP than for controls (hazard ratio [HR], 4.12; 95% confidence interval [CI], 3.28-5.17; P < .001). The increased risk was mainly due to CRC (HR, 4.61; 95% CI, 2.58-8.22; P < .001), pancreatic cancer (HR, 6.45; 95% CI, 2.02-20.64; P = .002), and duodenal/small-bowel cancer (HR, 14.49; 95% CI, 1.76-119.47; P = .013), whereas no significant difference was observed for gastric cancer (HR, 3.29; 95% CI, 0.53-20.23; P = .20). Furthermore, the risk of a second primary cancer was significantly higher for patients with FAP (HR, 1.89; 95% CI, 1.02-3.50; P = .042). Between 1980 and 2020, the risk of cancer among patients with FAP decreased by ∼50%. CONCLUSIONS Despite an absolute reduction in the risk of developing cancer among patients with FAP, the risk remained significantly higher than for the background population due to colorectal, pancreatic, and duodenal/small-bowel cancers.
Collapse
Affiliation(s)
- John Gásdal Karstensen
- Danish Polyposis Register, Gastro Unit, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Steffen Bülow
- Danish Polyposis Register, Gastro Unit, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark
| | - Helle Højen
- Danish Polyposis Register, Gastro Unit, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark
| | - Anne Marie Jelsig
- Department of Clinical Genetics, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Niels Jespersen
- Danish Polyposis Register, Gastro Unit, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark
| | | | - Mads Damsgaard Wewer
- Danish Polyposis Register, Gastro Unit, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark; Gastro Unit, Medical Division, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark
| | - Johan Burisch
- Danish Polyposis Register, Gastro Unit, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark; Gastro Unit, Medical Division, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark
| | - Hans Christian Pommergaard
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Surgery and Transplantation, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| |
Collapse
|
8
|
Iwata K, Kato M, Sasaki M, Miyazaki K, Kubosawa Y, Masunaga T, Mizutani M, Hayashi Y, Takatori Y, Matsuura N, Nakayama A, Takabayashi K, Kanai T, Yahagi N. Intensive endoscopic resection strategy for multiple duodenal polyposis associated with familial adenomatous polyposis. J Gastroenterol Hepatol 2023; 38:1592-1597. [PMID: 37423767 DOI: 10.1111/jgh.16281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/10/2023] [Accepted: 06/22/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND AND AIM Multiple duodenal polyposis associated with familial adenomatous polyposis (FAP) is a high risk of duodenal cancer development. We evaluated the feasibility of intensive endoscopic resection that is a comprehensive treatment strategy combining multiple kinds of endoscopic treatments. METHODS This is a retrospective observational study. From January 2012 to July 2022, a total of 28 consecutive patients in FAP who underwent endoscopic resection for multiple duodenal polyposis more than twice were included. Various endoscopic treatments, such as cold polypectomy (CP), endoscopic mucosal resection (EMR), underwater EMR (UEMR), endoscopic submucosal dissection (ESD), and endoscopic papillectomy (EP), were applied depending on lesions size and location. We evaluated individual information from patients' medical records, including patient characteristics, lesion characteristics, details of endoscopic treatment, pathologic findings, and Spigelman index (SI). We compared the differences in the number of treatments and observation periods with and without SI decrease. RESULTS A total of 1040 lesions were removed by 138 sessions of endoscopic resections. The median follow-up period was 3.2 years. At the beginning of the endoscopic intervention, median SI was 9 (6-11) and the proportion of Spigelman stage (SS) IV was 61%. Repeated endoscopic treatments finally reduced SI in 26 patients (93%), and the proportion of SS IV significantly decreased to 13% with every endoscopic treatment. The mean SI change was -4.2 points per year (95% confidence interval: -0.6 to -5.9). There were no patients required surgical duodenectomy during the follow-up period. CONCLUSION Intensive resection has a potential of downstaging duodenal lesions associated with FAP.
Collapse
Affiliation(s)
- Kentaro Iwata
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Motohiko Kato
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Motoki Sasaki
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Kurato Miyazaki
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yoko Kubosawa
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Teppei Masunaga
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Mari Mizutani
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yukie Hayashi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
- Center for Diagnostic and Therapeutic Endoscopy, School of Medicine, Keio University, Tokyo, Japan
| | - Yusaku Takatori
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Noriko Matsuura
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Atsushi Nakayama
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Kaoru Takabayashi
- Center for Diagnostic and Therapeutic Endoscopy, School of Medicine, Keio University, Tokyo, Japan
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Naohisa Yahagi
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| |
Collapse
|
9
|
Trpchevska EN, Todorovska B, Todorovska MB, Trajkovska M, Nikolova D, Dzambaz D, Deriban G, Licoska-Josifovikj F. Testicular Mixed Germ Cell Tumor Presenting with Upper Gastrointestinal Bleeding: A Case Report. Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2023; 44:47-52. [PMID: 37453124 DOI: 10.2478/prilozi-2023-0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Testicular mixed germ cell tumors (TMGCTs) are aggressive neoplasms that often have metastases at the time of diagnosis, primarily in the lungs, bones, and brain. Gastrointestinal metastases are rare, occurring in less than 5% of cases, while duodenal involvement is extremely rare, with only few reported cases. Furthermore, gastrointestinal bleeding is an atypical initial presentation of metastatic TMGCTs. Herein, we present a very rare case of upper gastrointestinal bleeding caused by a duodenal metastasis of a TMGCT in a 24-year-old man. The patient was admitted to our hospital due to abdominal pain and melena with a hemoglobin level of 52 g/L. He had no history of testicular swelling, or any other symptoms or signs of a testicular tumor. Upper gastrointestinal endoscopy revealed a duodenal tumor mass with irregular bleeding, and abdominal ultrasound and computed tomography showed a duodenal mass that infiltrate retroperitoneum. Emergency surgery was performed, and the histopathological findings of the resected specimen were consistent with TMGCT metastasis. Subsequently, a testicular tumor was confirmed and surgically removed; however, multiple metastatic deposits were observed in the lungs. Due to the patient's poor general condition, chemotherapy was not performed. The patient died 3 months after the initial diagnosis. This case suggests that, although duodenal metastatic TMGCTs are rare, they should be considered in the differential diagnosis of gastrointestinal bleeding in young male patients.
Collapse
Affiliation(s)
- Emilija Nikolovska Trpchevska
- 1University Clinic of Gastroenterohepatology, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, RN Macedonia
| | - Beti Todorovska
- 1University Clinic of Gastroenterohepatology, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, RN Macedonia
| | | | - Meri Trajkovska
- 1University Clinic of Gastroenterohepatology, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, RN Macedonia
| | - Dafina Nikolova
- 1University Clinic of Gastroenterohepatology, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, RN Macedonia
| | - Darko Dzambaz
- 3University Clinic of Digestive Surgery, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, RN Macedonia
| | - Gjorgji Deriban
- 1University Clinic of Gastroenterohepatology, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, RN Macedonia
| | - Fana Licoska-Josifovikj
- 1University Clinic of Gastroenterohepatology, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, RN Macedonia
| |
Collapse
|
10
|
Severin S, Terrones Munoz V, Meert N, Peche R. [Duodenal bleeding due to metastasis from lung adenocarcinoma controlled by radiotherapy: A case report and literature review]. Rev Mal Respir 2023; 40:359-365. [PMID: 36868976 DOI: 10.1016/j.rmr.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 01/31/2023] [Indexed: 03/05/2023]
Abstract
INTRODUCTION Gastrointestinal (GI) metastases in lung cancer rarely occur. CASE REPORT We report here the case of a 43-year-old male active smoker who was admitted to our hospital for cough, abdominal pain and melena. Initial investigations revealed poorly differentiated adenocarcinoma of the superior-right lobe of the lung: positive for thyroid transcription factor-1 and negative for protein p40 and for antigen CD56, with peritoneal, adrenal and cerebral metastasis, as well as anemia requiring major transfusion support. Over 50% of cells were positive for PDL-1, and ALK gene rearrangement was detected. GI endoscopy showed a large ulcerated nodular lesion of the genu superius with active intermittent bleeding, as well as an undifferentiated carcinoma with positivity for CK AE1/AE3 and TTF-1, and negativity for CD117, corresponding to metastatic invasion originating from lung carcinoma. Palliative immunotherapy with pembrolizumab was proposed, followed by targeted therapy with brigatinib. Gastrointestinal bleeding was controlled with a single 8Gy dose of haemostatic radiotherapy. CONCLUSION GI metastases are rare in lung cancer and present nonspecific symptoms and signs but no characteristic endoscopic features. GI bleeding is a common revelatory complication. Pathological and immunohistological findings are critical to diagnosis. Local treatment is usually guided by the occurrence of complications. In addition to surgery and systemic therapies, palliative radiotherapy may contribute to bleeding control. However, it must be used cautiously, given a present-day lack of evidence and the pronounced radiosensitivity of certain gastrointestinal tract segments.
Collapse
Affiliation(s)
- S Severin
- Département de Médecine Interne, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgique.
| | - V Terrones Munoz
- Service de Pneumologie, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgique
| | - N Meert
- Service de Radiothérapie, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgique
| | - R Peche
- Service de Pneumologie, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgique
| |
Collapse
|
11
|
Veisman I, Oppenheim A, Sub laban Z, Kenig A, Ukashi O, Shacham-Shmueli E, Engel T, Kopylov U, Ben-Horin S, Lang A. Disproportionately Low Albumin and High Neutrophil-to-Lymphocyte Ratio in Small Bowel Adenocarcinoma Patients With Long-Duration Crohn's Disease. Clin Transl Gastroenterol 2023; 14:e00553. [PMID: 36449698 PMCID: PMC9945550 DOI: 10.14309/ctg.0000000000000553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 11/16/2022] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Although Crohn's disease (CD) is a known risk factor of small bowel adenocarcinoma (SBA), early diagnosis remains a significant clinical challenge. Identification of biomarkers for SBA may lead to early detection. METHODS This is a retrospective study comparing albumin levels and neutrophil-to-lymphocyte ratio (NLR) of patients with long-standing CD who underwent small bowel resection with and without malignancy. RESULTS Forty-two patients with CD were included in this study (11 with SBA). Median NLR before surgery was 8.5 (interquartile range 6.2-31.3) in patients with SBA and 3.8 (interquartile range 2.8-5.3) for patients without SBA ( P < 0.05). Mean albumin levels before surgery were significantly lower among patients with SBA compared with patients without SBA (2.6 ± 0.6 g/dL vs 3.5 ± 0.6 g/dL, respectively, P < 0.05), despite patients with SBA being under longer total parenteral nutrition treatment duration. DISCUSSION CD patients with SBA diagnosis have increased NLR and lower albumin before surgery compared with CD patients without detection of SBA.
Collapse
Affiliation(s)
- Ido Veisman
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Amit Oppenheim
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Internal Medicine A, Sheba Medical Center, Tel Hashomer, Israel
| | - Zuheir Sub laban
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Internal Medicine A, Sheba Medical Center, Tel Hashomer, Israel
| | - Ariel Kenig
- Faculty of Medicine, the Hebrew University, Jerusalem, Israel
- Oncology Department, Sheba Medical Center, Tel Hashomer, Israel
| | - Offir Ukashi
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Internal Medicine A, Sheba Medical Center, Tel Hashomer, Israel
| | - Einat Shacham-Shmueli
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Medicine, Hadassah Medical Center, Jerusalem, Israel
| | - Tal Engel
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Uri Kopylov
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shomron Ben-Horin
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Alon Lang
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| |
Collapse
|
12
|
Shmais M, Dagher H, Sharara AI. Multiple Duodenal Polyps in a Young Patient With Liver Cirrhosis. Mayo Clin Proc 2023; 98:222-223. [PMID: 36737112 DOI: 10.1016/j.mayocp.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/21/2022] [Accepted: 10/10/2022] [Indexed: 02/05/2023]
Affiliation(s)
- Manar Shmais
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - Hassan Dagher
- Department of Pathology and Laboratory Medicine, American University of Beirut, Beirut, Lebanon
| | - Ala I Sharara
- Division of Gastroenterology and Hepatology, American University of Beirut Medical Center, Beirut, Lebanon; Duke University Medical Center, Durham, NC.
| |
Collapse
|
13
|
Nagy GA, Neag MA, Drasovean R, Crisan D, Chira RI. Duodenal Ampulla Neuroendocrine Tumor with GISTs of the Proximal Jejunum: A Case Report. Int J Mol Sci 2022; 23:ijms231810351. [PMID: 36142264 PMCID: PMC9499482 DOI: 10.3390/ijms231810351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 09/01/2022] [Accepted: 09/02/2022] [Indexed: 11/29/2022] Open
Abstract
Neuroendocrine tumors (NEN) are a type of heterogenous, slow-growing tumors, that only in about half of the cases can be found in the gastrointestinal tract. Half of these is in the small intestine. The ampullary NENs are rare, accounting for less than 1% of gastroenteropancreatic NENs. Gastrointestinal stromal tumors (GIST) are a more common type of tumors of the gastrointestinal tract that consist of pacemaker cells. The occurrence of both tumors simultaneously is rare, but in patients with neurofibromatosis type 1, the co-existence of NEN and GIST is more often. Here we report a case of simultaneous occurrence of a well-differentiated NEN and a GIST in a patient without neurofibromatosis. Also, we provide a short review of the current knowledge and treatment strategies regarding these tumors.
Collapse
Affiliation(s)
- Georgiana Anca Nagy
- Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
- Department of Gastroenterology, Emergency Clinical County Hospital, 400006 Cluj-Napoca, Romania
| | - Maria Adriana Neag
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Iuliu Hatieganu University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania
- Correspondence:
| | - Radu Drasovean
- Department of Surgery, Iuliu Hatieganu University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
| | - Doinita Crisan
- Department of Pathology, Iuliu Hatieganu University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
| | - Romeo Ioan Chira
- Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
- Department of Gastroenterology, Emergency Clinical County Hospital, 400006 Cluj-Napoca, Romania
| |
Collapse
|
14
|
Giordano A, Moroni F, Di Filippo G, Cammelli F, Baraghini M, Giudicissi R, Vellei S, Feroci F, Cantafio S. Emergency duodenal resection for giant GIST with acute gastrointestinal bleeding A case report. Ann Ital Chir 2021; 10:S2239253X21036707. [PMID: 34738535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Gastrointestinal stromal tumors (GISTs) are rare tumors of the gastrointestinal tract, which cover about 1-2% of gastrointestinal neoplasms. They are more common in the stomach (40-60%) while a minor part in jejunum/ileus (25- 30%), duodenum (<5%), colorectal (5-15%) and esophagus (<1%). The clinical presentation depends on the primary localization of the neoplasma and tumor size, however in 18% it is asymptomatic. Gastrointestinal bleeding is the most dangerous complication, often necessitating emergency surgery and represents a common symptom of duodenal GIST. We present a case of a 82-year-old male presented with abdominal pain, asthenia and melena with haemodynamically stable. The patient underwent a recent coronary angioplasty and currently on double antiplatelet therapy. During observation a palpable mass was detected in the periumbilical region and right hypochondrium. A superior digestive endoscopy was performed which revealed an ab estrinseco compression of second duodenal segment and bleeding of third duodenal mucosa segment. No local haemostasis could be accomplished. An Angio-CT showed a large exophytic tumor arising from the 3th duodenal segment with approximately 13x9 cm, with apparent intratumoral bleeding. No indication for possible angioembolization. Due to gradual modification of the haemodynamic , the patient was submitted to emergency laparotomy. A segmental enterectomy was performed and the post-operative period ran without complications. The histopathologic exam showed a gastro-intestinal stromal tumor of epithelioid cell nature with low mitotic count (2 per 50HPF). The immunohistochemical analysis revealed positivity for CD117 (c-Kit) and DOG1 with Ki67<1%. KEY WORDS: Bleeding, Duodenal GIST, Gastrointestinal, Gastrointestinal stromal tumor.
Collapse
|
15
|
Liang M, Liwen Z, Jianguo S, Juan D, Ting S, Jianping C. A case report of endoscopic resection for the treatment of duodenal Brunner's gland adenoma with upper gastrointestinal bleeding. Medicine (Baltimore) 2020; 99:e23047. [PMID: 33350721 PMCID: PMC7769294 DOI: 10.1097/md.0000000000023047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 09/26/2020] [Accepted: 10/06/2020] [Indexed: 01/09/2023] Open
Abstract
RATIONALE Gastrointestinal bleeding as the first sign of Brunner's gland adenoma (BGA) is an extremely rare, and its clinical features and treatment methods have not been well described. PATIENT CONCERNS We described a 81-year-old female patient with coronary artery disease and chronic atrial fibrillation presenting with presenting with gastrointestinal bleeding requiring blood transfusion. DIAGNOSES The diagnosis of our case mainly refered to radiologic imaging and endoscopic examination. Histological result was compatible with BGA. INTERVENTIONS This mass lesion (6 × 7 cm diameter) was successfully totally removed by endoscopic submucosal dissection (ESD) for more than three hours. OUTCOMES The patient was followed up for 6 months to date without recurrence. LESSONS Endoscopic removal is considered as a safe and low-risk treatment for elderly patients with severe underlying diseases presenting with gastrointestinal bleeding.
Collapse
Affiliation(s)
- Ma Liang
- Department of Digestive Disease, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University
| | - Zhang Liwen
- Department of Pediatrics, the Second People's Hospital of Changzhou, Affiliate Hospital of NanJing medical University, Changzhou, Jiangsu
| | - Song Jianguo
- Department of Gastroenterology, The People's Hospital of Wuqia, Xin Jiang, China
| | - Dai Juan
- Department of Digestive Disease, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University
| | - Shen Ting
- Department of Digestive Disease, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University
| | - Chen Jianping
- Department of Digestive Disease, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University
| |
Collapse
|
16
|
Abstract
About 30% of patients with MEN1 develop a Zollinger-Ellison syndrome. Meanwhile it is well established that the causative gastrinomas are almost exclusively localized in the duodenum and not in the pancreas, MEN1 gastrinomas occur multicentric and are associated with hyperplastic gastrin cell lesions and tiny gastrin-producing micro tumors in contrast to sporadic duodenal gastrinomas. Regardless of the high prevalence of early lymphatic metastases, the survival is generally good with an aggressive course of disease in only about 20% of patients. Symptoms can be controlled medically. The indication, timing, type, and extent of surgery are highly controversial and are discussed in detail in this article by a thorough and critical review of literature. More radical procedures, like partial pancreaticoduodenectomy, are weighed against less aggressive local excision of gastrinomas and the pros and cons of both approaches are discussed in terms of long-term morbidity, biochemical cure, and survival.
Collapse
Affiliation(s)
- Max B Albers
- Department of Visceral, Thoracic, and Vascular Surgery, Philipps University Marburg, Baldingerstr, 35037 Marburg, Germany.
| | - Jerena Manoharan
- Department of Visceral, Thoracic, and Vascular Surgery, Philipps University Marburg, Baldingerstr, 35037 Marburg, Germany
| | - Detlef K Bartsch
- Department of Visceral, Thoracic, and Vascular Surgery, Philipps University Marburg, Baldingerstr, 35037 Marburg, Germany
| |
Collapse
|
17
|
Seitter S, Copeland-Halperin L, Younan G. Incidental Finding of Benign Meyenburg Complexes. Clin Gastroenterol Hepatol 2019; 17:A28. [PMID: 29730437 DOI: 10.1016/j.cgh.2018.04.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 04/20/2018] [Accepted: 04/24/2018] [Indexed: 02/07/2023]
|
18
|
Sato J, Ishiwatari H, Ashida R, Sasaki K, Fujie S, Kaneko J, Satoh T, Matsubayashi H, Kishida Y, Yoshida M, Ito S, Kawata N, Imai K, Kakushima N, Takizawa K, Hotta K, Uesaka K, Ono H. Primary non-ampullary duodenal follicular lymphoma presenting with obstructive jaundice. Clin J Gastroenterol 2019; 13:214-218. [PMID: 31401784 DOI: 10.1007/s12328-019-01033-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 08/05/2019] [Indexed: 12/29/2022]
Abstract
Primary gastrointestinal follicular lymphoma is a rare disease. Follicular lymphoma does not cause any typical symptoms, although it usually shows the presence of multiple white granules on endoscopy. Few patients with follicular lymphoma present with the initial symptom of jaundice, which is usually associated with follicular lymphomas located in the papilla of Vater. Herein, we present the first case of a duodenal follicular lymphoma that presented with obstructive jaundice despite not being located in the ampulla, and it did not demonstrate the typical endoscopic findings of multiple white granules. A 72-year-old Japanese man with jaundice was referred to our hospital. Imaging revealed a hypovascular lesion extending into the second part of the duodenum and the pancreatic head, and the common bile duct was dilated upstream of the lesion. Biopsy of the lesion was negative for malignancy. Finally, we suspected the lesion as a pancreatic adenosquamous carcinoma, and not a typical pancreatic ductal carcinoma, because the lesion showed no pancreatic duct dilation and had a partially hyperechoic part within. Therefore, we performed pancreaticoduodenectomy. The final diagnosis was a duodenal follicular lymphoma. The findings of this case may assist in distinguishing between atypical follicular lymphoma and jaundice from pancreatic cancer.
Collapse
Affiliation(s)
- Junya Sato
- Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo Nagaizumi-cho, Sunto-gun, Shizuoka, Japan
| | - Hirotoshi Ishiwatari
- Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo Nagaizumi-cho, Sunto-gun, Shizuoka, Japan.
| | - Ryo Ashida
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Keiko Sasaki
- Division of Pathology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Shinya Fujie
- Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo Nagaizumi-cho, Sunto-gun, Shizuoka, Japan
| | - Junichi Kaneko
- Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo Nagaizumi-cho, Sunto-gun, Shizuoka, Japan
| | - Tatsunori Satoh
- Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo Nagaizumi-cho, Sunto-gun, Shizuoka, Japan
| | - Hiroyuki Matsubayashi
- Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo Nagaizumi-cho, Sunto-gun, Shizuoka, Japan
| | - Yoshihiro Kishida
- Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo Nagaizumi-cho, Sunto-gun, Shizuoka, Japan
| | - Masao Yoshida
- Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo Nagaizumi-cho, Sunto-gun, Shizuoka, Japan
| | - Sayo Ito
- Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo Nagaizumi-cho, Sunto-gun, Shizuoka, Japan
| | - Noboru Kawata
- Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo Nagaizumi-cho, Sunto-gun, Shizuoka, Japan
| | - Kenichiro Imai
- Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo Nagaizumi-cho, Sunto-gun, Shizuoka, Japan
| | - Naomi Kakushima
- Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo Nagaizumi-cho, Sunto-gun, Shizuoka, Japan
| | - Kohei Takizawa
- Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo Nagaizumi-cho, Sunto-gun, Shizuoka, Japan
| | - Kinichi Hotta
- Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo Nagaizumi-cho, Sunto-gun, Shizuoka, Japan
| | - Katsuhiko Uesaka
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hiroyuki Ono
- Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo Nagaizumi-cho, Sunto-gun, Shizuoka, Japan
| |
Collapse
|
19
|
Mezza T, Moffa S, Ferraro PM, Quero G, Capece U, Carfì A, Cefalo CMA, Cinti F, Sorice GP, Impronta F, Mari A, Pontecorvi A, Alfieri S, Holst JJ, Giaccari A. Bile Modulates Secretion of Incretins and Insulin: A Study of Human Extrahepatic Cholestasis. J Clin Endocrinol Metab 2019; 104:2685-2694. [PMID: 30874733 DOI: 10.1210/jc.2018-02804] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 03/11/2019] [Indexed: 02/09/2023]
Abstract
OBJECTIVE Changes in bile flow after bariatric surgery may beneficially modulate secretion of insulin and incretins, leading to diabetes remission. However, the exact mechanism(s) involved is still unclear. Here, we propose an alternative method to investigate the relationship between alterations in physiological bile flow and insulin and incretin secretion by studying changes in gut-pancreatic function in extrahepatic cholestasis in nondiabetic humans. METHODS To pursue this aim, 58 nondiabetic patients with recent diagnosis of periampullary tumors underwent an oral glucose tolerance test (OGTT), and a subgroup of 16 patients also underwent 4-hour mixed meal tests and hyperinsulinemic-euglycemic clamps. RESULTS The analysis of the entire cohort revealed a strong inverse correlation between total bilirubin levels and insulinogenic index. When subjects were divided on the basis of bilirubin levels, used as a marker of altered bile flow, subjects with high bilirubin levels displayed inferior glucose control and decreased insulin secretion during the OGTT. Altered bile flow elicited a markedly greater increase in glucagon and glucagon-like peptide 1 (GLP-1) secretion at fasting state, and following the meal, both glucagon and GLP-1 levels remained increased over time. Conversely, Glucose-dependent insulinotropic polypeptide (GIP) levels were comparable at the fasting state, whereas the increase following meal ingestion was significantly blunted with high bilirubin levels. We reveal strong correlations between total bilirubin and glucagon and GLP-1 levels. CONCLUSIONS Our findings suggest that acute extrahepatic cholestasis determines major impairment in enteroendocrine gut-pancreatic secretory function. The altered bile flow may determine a direct deleterious effect on β-cell function, perhaps mediated by the impairment of incretin hormone function.
Collapse
Affiliation(s)
- Teresa Mezza
- U.O.C., Endocrinologia e Diabetologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Istituto Patologia Speciale Medica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Simona Moffa
- U.O.C., Endocrinologia e Diabetologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Istituto Patologia Speciale Medica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Pietro Manuel Ferraro
- U.O.C., Nefrologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Istituto di Medicina Interna e Geriatria, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giuseppe Quero
- U.O.C., Chirurgia Digestiva, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- U.O.C., Istituto di Semeiotica Chirurgica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Umberto Capece
- U.O.C., Endocrinologia e Diabetologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Istituto Patologia Speciale Medica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Carfì
- U.O.C., Endocrinologia e Diabetologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Istituto Patologia Speciale Medica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Chiara M A Cefalo
- U.O.C., Endocrinologia e Diabetologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Istituto Patologia Speciale Medica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesca Cinti
- U.O.C., Endocrinologia e Diabetologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Istituto Patologia Speciale Medica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gian Pio Sorice
- U.O.C., Endocrinologia e Diabetologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Istituto Patologia Speciale Medica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Flavia Impronta
- U.O.C., Endocrinologia e Diabetologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Istituto Patologia Speciale Medica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Mari
- U.O.C., Institute of Neuroscience, National Research Council, Padua, Italy
| | - Alfredo Pontecorvi
- U.O.C., Endocrinologia e Diabetologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Istituto Patologia Speciale Medica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Sergio Alfieri
- U.O.C., Chirurgia Digestiva, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- U.O.C., Istituto di Semeiotica Chirurgica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Jens J Holst
- NNF Center for Basic Metabolic Research and Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Andrea Giaccari
- U.O.C., Endocrinologia e Diabetologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Istituto Patologia Speciale Medica, Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
20
|
Abstract
RATIONALE Cholestasis in pediatric patients has diverse etiologies and can be broadly classified as intrahepatic or extrahepatic. The common causes of extrahepatic cholestasis are bile duct calculus, inflammation, or pancreatitis. Malignant tumor is a rare cause of bile ducts obstruction in adolescent. Here we report a 14-year-old male patient with cholestasis due to poorly differentiated adenocarcinoma. PATIENT CONCERNS A 14-year-old male patient with cholestasis was admitted because of jaundice, weakness, weight loss, and stomach pain for 2 months. The patient had been diagnosed with epilepsy 4 years previously and was being treated with sodium valproate and oxcarbazepine. On admission, laboratory studies showed elevated levels of aspartate aminotransferase (271 IU/L), alanine aminotransferase (224 IU/l), γ-glutamyltransferase (1668.9 IU/L), total bilirubin (66.4 μmol/L), and direct bilirubin (52.6 μmol/L). Additional laboratory tests eliminated common causes of cholestasis such as bacterial/viral infection, autoimmune liver disease, Wilson disease, Alagille syndrome, or progressive familial intrahepatic cholestasis type 3. The results of laboratory investigations showed no improvement after 10 days of treatment with ursodeoxycholic acid and vitamins A, D, and K1. Enhanced magnetic resonance imaging demonstrated a tumor of 22 mm diameter in the duodenal lumen and dilatation of the common bile duct. Endoscopic retrograde cholangiopancreatography detected a tumor in the duodenal lumen. DIAGNOSIS Considering the clinical features, imaging manifestation, endoscopic findings, and pathologic characteristic, the patient was diagnosed with poorly differentiated adenocarcinoma. INTERVENTIONS The patient underwent pancreaticoduodenectomy and chemotherapy. OUTCOME The patient recovered well. Elevated levels of tumor biomarkers or abnormal liver function tests have not occurred during the 2-year follow-up. CONCLUSION Cholestasis resulting from primary duodenal papillary carcinoma is rare in pediatric patients but should be considered in the differential diagnosis.
Collapse
Affiliation(s)
- Haiyan Fu
- Department of Infectious and Digestive Diseases, Children’ Hospital of Hebei Province
| | - Yingchao Li
- Department of Pediatric Surgery, The Second Hospital of Hebei Medical University
| | - Gelan Bai
- Department of Infectious and Digestive Diseases, Children’ Hospital of Hebei Province
| | - Runkai Yin
- Department of Infectious and Digestive Diseases, Children’ Hospital of Hebei Province
| | - Chunlan Yin
- Department of Infectious and Digestive Diseases, Children’ Hospital of Hebei Province
| | - Weina Shi
- Department of Infectious and Digestive Diseases, Children’ Hospital of Hebei Province
| | - Lili Zhang
- Department of Pathology, Children’ Hospital of Hebei Province
| | - Rongpin Li
- Department of Medical Imagine, Children’ Hospital of Hebei Province, Hebei Shijiazhuang, China
| | - Ruiqin Zhao
- Department of Infectious and Digestive Diseases, Children’ Hospital of Hebei Province
| |
Collapse
|
21
|
Noh CK, Roh J, Lee KJ. Monomorphic epitheliotropic intestinal T cell lymphoma presenting in weblike feature. Gastrointest Endosc 2019; 89:891-892. [PMID: 30576648 DOI: 10.1016/j.gie.2018.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 12/11/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Choong-Kyun Noh
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jin Roh
- Department of Pathology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Kwang Jae Lee
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Republic of Korea
| |
Collapse
|
22
|
Bruno G, Trentino P, Viarengo MA, Toma A, Virili C, Centanni M, Picarelli A, Gozzo P, Accarpio F, Porowska B. Sporadic pedunculated duodenal adenomas. Clinical presentations and endoscopic management: a case series. G Chir 2018; 39:248-254. [PMID: 30039794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The prevalence of sporadic duodenal polyps is estimated to be 0.3%-4.6% in patients referred for an upper endoscopy. Most of patients are asymptomatic (66-80%) at the time of diagnosis though bleeding, anemia and abdominal pain are the most commonly reported symptoms. These are related to the polyp's size, location and histological characteristics. We describe three cases of big, pedunculated nonampullary sporadic duodenal polyps (tubulovillous low-grade dysplasia adenomas) located in the second part of the duodenum and characterized by different clinical presentations, managed in our Endoscopic Unit within one year (between 2016 and 2017). Polypectomies were performed, either piece-meal or en-bloc using various endoscopic instruments. In one of our patients (case 1), a delayed bleeding (36 hours after the procedure) occurred eventually managed conservatively with two units of blood transfusion. In the same patient, in the following months after polypectomy, the pre-procedural state of anemia misclassified as Mediterranean anemia has improved with a significant rise of hemoglobin value (14.1g/dl). In a patient who previously underwent a renal transplant (case 2), endoscopy was indicated, based on the positive fecal occult blood test. In another patient (case 3), a big polyp induced pancreatitis since it exerted a strong traction on the duodenal wall during peristaltic movements. The removal of the polyp has led to the resolution of pancreatitis and associated symptoms.
Collapse
|
23
|
Lenci I, Milana M, Toti L, Palmieri G, Manzia TM, Angelico M, Tisone G, Baiocchi L. An unusual duodenal polyp causing anemia in a liver-transplanted patient. Am J Gastroenterol 2018; 113:918-919. [PMID: 29686271 DOI: 10.1038/s41395-018-0046-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 01/28/2018] [Indexed: 02/08/2023]
Affiliation(s)
- Ilaria Lenci
- Hepatology Unit, Department of Experimental Medicine and Surgery, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy. Liver Transplant Unit, Department of Experimental Medicine and Surgery, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy. Pathology Unit, Department of Biomedicine and Prevention, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy
| | - Martina Milana
- Hepatology Unit, Department of Experimental Medicine and Surgery, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy. Liver Transplant Unit, Department of Experimental Medicine and Surgery, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy. Pathology Unit, Department of Biomedicine and Prevention, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy
| | - Luca Toti
- Hepatology Unit, Department of Experimental Medicine and Surgery, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy. Liver Transplant Unit, Department of Experimental Medicine and Surgery, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy. Pathology Unit, Department of Biomedicine and Prevention, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy
| | - Giampiero Palmieri
- Hepatology Unit, Department of Experimental Medicine and Surgery, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy. Liver Transplant Unit, Department of Experimental Medicine and Surgery, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy. Pathology Unit, Department of Biomedicine and Prevention, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy
| | - Tommaso Maria Manzia
- Hepatology Unit, Department of Experimental Medicine and Surgery, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy. Liver Transplant Unit, Department of Experimental Medicine and Surgery, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy. Pathology Unit, Department of Biomedicine and Prevention, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy
| | - Mario Angelico
- Hepatology Unit, Department of Experimental Medicine and Surgery, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy. Liver Transplant Unit, Department of Experimental Medicine and Surgery, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy. Pathology Unit, Department of Biomedicine and Prevention, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy
| | - Giuseppe Tisone
- Hepatology Unit, Department of Experimental Medicine and Surgery, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy. Liver Transplant Unit, Department of Experimental Medicine and Surgery, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy. Pathology Unit, Department of Biomedicine and Prevention, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy
| | - Leonardo Baiocchi
- Hepatology Unit, Department of Experimental Medicine and Surgery, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy. Liver Transplant Unit, Department of Experimental Medicine and Surgery, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy. Pathology Unit, Department of Biomedicine and Prevention, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy
| |
Collapse
|
24
|
Affiliation(s)
- Hung-Chieh Lan
- Division of Gastroenterology, Department of Medicine, Taipei City Hospital, Taipei, Taiwan, ROC.
| | - Tseng-Shing Chen
- Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan, ROC
| |
Collapse
|
25
|
Staub J, Siddiqui A, Taylor LJ, Loren D, Kowalski T, Adler DG. ERCP performed through previously placed duodenal stents: a multicenter retrospective study of outcomes and adverse events. Gastrointest Endosc 2018; 87:1499-1504. [PMID: 29425886 DOI: 10.1016/j.gie.2018.01.040] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 01/28/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS ERCP performed through previously placed enteral stents is an uncommon procedure without a significant amount of supporting literature and with a wide reported range of technical success. The purpose of this study was to evaluate and better define the technical feasibility and safety of performing ERCP through enteral stents in patients with combined malignant biliary and gastric outlet obstruction. METHODS We conducted a multicenter, retrospective study on 71 patients with combined gastric outlet and biliary obstruction who underwent ERCP through a previously placed enteral stent at 2 tertiary care centers. Outcomes included but were not limited to technical success, clinical success, need for repeat ERCP, adverse events, and survival time. RESULTS Overall technical success was achieved in 60 of 71 patients (85%), with technical success of 40 of 46 (87%) in type I obstructions (gastric outlet obstruction above the ampulla), 16 of 21 (76%) in type II obstructions (gastric outlet obstruction at the level of the ampulla), and 4 of 4 (100%) in type III obstructions (gastric outlet obstruction distal to the ampulla). In general, patients who achieved technical success also achieved clinical success. Adverse events occurred in 3 patients (3/71): 2 patients with acute cholangitis and 1 patient with perforation. Average survival time after the procedure was 4.6 months overall. CONCLUSIONS ERCP performed through enteral stents is safe, with a high technical and clinical success rate, but may be more technically challenging in the setting of type II obstructions. This procedure could be considered first line in the unique setting that a patient requires ERCP through a previously placed enteral stent for malignant gastric outlet and biliary obstruction.
Collapse
Affiliation(s)
- Judith Staub
- Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Ali Siddiqui
- Gastroenterology and Hepatology, Jefferson University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Linda Jo Taylor
- Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - David Loren
- Gastroenterology and Hepatology, Jefferson University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Tom Kowalski
- Gastroenterology and Hepatology, Jefferson University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Douglas G Adler
- Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| |
Collapse
|
26
|
Félix-Oliveira A, Vale N, Madeira S, Mendes M. Acute coronary syndrome in the oncology patient: An avoidable event? Rev Port Cardiol 2018; 37:791.e1-791.e4. [PMID: 29803650 DOI: 10.1016/j.repc.2017.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 03/28/2017] [Accepted: 04/07/2017] [Indexed: 11/16/2022] Open
Abstract
5-Fluorouracil is a first-line agent in several cancer-therapy regimens. Cardiotoxicity is common, with coronary artery disease being an important risk factor. We report the case of an acute coronary syndrome presumably induced by 5-FU, in a patient with previously unknown and asymptomatic coronary artery disease, with an estimated intermediate risk for cardiovascular events. Pre-chemotherapy risk evaluation and optimal patient care are still not standardized in this clinical scenario.
Collapse
Affiliation(s)
- Afonso Félix-Oliveira
- Serviço de Cardiologia, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal; Faculdade de Medicina da Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisboa, Portugal.
| | - Nélson Vale
- Serviço de Cardiologia, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal
| | - Sérgio Madeira
- Serviço de Cardiologia, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal
| | - Miguel Mendes
- Serviço de Cardiologia, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal; Nova Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| |
Collapse
|
27
|
Stretch C, Aubin JM, Mickiewicz B, Leugner D, Al-manasra T, Tobola E, Salazar S, Sutherland FR, Ball CG, Dixon E, Vogel HJ, Damaraju S, Baracos VE, Bathe OF. Sarcopenia and myosteatosis are accompanied by distinct biological profiles in patients with pancreatic and periampullary adenocarcinomas. PLoS One 2018; 13:e0196235. [PMID: 29723245 PMCID: PMC5933771 DOI: 10.1371/journal.pone.0196235] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 04/09/2018] [Indexed: 01/06/2023] Open
Abstract
Introduction Pancreatic and periampullary adenocarcinomas are associated with abnormal body composition visible on CT scans, including low muscle mass (sarcopenia) and low muscle radiodensity due to fat infiltration in muscle (myosteatosis). The biological and clinical correlates to these features are poorly understood. Methods Clinical characteristics and outcomes were studied in 123 patients who underwent pancreaticoduodenectomy for pancreatic or non-pancreatic periampullary adenocarcinoma and who had available preoperative CT scans. In a subgroup of patients with pancreatic cancer (n = 29), rectus abdominus muscle mRNA expression was determined by cDNA microarray and in another subgroup (n = 29) 1H-NMR spectroscopy and gas chromatography-mass spectrometry were used to characterize the serum metabolome. Results Muscle mass and radiodensity were not significantly correlated. Distinct groups were identified: sarcopenia (40.7%), myosteatosis (25.2%), both (11.4%). Fat distribution differed in these groups; sarcopenia associated with lower subcutaneous adipose tissue (P<0.0001) and myosteatosis associated with greater visceral adipose tissue (P<0.0001). Sarcopenia, myosteatosis and their combined presence associated with shorter survival, Log Rank P = 0.005, P = 0.06, and P = 0.002, respectively. In muscle, transcriptomic analysis suggested increased inflammation and decreased growth in sarcopenia and disrupted oxidative phosphorylation and lipid accumulation in myosteatosis. In the circulating metabolome, metabolites consistent with muscle catabolism associated with sarcopenia. Metabolites consistent with disordered carbohydrate metabolism were identified in both sarcopenia and myosteatosis. Discussion Muscle phenotypes differ clinically and biologically. Because these muscle phenotypes are linked to poor survival, it will be imperative to delineate their pathophysiologic mechanisms, including whether they are driven by variable tumor biology or host response.
Collapse
Affiliation(s)
- Cynthia Stretch
- Department of Oncology, University of Calgary, Calgary, Canada
| | | | - Beata Mickiewicz
- Department of Biological Sciences, University of Calgary, Calgary, Canada
| | - Derek Leugner
- Department of Surgery, University of Calgary, Calgary, Canada
| | - Tariq Al-manasra
- Department of Biological Sciences, University of Calgary, Calgary, Canada
| | | | | | | | - Chad G. Ball
- Department of Surgery, University of Calgary, Calgary, Canada
| | - Elijah Dixon
- Department of Surgery, University of Calgary, Calgary, Canada
| | - Hans J. Vogel
- Department of Biological Sciences, University of Calgary, Calgary, Canada
| | - Sambasivario Damaraju
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada
- Department of Oncology, University of Alberta, Edmonton, Canada
| | | | - Oliver F. Bathe
- Department of Oncology, University of Calgary, Calgary, Canada
- Department of Surgery, University of Calgary, Calgary, Canada
- * E-mail:
| |
Collapse
|
28
|
Abstract
Results obtained in 70 patients with neoplastic (primary or metastatic) biliary obstruction and submitted to percutaneous transhepatic biliary drainage indicate the effectiveness of the technique in relieving jaundice, improving general conditions and restoring liver function. In 25.4% of cases, the drainage allowed the patients to undergo surgical treatment of the neoplasm. In 74.6%, the drainage was left in place as definitive palliation. The complication rate was very low and similar to that described in the literature. At this time it is difficult to identify prognostic factors and foresee the results of percutaneous transhepatic biliary drainage, but the procedure is always indicated in patients at high operative risk or inoperable.
Collapse
|
29
|
Abstract
Metastatic involvement of the upper gastrointestinal tract from breast cancer has been reported in autopsy series as occurring in more than 15% of patients, usually associated with extensive systemic spread; clinical manifestations from such metastases have been described in less than 1% of cases. Lobular infiltrating carcinoma seems to have a different metastatic pattern than the ductal type, with an apparent predilection for the gastrointestinal tract. Metastatic presentation as an isolated intestinal obstruction without other signs of metastatic spread is extremely rare. We present a case of isolated duodenal metastasis from breast cancer, associated with intestinal obstruction, as the first sign of metastatic spread.
Collapse
|
30
|
Kitamura F, Doi K, Ishiodori H, Ochi T, Baba H. [Experience of Nine Cases of Endoscopic Gastroduodenal Stenting for Malignant Gastroduodenal Obstruction]. Gan To Kagaku Ryoho 2018; 45:737-739. [PMID: 29650852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND We reported our results of endoscopic gastroduodenal stenting for malignant gastroduodenal obstruction. METHODS This retrospective study investigated cases of malignant gastric and duodenal obstruction treated with gastroduodenal stenting between April 2014 and December 2016. RESULTS The mean operative time was 34 minutes. The mean time to the first intake of solid food was 2.7 days, and the median time was 3 days. Complications were restenosis, vomiting, anemia, anorexia, and gastric pain. In 8 patients, the GOOSS score was improved. In 5 patients, the CONUT score was improved. In 6 patients, the albumin level was improved. The mean overall survival time was 130 days, and the median time was 112 days. CONCLUSION Our study suggested that gastroduodenal stenting for malignant gastroduodenal obstruction was minimally invasive and improved quality of life(QOL)in a short time.
Collapse
Affiliation(s)
- Fumimasa Kitamura
- Dept. of Gastroenterological Surgery, Miyazaki Prefectural Nobeoka Hospital
| | | | | | | | | |
Collapse
|
31
|
Ota H, Yokoyama S, Tanaka E, Nakai S, Takiguchi N, Honda S, Yukimoto R, Tokuyama S, Saito A, Takeoka T, Matsuno H, Konishi K, Okada K, Fukunaga M, Kobayashi K. [A Case of Primary Duodenal Cancer with Duodenocolic Fistula Treated with Pancreatoduodenectomy and Right Hemicolectomy]. Gan To Kagaku Ryoho 2018; 45:492-495. [PMID: 29650915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
A patient was 59-year-old female. She presented our hospital with weight loss, anorexia and lower abdominal bloating. Abdominal computed tomography(CT), gastrointestinal endoscopy, colonoscopy and duodenal fistulagram showed duodenal cancer or colon cancer with duodenocolic fistula and ovary metastasis. She underwent subtotal stomach preserving pancreatoduodenectomy and right hemicolectomy. In these pathological findings, tumor was diagnosed as a duodenal cancer with duodenocolic fistula. She was surviving 12 months after the last surgery. In cases of cancer with duodenocolic fistula, pancreatoduodenectomy with right hemicolectomy would be necessary for nutrition improvement and cancer treatment.
Collapse
Affiliation(s)
- Hideo Ota
- Dept. of Gastrointestinal Surgery, Hyogo Prefectural Nishinomiya Hospital
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Shah SF, Hameed S, Aurakzai JK, Raza A, Chaudhry MA, Shah SH, Shah SZ. Comparison Of Biliary Stenting And Surgical Bypass In Palliative Management Of Irresectable Periampullary Carcinoma. J Ayub Med Coll Abbottabad 2018; 30:30-33. [PMID: 29504325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Some 20-40% of the periampullary carcinoma is irresectable at the time of diagnosis. Biliary stenting and surgical bypass are commonly used palliative procedure. There is no consensus favouring one procedure over the other. This study compares the both procedures. METHODS This Randomized Controlled Trial included 47 patients who presented with diagnosis of obstructive jaundice due to periampullary carcinoma to the Department of Surgery, Federal General Hospital, Islamabad from July 2012 to December 2014. RESULTS Out of total 47 patients 27 (57.44%) were males and 20 (42.55%) were females. Group-A included 25 (53.19%) patients while group-B included 22 (46.81%) patients. The mean age in both groups was 62.34 years (SD=±5.01). All patients died during the study. The mean survival time for the stent patients was 7.5 months while the mean survival time for surgical bypass patients was 8.3 months. The jaundice was relived in all surgical (22, 100%) of the patients as compared to (18, 72%) of the patients in stent group. CONCLUSIONS We concluded that surgical bypass as a primary procedure in selected patients provided better jaundice relieve as compared to biliary stenting..
Collapse
Affiliation(s)
- Syed Fahd Shah
- Department of Surgery, Federal General Hospital, Chak Shahzad Islamabad, Pakistan
| | - Sania Hameed
- Department of Medicine, Federal Government Polyclinic Hospital, Pakistan
| | | | - Ali Raza
- Department of Surgery, Federal General Hospital, Chak Shahzad Islamabad, Pakistan
| | | | | | | |
Collapse
|
33
|
Mirea CS, Ciorbagiu MC, Obleagă CV, Moraru E, Mogoantă SŞ, Ciurea RN, Foarfă MC, Vîlcea AM, Vîlcea ID. Stage IV duodenal GIST requiring emergency pancreaticoduodenectomy - diagnosis difficulties and therapeutic options. Rom J Morphol Embryol 2018; 59:543-548. [PMID: 30173260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This paper presents a very rarely encountered case of a 45-year-old female, admitted in our Surgical Clinic for upper digestive bleeding (repeated hematochezia). The upper endoscopy was negative, but the barium meal discovered an apparently extrinsic duodenal (D3) stenosis; abdominal ultrasound diagnosed a left liver mass suggesting a metastatic tumor. The hematochezia relapse, with hemodynamic instability imposed emergency surgery; on laparotomy, a bleeding tumor located on the duodenopancreatic region was discovered, and a pylorus-preserving pancreaticoduodenectomy (Traverso-Longmire) was performed. The histology and immunohistochemistry established the diagnosis of duodenal stromal tumor, CD34 and CD117 positive, with an estimated progression risk of 34%. The postoperative evolution was favorable, the patient being alive, four years after the surgery.
Collapse
Affiliation(s)
- Cecil Sorin Mirea
- IInd Surgical Clinic, University of Medicine and Pharmacy of Craiova, Romania;
| | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Miura Y, Sakata J, Ando T, Soma D, Yuza K, Hirose Y, Ishikawa H, Miura K, Takizawa K, Kobayashi T, Ichikawa H, Nagahashi M, Shimada Y, Kameyama H, Wakai T. [Mixed Type Liposarcoma with Intra-Abdominal Bleeding - Report of a Case]. Gan To Kagaku Ryoho 2017; 44:1155-1157. [PMID: 29394565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A 71-year-old man presented with sudden abdominal pain. He had past history of atrial fibrillation, cerebral infarction and heart-valve replacement and received anticoagulant therapy with warfarin. Computed tomography of the abdomen revealed bloody ascites and a huge mass in contact with the third portion of the duodenum. The mass was encapsulated and consisted of a solid component with calcification and hematoma. Under the preoperative diagnosis of gastrointestinal stromal tumor with intra-abdominal bleeding, laparotomy was performed. Intraoperative findings revealed the tumor arising from the right mesocolon and excision of the tumor with right hemicolectomy was performed. Histologic examination confirmed a diagnosis of mixed type liposarcoma. No postoperative complication was observed and he was discharged home on the 8th postoperative day. He remains alive and well with no evidence of disease 52 months after resection.
Collapse
Affiliation(s)
- Yohei Miura
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Hatakeyama T, Sakai K, Matsumura A, Ogino S, Akami T, Okano S, Ueda Y, Mazak T. [A Case of Perforation Peritonitis with Multiple Duodenal and Intestinal Malignant Lymphomas]. Gan To Kagaku Ryoho 2017; 44:2023-2025. [PMID: 29394855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Malignant lymphomas of the duodenum and small intestine are relatively rare, but are clinically important, as they may result in perforation peritonitis. Here, we report a case of perforation peritonitis caused by multiple duodenal and small intestinal malignant lymphomas. An 84-year-old man was diagnosed with malignant lymphoma of the duodenum. Although chemotherapy was planned, emergency surgery was performed to treat perforation peritonitis. Laparoscopic observation revealed that the perforation was not in the duodenum, but in the ileum. In addition, numerous lymphoma lesions were revealed throughout the small intestine. Partial resection of the small intestine including the perforation was performed. Primary gastrointestinal malignant lymphoma may exist over multiple digestive tracts and it is necessary to carefully diagnose and treat, even in emergency surgery.
Collapse
Affiliation(s)
- Tomoya Hatakeyama
- Dept. of Surgery, Osaka General Hospital of West Japan Railway Company
| | | | | | | | | | | | | | | |
Collapse
|
36
|
Miyata Y, Nakazawa A, Mitsui T, Ninomiya R, Komagome M, Maki A, Beck Y. [Pancreaticoduodenectomy in a Patient with Severe Hyperbilirubinemia - A Case Report]. Gan To Kagaku Ryoho 2017; 44:1284-1286. [PMID: 29394608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Although the safety of pancreaticoduodenectomy(PD)with hyperbilirubinemia has been reported, the permissible value of preoperative serum bilirubin is unknown. A 58-year-old man developed obstructive jaundice due to duodenal adenocarcino- ma. The initial serum bilirubin value was 26.8mg/dL, and preoperative biliary drainage was performed. However, the serum bilirubin value only decreased to 17.7mg/dL. The other liver function tests were normal. Therefore, we decided to perform PD despite persistent severe hyperbilirubinemia. The postoperative course was uneventful and the bilirubin value improved. He was discharged 17 days after the operation. In the present case, we safely performed PD despite severe jaundice after adequate preoperative liver function evaluation. The attempt to reduce the bilirubin value before surgery did not appear to affect the postoperative course.
Collapse
Affiliation(s)
- Yoichi Miyata
- Dept. of Hepato-Biliary-Pancreatic Surgery and Pediatric Surgery, Saitama Medical Center Saitama Medical University
| | | | | | | | | | | | | |
Collapse
|
37
|
Tornambe A, Tornambe G. Duodenal gastrointestinal stromal tumor A case report. Ann Ital Chir 2017; 6:S2239253X17027220. [PMID: 28874632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
AIM To report an another case of duodenal GIST in patient that was treated with Whipple procedure. MATERIAL OF STUDY We report a case of 69 years old men that was admitted with melena. The preoperative investigations suggested a suspected duodenal GIST.A Whipple pancreatico-duodenectomy was performed. Only 3-5% of GISTs occur in the duodenum. DISCUSSION GIST were described as a separate entity by Mazur and Clark in 1983. These tumors are the most common among mesenchymal tumors of the gastrointeninal tract. The clinical presentations of duodenal GIST are highly variable. There is no consensus on the optimal surgical treatment of duodenal GIST.The aim was to achieve a R0-type surgery with complete en bloc surgical resection of the tumor and the surrounding tissue CONCLUSION: In conclusion the duodenal GIST are fairly rare. The clinical symptomatology is very variable even if frequently occur with digestive bleeding. the purpose of the surgery is the complete removal of the tumor (R0) however looking to perform minimum resections. KEY WORDS GI bleeding, GIST, Pancreaticoduodenectomy.
Collapse
|
38
|
Elli L, Branchi F, Ferretti F, Penagini R. Duodenal underwater polypectomy in celiac disease. Dig Liver Dis 2017; 49:822. [PMID: 28396104 DOI: 10.1016/j.dld.2017.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 03/12/2017] [Accepted: 03/13/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Luca Elli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milano, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milano, Italy; Center for the Prevention and Diagnosis of Celiac Disease, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico,Milano, Italy.
| | - Federica Branchi
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milano, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milano, Italy; Center for the Prevention and Diagnosis of Celiac Disease, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico,Milano, Italy
| | - Francesca Ferretti
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milano, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milano, Italy; Center for the Prevention and Diagnosis of Celiac Disease, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico,Milano, Italy
| | - Roberto Penagini
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milano, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milano, Italy
| |
Collapse
|
39
|
Espinoza-Ríos J, Salas Y, Leiva Reyes N, Prochazka Zárate R, García Encinas C, Cok Garcia J, Pinto Valdivia J, Bravo Paredes E, Bussalleu Rivera A. [Duodenal melanoma: a case report and review of the literature]. Rev Gastroenterol Peru 2017; 37:267-270. [PMID: 29093593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
We report the case of a male patient of 75 years old who presents with abdominal pain, hyporexia, early satiety, general malaise and watery stools, admitted in emergency for an episode of syncope. On physical examination, hepatomegaly of 6cm below the right costal margin was detected. CT scan showed multiple liver metastases. An upper endoscopy found multiple hyperpigmented lesions on the second portion of the duodenum. Histology and immunohistochemistry studies concluded it was duodenal melanoma. Skin and ocular examination did not reveal associated neoplastic lesions.
Collapse
Affiliation(s)
| | | | | | - Ricardo Prochazka Zárate
- Hospital Nacional Cayetano Heredia. Lima, Perú; Universidad Peruana Cayetano Heredia. Lima, Perú
| | | | - Jaime Cok Garcia
- Hospital Nacional Cayetano Heredia. Lima, Perú; Universidad Peruana Cayetano Heredia. Lima, Perú
| | - José Pinto Valdivia
- Hospital Nacional Cayetano Heredia. Lima, Perú; Universidad Peruana Cayetano Heredia. Lima, Perú
| | - Eduar Bravo Paredes
- Hospital Nacional Cayetano Heredia. Lima, Perú; Universidad Peruana Cayetano Heredia. Lima, Perú
| | | |
Collapse
|
40
|
Turculeţ C, Ene D, Georgescu TF, Ciucă E, Vlădăşcău A, Iordache F, Beuran M. A Rare Case of Upper Digestive Hemorrhage due to Bleeding Duodenal Tumor. Chirurgia (Bucur) 2017; 111:505-508. [PMID: 28044953 DOI: 10.21614/chirurgia.111.6.505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2016] [Indexed: 11/23/2022]
Abstract
We present the case of a 48-year-old patient with no medical history, who presents himself to the emergency room with melena, asthenia and dizziness. The blood tests revealed a severe anemia (Hb = 4,8 g/dL). He is admitted in the Gastroenterology ward, where a first superior digestive endoscopy is performed which shows a duodenal bleeding tumor (second duodenum) of 7 cm in length. After the administration of red blood cell mass, plasma and haemostatic agents the level of the hemoglobin increases. The abdominal CT scan reveals a 3/5 tumor localized in the second and third duodenum. The superior digestive endoscopy is repeated and haemostasis of the bleeding tumor is accomplished. The surgical exploration of the peritoneal cavity discovered a partial stenosing, ulcerated duodenal tumor (third and fourth duodenum) and duodenectomy (third and fourth duodenum), segmental enterectomy (first loop of the jejunum), end to end duodeno-jejunal anastomosis, transgastric closure of the pylorus, gastro-enteric anastomosis on Omega loop with Braun fistula were performed, after the result of the extemporaneous histopathological exam suggested a GIST tumor. The postoperative evolution was favorable. The histopathological exam diagnosed the duodenal tumor as a gastrointestinal stromal tumor (GIST) with tumor free resection margins. The particularity of this case is the rare etiology of the upper gastrointestinal hemorrhage and its severity.
Collapse
|
41
|
Abstract
RATIONALE Metastatic involvement of the gastrointestinal tract is an uncommon scenario encountered in the clinical practice. Our case represents a gastric outlet obstruction (GOO) as a consequence of distant Transitional cell carcinoma (TCC) metastasis without any lymph node involvement in association with inflammatory stranding leading to extrinsic duodenal obstruction. PATIENT CONCERNS We report an unusual case of a 73-year-old male presented with a five-week history of nausea, vomiting and abdominal pain due to the metastatic extension from TCC that had been considered in remission. DIAGNOSES Computed tomography (CT) of the abdomen and pelvis revealed new circumferential thickening and inflammatory stranding involving the ascending colon extending to the hepatic flexure. Based on the imaging findings, colonoscopy was pursued which demonstrated a mass at the hepatic flexure and biopsies obtained confirmed invasive transitional cell cancer. INTERVENTION Patient underwent a Wall Flex (22 mm × 120 mm) metal stent to help alleviate the gastric outlet obstruction. Chemotherapy was planned by oncology. LESSONS Our case highlights the importance of ruling out distant metastases in the evaluation of new gastrointestinal tract pathology, for instance, Gastric Outlet Obstruction in our patient; with a prior history of TCC without any lymph node involvement under remission.
Collapse
Affiliation(s)
| | - Noemi Baffy
- Department of Gastroenterology, Mayo Clinic, Arizona
| |
Collapse
|
42
|
Elston MS, Sehgal S, Dray M, Phillips E, Conaglen JV, Clifton-Bligh RJ, Gill AJ. A Duodenal SDH-Deficient Gastrointestinal Stromal Tumor in a Patient With a Germline SDHB Mutation. J Clin Endocrinol Metab 2017; 102:1447-1450. [PMID: 28324028 DOI: 10.1210/jc.2017-00165] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 03/09/2017] [Indexed: 02/13/2023]
Abstract
CONTEXT Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors of the gastrointestinal tract arising from the interstitial cells of Cajal. Succinate dehydrogenase (SDH)-deficient GISTs are a unique class of GIST defined by loss of immunohistochemical expression of SDHB, indicating dysfunction of the mitochondrial complex 2; lack of driver mutations in KIT and PDGFRA; and distinctive morphologic features and natural history. To date, all reported SDH-deficient GISTs have arisen in the stomach. We report an SDH-deficient GIST arising in the gastrointestinal tract outside the stomach. CASE DESCRIPTION A 29-year-old man with a germline SDHB mutation (p.Arg90*) presented with acute upper gastrointestinal hemorrhage. Endoscopy identified a lesion in the second part of the duodenum, close to the distal common bile duct, consistent with a GIST. Endoscopic ultrasonography and magnetic resonance imaging did not demonstrate metastatic or nodal disease. Open transduodenal excision was performed to remove the tumor. Histologic evaluation confirmed the clinical diagnosis of a GIST, with positive staining for DOG1 and KIT. The mitotic count was low (1 per 50 high-power fields). Immunohistochemistry for SDHB was negative in the presence of an internal control. SDHA expression was retained. No somatic mutations were identified in KIT (exons 9, 11, 13, and 17) or PDGFRA (exons 12, 14, and 18). The germline SDHB mutation and loss of heterozygosity were confirmed on molecular testing of the tumor. CONCLUSION We describe an SDH-deficient GIST occurring outside of the stomach. This case indicates that SDH-deficient GISTs may also arise in the small intestine.
Collapse
Affiliation(s)
- Marianne S Elston
- Department of Endocrinology, Waikato Hospital, Hamilton 3240, New Zealand
- Waikato Clinical Campus, University of Auckland, Hamilton 3240, New Zealand
| | - Shekhar Sehgal
- Department of Endocrinology, Waikato Hospital, Hamilton 3240, New Zealand
| | - Michael Dray
- Department of Anatomical Pathology, Waikato Hospital, Hamilton 3240, New Zealand
| | - Elizabeth Phillips
- Department of Gastroenterology, Waikato Hospital, Hamilton 3240, New Zealand
| | - John V Conaglen
- Waikato Clinical Campus, University of Auckland, Hamilton 3240, New Zealand
| | - Roderick J Clifton-Bligh
- Cancer Genetics Laboratory, Kolling Institute, Royal North Shore Hospital, St Leonards 2065, Australia
- Department of Medicine, University of Sydney, Sydney 2006, Australia
| | - Anthony J Gill
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards 2065, Australia
- Sydney Medical School, University of Sydney, Sydney 2006, Australia
| |
Collapse
|
43
|
Ødorf K, Knuthsen S. [Duodenal lipoma is a rare cause of gastrointestinal bleeding]. Ugeskr Laeger 2017; 179:V10160730. [PMID: 28263162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Lipomas of the gastrointestinal tract are extremely rare, slow-growing and most often asymptomatic tumours. They are composed of highly differentiated fat cells surrounded by a fibrous capsule. Tumours larger than 2 cm can produce symptoms of abdominal pain and discomfort or cause anaemia due to ulceration and bleeding, or intestinal obstruction due to intussusception. This is a case report of a 73-year-old man with a bleeding duodenal lipoma situated at the papilla duodeni major which caused difficulty in the diagnostic process, and the endoscopic visualization raised suspicion of cancer of the papilla.
Collapse
|
44
|
Shabunin AV, Lebedev SS, Chechenin GM, Barinov YV, Sidorova YV, Bagateliya ZA, Vardanyan AV, Dolidze DD. [Metal self-expanding stents for malignant obstruction of stomach outlet and duodenum]. Khirurgiia (Mosk) 2017:47-50. [PMID: 28805778 DOI: 10.17116/hirurgia2017847-50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
AIM To compare different types of self-expanding stents (partially coated or uncovered) for malignant pyloroduodenal obstruction (MPDO). MATERIAL AND METHODS 89 MPDO patients underwent stenting at the Botkin City Hospital (Moscow) for the period 2008-2016. The causes of malignant obstruction were: stomach cancer - 53 (59.5%), pancreatic cancer - 31 (34.8%), compression by retroperitoneal lymph nodes - 3 (3.4%), duodenal cancer - 2 (2.2%). Patients were divided into two homogeneous groups. In group 1 (32 patients) partially coated stents were used, in group 2 (57 patients) - uncovered stents. Mean age was 68.3±6.2 and 64.3±5.7 years in both groups respectively; male/female ratio 18/14 in group 1, 32/25 in group 2. Length of stricture was 51±5.1 mm in group 1, 48±4.8 mm in group 2. GOOSS score in group 1: 0-8, 1-13, 2-11, 3-0, in group 2 0-14, 1-25, 2-18, 3-0 (p=0.03). RESULTS AND DISCUSSION Technical success was achieved in 32 patients of group 1 (100%) and in 57 patients of group 2 (100%). There were no procedure-associated complications and mortality. Clinical success was observed in 29 (90.6%) patients of group 1 and in 50 (87.7%) patients of group 2. GOOSS score of group 1: 0-8, 1-8, 2-10, 3-12, group 2: 0-3, 1-15, 2-19, 3-20. There were 3 distal dislocations of the stent within 1 - days in group 1, in group 2 dislocations were absent. Postoperative chemotherapy was prescribed in 20 (62.5%) patients of group 1 and 38 (66.7%) patients of group 2 (p=0.08). 27 patients of group 1 and 49 patients of group 2 died due to progression of the disease, others are under observation. Mean life expectancy: group 1 (18 patients - 50 days, 9 patients - 100 days, 5 patients were alive by the moment of study); group 2 (32 patients - 50 days, 100 days - 17 patients, 8 patients were alive by the moment of study). 3 patients (9.4%) in group 1 and 7 (12.3%) patients in group 2 had stent dysfunction (p=0.02). Mean period of partially covered stent function was 138±3.9 days, uncovered stent - 96±4.8 days (р=0.003). CONCLUSION Our study showed that time of stent function corresponds to median survival. Greater number of stent migration in group 1 is due to stent coverage, higher incidence of stent dysfunction in group 2 - due to malignant invasion.
Collapse
Affiliation(s)
- A V Shabunin
- Department of Surgery, Russian Medical Academy of Continuing Vocational Education, Health Ministry of the Russian Federation, Moscow, Russia
| | - S S Lebedev
- Department of Surgery, Russian Medical Academy of Continuing Vocational Education, Health Ministry of the Russian Federation, Moscow, Russia
| | - G M Chechenin
- Department of Surgery, Russian Medical Academy of Continuing Vocational Education, Health Ministry of the Russian Federation, Moscow, Russia
| | - Yu V Barinov
- Department of Surgery, Russian Medical Academy of Continuing Vocational Education, Health Ministry of the Russian Federation, Moscow, Russia
| | - Yu V Sidorova
- Department of Surgery, Russian Medical Academy of Continuing Vocational Education, Health Ministry of the Russian Federation, Moscow, Russia
| | - Z A Bagateliya
- Department of Surgery, Russian Medical Academy of Continuing Vocational Education, Health Ministry of the Russian Federation, Moscow, Russia
| | - A V Vardanyan
- Department of Surgery, Russian Medical Academy of Continuing Vocational Education, Health Ministry of the Russian Federation, Moscow, Russia
| | - D D Dolidze
- Department of Surgery, Russian Medical Academy of Continuing Vocational Education, Health Ministry of the Russian Federation, Moscow, Russia
| |
Collapse
|
45
|
Moris D, Spanou E, Sougioultzis S, Dimitrokallis N, Kalisperati P, Delladetsima I, Felekouras E. Duodenal plexiform fibromyxoma as a cause of obscure upper gastrointestinal bleeding: A case report. Medicine (Baltimore) 2017; 96:e5883. [PMID: 28072751 PMCID: PMC5228711 DOI: 10.1097/md.0000000000005883] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
RATIONALE We are reporting the first-to our knowledge-case of duodenal Plexiform Fibromyxoma causing obscure upper gastrointestinal bleeding. PATIENT CONCERNS Plexiform fibromyxoma triggered recurrent upper gastrointestinal bleeding episodes in a 63-year-old man who remained undiagnosed, despite multiple hospitalizations, extensive diagnostic workups and surgical interventions (including gastrectomies), for almost 17 years. DIAGNOSES-INTERVENTIONS During hospitalization for the last bleeding episode, an upper gastrointestinal endoscopy revealed an intestinal hemorrhagic nodule. The lesion was deemed unresectable by endoscopic means. An abdominal computerized tomography disclosed no further lesions and surgery was decided. The lesion at operation was found near the edge of the duodenal stump and treated with pancreas-preserving duodenectomy (1st and 2nd portion). OUTCOMES Postoperative recovery was mainly uneventful and a 20-month follow-up finds the patient in good health with no need for blood transfusions.Plexiform fibromyxomas stand for a rare and widely unknown mesenchymal entity. Despite the fact that they closely resemble other gastrointestinal tumors, they distinctly vary in clinical management as well as the histopathology. Clinical awareness and further research are compulsory to elucidate its clinical course and prognosis.
Collapse
Affiliation(s)
- Demetrios Moris
- First Department of Surgery
- Department of Immunology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | - Evangelia Spanou
- Department of Pathophysiology, “Laikon” General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Stavros Sougioultzis
- Department of Pathophysiology, “Laikon” General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Polyxeni Kalisperati
- Department of Pathophysiology, “Laikon” General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioanna Delladetsima
- Department of Pathology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | |
Collapse
|
46
|
Yamada Y, Shiozawa S, Usui T, Kuhara K, Kouno T, Asaka S, Yamaguchi K, Yokomizo H, Shimakawa T, Yoshimatsu K, Katsube T, Naritaka Y. [Neuroendocrine Tumor of the Ampulla of Vater and Gastrointestinal Stromal Tumor of the Duodenum in a Patient with Von Recklinghausen's Disease]. Gan To Kagaku Ryoho 2016; 43:2365-2367. [PMID: 28133323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A 57-year-old woman with von Recklinghausen's disease presented with epigastralgia. Gastroduodenoscopy revealed swelling of the ampulla of Vater in the ventral and caudal direction, forming a hard, elastic mass. She was diagnosed with a tumor of the ampulla of Vater, and a subtotal stomach-preserving pancreaticoduodenectomy and D2 lymph node dissection were performed. The isolated specimen showed an intra-ampullary tumor of the ampulla of Vater and a submucosal tumor in the descending duodenum, which were diagnosed as a somatostatin-producing neuroendocrine tumor and gastrointestinal stromal tumor, respectively, on pathological examination. We believe that the neuroendocrine tumor of the ampulla of Vater and gastrointestinal stromal tumor of the duodenum are common gastrointestinal lesions in von Recklinghausen's disease.
Collapse
Affiliation(s)
- Yasufumi Yamada
- Dept. of Surgery, Tokyo Women's Medical University Medical Center East
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Hirose Y, Sakata J, Soma D, Katada T, Ishikawa H, Miura K, Ohashi T, Takizawa K, Takano K, Kobayashi T, Kameyama H, Wakai T. [Resection for a Locally Advanced Duodenal Adenocarcinoma with Obstructive Jaundice and Hepatic and Pancreatic Invasion - A Case Report]. Gan To Kagaku Ryoho 2016; 43:2077-2079. [PMID: 28133227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A 64-year-old woman diagnosed with duodenal adenocarcinoma with duodenal stenosis and obstructive jaundice was referred to our hospital. Computed tomography revealed a tumor measuring 9×6 cm in the second portion of the duodenum that had invaded the liver(S6)and head of the pancreas. After percutaneous transhepatic biliary drainage for obstructive jaundice, the patient underwent subtotal stomach-preserving pancreaticoduodenectomy, partial resection of the liver(S6), and partial resection of the colon. Histologic examination showed the primary tumor to be moderately and poorly differentiated adenocarcinoma with hepatic and pancreatic invasion; lymph node metastasis was not found. The patient received S-1 for 1 year and remains alive and well with no evidence of disease 15 months after resection.
Collapse
Affiliation(s)
- Yuki Hirose
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Tarangelo NP, Ha K, Skole KS. Duodenal Glomus Tumor: A Rare Cause of Upper GI Bleeding. Clin Gastroenterol Hepatol 2016; 14:e123-4. [PMID: 27033430 DOI: 10.1016/j.cgh.2016.03.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 02/09/2016] [Accepted: 03/18/2016] [Indexed: 02/07/2023]
Affiliation(s)
| | - Kai Ha
- Robert Wood Johnson University Hospital, New Brunswick, New Jersey
| | - Kevin S Skole
- University Medical Center at Princeton-Plainsboro, Plainsboro, New Jersey
| |
Collapse
|
49
|
Kaneko H, Miyake A, Ishii Y, Sue S, Miwa H, Sasaki T, Tamura T, Kondo M, Maeda S. Case of a tumor comprising gastric cancer and duodenal neuroendocrine tumor. World J Gastroenterol 2016; 22:8242-8246. [PMID: 27688667 PMCID: PMC5037094 DOI: 10.3748/wjg.v22.i36.8242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 05/20/2016] [Accepted: 06/13/2016] [Indexed: 02/06/2023] Open
Abstract
The present report describes a rare case of a tumor composed of early gastric cancer and a duodenal neuroendocrine tumor (NET). A 78-year-old woman underwent esophagogastroduodenoscopy at a local institution for screening of the upper gastrointestinal tract which revealed a protruded tumor through the pyloric ring from the pyloric antrum. The tumor was too large to treat at the facility; consequently, she was referred to our hospital for further management. Esophagogastroduodenoscopy with tumor biopsy of the lesion revealed the diagnosis of early gastric cancer. Endoscopic submucosal dissection was performed with sufficient free margins in both vertical and horizontal directions. Histopathological findings showed NET confined to the submucosal layer and covered by well-differentiated adenocarcinoma. Immunohistochemical stainings showed that the two lesions existed continuously. While the possibility of a collision cancer was considered, it was suggested that the two lesions existed continuously. Finally, the tumor was diagnosed as gastric cancer composed of duodenal NET G1, with a lymphatic invasion of NET component.
Collapse
|
50
|
Zaafouri H, Lahmidi A, Ariane E, Esseghaeir S, Bouhafa A, Maamer AB. [Recklinghausen bleeding duodenal stromal tumor and Von Recklinghausen's disease]. Presse Med 2016; 45:798-800. [PMID: 27526984 DOI: 10.1016/j.lpm.2016.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 06/13/2016] [Accepted: 07/18/2016] [Indexed: 02/05/2023] Open
Affiliation(s)
- Haithem Zaafouri
- Hôpital Habib Thameur, service de chirurgie générale, Tunis, Tunisie.
| | - Amine Lahmidi
- Hôpital Habib Thameur, service de chirurgie générale, Tunis, Tunisie
| | - Emir Ariane
- Hôpital Habib Thameur, service de chirurgie générale, Tunis, Tunisie
| | | | - Ahmed Bouhafa
- Hôpital Habib Thameur, service de chirurgie générale, Tunis, Tunisie
| | - Anis Ben Maamer
- Hôpital Habib Thameur, service de chirurgie générale, Tunis, Tunisie
| |
Collapse
|