The prognostic significance of duodenal wall invasion in pancreatic adenocarcinoma.

OBJECTIVE: The most recent edition of the American Joint Committee on Cancer Staging Manual (AJCC, 8th edition) relies only on tumor size for staging resectable pancreatic adenocarcinoma, and the presence of duodenal wall invasion (DWI) no longer has an impact on staging. However, very few studies have evaluated its significance. In this study, we aim to evaluate the prognostic significance of DWI in pancreatic adenocarcinoma. METHODS: We reviewed 97 consecutive internal cases of resected pancreatic head ductal adenocarcinoma, and clinicopathologic parameters were recorded. All cases were staged according to the 8th edition of AJCC, and the patients were divided into two groups based on the presence or absence of DWI. RESULTS: Out of our 97 cases, 53 patients had DWI (55%). In univariate analysis, DWI was significantly associated with lymphovascular invasion and lymph node metastasis (AJCC 8th edition pN stage). In univariate analysis of overall survival, age > 60, absence of DWI, and African American race were associated with worse overall survival. In multivariate analysis, age > 60, absence of DWI, and African American race were associated with worse progression-free survival and overall survival. CONCLUSION: Although DWI is associated with lymph node metastasis, it is not associated with inferior disease-free/overall survival.

A Giant Sporadic Intra-abdominal Desmoid Tumor in a Male Patient: A Case Report.

Desmoid tumors (DTs) are rare locally aggressive benign soft tissue tumors with an estimated annual incidence of two to four new cases per million people. The giant intra-abdominal mass presents a diagnostic challenge that includes a broad differential diagnosis of gastrointestinal stromal tumor (GIST), fibrosarcoma, retroperitoneal fibrosis, and other malignancies from adjacent organs. We report a case of a 38-year-old male patient with a giant intra­abdominal mass. Magnetic resonance imaging (MRI) of the abdomen and pelvis indicated mucinous cystic neoplasm or gastrointestinal stromal tumor (GIST), but histopathology confirmed it to be a desmoid tumor. The patient was discharged, and on follow-up five months until now, there is no recurrence. This case highlighted the importance of including DT in the differential diagnosis of very large intra­abdominal masses.