Subject(s)
Adenoma , Brunner Glands , Duodenal Neoplasms , Gastrointestinal Hemorrhage , Humans , Adenoma/surgery , Adenoma/complications , Ligation/methods , Brunner Glands/surgery , Brunner Glands/pathology , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/surgery , Duodenal Neoplasms/surgery , Duodenal Neoplasms/complications , Male , Female , Middle AgedABSTRACT
RATIONALE: Aggressive fibromatosis (AF) is a fibroblastic/myofibroblastic tumor known for its locally aggressive properties. Intra-abdominal AF primarily occurs in the small intestine mesentery, ileocolic mesocolon, omentum, retroperitoneum, and pelvis, and rarely originates from the intestinal wall. Here, we report a rare case of small bowel obstruction caused by duodenum-derived AF with ß-catenin (CTNNB1) T41A mutation. PATIENT CONCERNS: A 35-year-old male had a 4-month history of abdominal pain, nausea, and vomiting, which gradually worsened over time. DIAGNOSES: Based on the results of CT examination, histopathology and Sanger sequencing, the patient was diagnosed with small bowel obstruction caused by duodenum-derived AF. INTERVENTIONS: Due to the extensive adhesion between the tumor and surrounding tissue, it is extremely challenging to completely remove the tumor through surgical resection with negative margins in this case. In order not to damage the function of surrounding vital organs, gastrojejunostomy was performed to relieve the symptoms of small bowel obstruction. OUTCOMES: The patient experienced a successful recovery. It is important to note that this patient is still at risk of local recurrence and requires regular follow-up. LESSONS: The best treatment should be taken based on the individual patient to relieve symptoms and improve quality of life. Moreover, histopathology plays a crucial role in diagnosing and differentiating duodenum-derived AF. The detection of mutations in exon 3 of the CTNNB1 has become strong evidence for diagnosing duodenum-derived AF.
Subject(s)
Fibromatosis, Aggressive , Intestinal Obstruction , Mutation , beta Catenin , Humans , Male , Adult , Intestinal Obstruction/etiology , Intestinal Obstruction/surgery , Intestinal Obstruction/genetics , Intestinal Obstruction/diagnosis , beta Catenin/genetics , Fibromatosis, Aggressive/genetics , Fibromatosis, Aggressive/complications , Fibromatosis, Aggressive/diagnosis , Fibromatosis, Aggressive/surgery , Intestine, Small/pathology , Duodenal Neoplasms/genetics , Duodenal Neoplasms/surgery , Duodenal Neoplasms/complications , Duodenal Neoplasms/diagnosisABSTRACT
BACKGROUND: Due to rarity of duodenal GISTs, clinicians have few information about its clinical features, diagnosis, management and prognosis. CASE REPORT: We report a case of promptly diagnosed duodenal GIST in a 61-year-old Egyptian man presented shocked with severe attack of hematemesis and melena. Upper gastroduodenal endoscopy was done and revealed a large ulcerating bleeding mass at first part of duodenum 4 hemo-clips were applied with good hemostasis. An exploratory laparotomy and distal gastrectomy, duodenectomy and gastrojejunostomy were performed. The morphology of the mass combined with immunohistochemistry was consistent with duodenal gastrointestinal stromal tumours (GISTs) of high risk type. The patient is on amatinib one tablet daily and he was well with no evidence of tumor recurrence. CONCLUSION: despite being rare, emergency presentation with sudden severe, life-threatening hemorrhagic shock duodenal GISTs might be a cause of potentially lethal massive combined upper and lower gastrointestinal bleeding which is the key feature of this rare and challenging tumor.
Subject(s)
Duodenal Neoplasms , Gastrointestinal Hemorrhage , Gastrointestinal Stromal Tumors , Shock, Hemorrhagic , Humans , Gastrointestinal Stromal Tumors/complications , Gastrointestinal Stromal Tumors/pathology , Gastrointestinal Stromal Tumors/diagnosis , Gastrointestinal Stromal Tumors/surgery , Male , Middle Aged , Gastrointestinal Hemorrhage/etiology , Duodenal Neoplasms/complications , Duodenal Neoplasms/surgery , Duodenal Neoplasms/pathology , Shock, Hemorrhagic/etiology , Melena/etiology , Hematemesis/etiology , GastrectomyABSTRACT
BACKGROUND: Recently, endoscopic ultrasound-guided (EUS) gastrojejunostomy (GJ) has emerged as an alternative option to surgical palliation and endoscopic duodenal stenting for malignant gastric outlet obstruction (GOO). Although early success rates are commonly reported with the technique, there is a paucity of data regarding the long-term efficacy of this approach. In this study, we investigated long-term outcomes in patients that underwent EUS-guided GJ for palliation of periampullary malignancies. METHODS: From a total of 192 studies that were reviewed, 6 studies with a follow-up time frame of a minimum of 5 months were analyzed, totaling 238 patients. Outcome variables included technical success rate, clinical success rate, adverse events, symptom recurrence, and re-intervention rates. RESULTS: The cohort of 238 patients had a technical success rate of 93.7% and a clinical success rate of 92.9%. A total of 25 patients (10.5%) experienced adverse events associated with EUS-GJ. A total of 14 patients (5.9%) experienced recurrence of GOO symptoms within 5 months. A total of 14 patients (5.9%) underwent re-intervention with the first 5 months. CONCLUSIONS: This systematic review shows that data are scarce regarding long-term effectiveness of EUS-guided GJ. Even though early success rates have been reported, further studies are needed to focus on long-term efficacy of this approach. Until such studies become available, surgical palliation should continue to be the treatment of choice for patients with malignant GOO with a prolonged life expectancy.
Subject(s)
Gastric Bypass , Gastric Outlet Obstruction , Gastric Outlet Obstruction/surgery , Gastric Outlet Obstruction/etiology , Humans , Gastric Bypass/methods , Gastric Bypass/adverse effects , Treatment Outcome , Palliative Care/methods , Endosonography/methods , Ampulla of Vater/surgery , Common Bile Duct Neoplasms/surgery , Common Bile Duct Neoplasms/complications , Duodenal Neoplasms/surgery , Duodenal Neoplasms/complicationsABSTRACT
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.
Subject(s)
Adenoma , Anemia , Duodenal Neoplasms , Male , Humans , Female , Occult Blood , Duodenum/surgery , Melena , Duodenal Neoplasms/complications , Duodenal Neoplasms/diagnosis , Duodenal Neoplasms/surgery , Anemia/etiology , Adenoma/complications , Adenoma/diagnosis , Adenoma/surgeryABSTRACT
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.
Subject(s)
Adenocarcinoma , Duodenal Neoplasms , Intestinal Obstruction , Jejunal Neoplasms , Ovarian Neoplasms , Female , Humans , Adenocarcinoma/surgery , Duodenal Neoplasms/complications , Intestinal Obstruction/etiology , Intestine, Small/pathology , Jejunal Neoplasms/diagnostic imaging , Jejunal Neoplasms/surgery , Ovarian Neoplasms/diagnosis , Ovarian Neoplasms/secondary , Ovarian Neoplasms/surgery , AdultSubject(s)
Duodenal Neoplasms , Gastrointestinal Hemorrhage , Lipoma , Humans , Lipoma/complications , Lipoma/diagnostic imaging , Lipoma/surgery , Lipoma/pathology , Duodenal Neoplasms/complications , Duodenal Neoplasms/pathology , Duodenal Neoplasms/diagnostic imaging , Duodenal Neoplasms/surgery , Gastrointestinal Hemorrhage/etiology , Male , Female , Middle AgedABSTRACT
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.
Subject(s)
Cholestasis , Colorectal Neoplasms , Duodenal Neoplasms , Lymphoma, Follicular , Middle Aged , Humans , Female , Lymphoma, Follicular/complications , Lymphoma, Follicular/diagnostic imaging , Lymphoma, Follicular/pathology , Duodenal Neoplasms/complications , Duodenal Neoplasms/diagnostic imaging , Duodenum/pathology , Prognosis , Colorectal Neoplasms/pathologyABSTRACT
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.
Subject(s)
Adenomatous Polyposis Coli , Adenomatous Polyps , Duodenal Neoplasms , Humans , Adenomatous Polyposis Coli/complications , Adenomatous Polyposis Coli/surgery , Duodenum/surgery , Duodenum/pathology , Endoscopy , Duodenal Neoplasms/complications , Duodenal Neoplasms/surgery , Duodenal Neoplasms/pathology , Retrospective StudiesABSTRACT
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.
Subject(s)
Duodenal Neoplasms , Neoplasms, Germ Cell and Embryonal , Testicular Neoplasms , Humans , Male , Young Adult , Adult , Gastrointestinal Hemorrhage/etiology , Neoplasms, Germ Cell and Embryonal/complications , Neoplasms, Germ Cell and Embryonal/diagnosis , Duodenal Neoplasms/complications , Duodenal Neoplasms/diagnosis , Duodenal Neoplasms/surgery , Tomography, X-Ray Computed/adverse effects , Testicular Neoplasms/complications , Testicular Neoplasms/pathologyABSTRACT
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.
Subject(s)
Angiolipoma , Duodenal Neoplasms , Female , Humans , Aged , Angiolipoma/complications , Angiolipoma/diagnostic imaging , Angiolipoma/surgery , Duodenal Neoplasms/complications , Duodenal Neoplasms/diagnostic imaging , Duodenal Neoplasms/surgery , Duodenum/pathology , Endoscopy, Gastrointestinal/adverse effects , Gastrointestinal Hemorrhage/surgeryABSTRACT
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 â¼50%. 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.
Subject(s)
Adenomatous Polyposis Coli , Colorectal Neoplasms , Duodenal Neoplasms , Neoplasms, Second Primary , Humans , Cohort Studies , Neoplasms, Second Primary/complications , Adenomatous Polyposis Coli/complications , Adenomatous Polyposis Coli/epidemiology , Adenomatous Polyposis Coli/surgery , Colorectal Neoplasms/epidemiology , Colorectal Neoplasms/complications , Duodenal Neoplasms/complications , Denmark/epidemiologyABSTRACT
The utilization of endoscopic ultrasound-guided gastrojejunostomy (EUS-GJ) in the setting of an obstructed (ingrown) duodenal stent as a bridge to pancreaticoduodenectomy (PD) remains undescribed. Herein, we report a case study of a 51-year-old patient who underwent EUS-GJ using lumen apposing metal stent (LAMS) for an obstructed duodenal stent during neoadjuvant treatment for duodenal adenocarcinoma. The patient ultimately underwent surgical resection by a classic PD 14 weeks after LAMS placement. EUS-GJ using LAMS represents a potential option as a salvage bridge to surgery for duodenal obstruction in the setting of an obstructed duodenal stent.
Subject(s)
Adenocarcinoma , Duodenal Neoplasms , Duodenal Obstruction , Gastric Bypass , Humans , Middle Aged , Duodenal Obstruction/diagnostic imaging , Duodenal Obstruction/etiology , Duodenal Obstruction/surgery , Stents , Duodenal Neoplasms/complications , Duodenal Neoplasms/diagnostic imaging , Duodenal Neoplasms/surgery , Ultrasonography, Interventional , Adenocarcinoma/complications , Adenocarcinoma/diagnostic imaging , Adenocarcinoma/surgeryABSTRACT
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.
Subject(s)
Adenocarcinoma of Lung , Duodenal Neoplasms , Gastrointestinal Hemorrhage , Lung Neoplasms , Adenocarcinoma of Lung/pathology , Adenocarcinoma of Lung/secondary , Lung Neoplasms/pathology , Lung Neoplasms/therapy , Neoplasm Metastasis , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/radiotherapy , Duodenal Neoplasms/complications , Duodenal Neoplasms/secondary , Duodenal Neoplasms/surgery , Humans , Adult , Male , Cough/etiology , Abdominal Pain/etiology , Melena/etiology , Treatment OutcomeABSTRACT
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.
Subject(s)
Adenocarcinoma , Crohn Disease , Duodenal Neoplasms , Ileal Neoplasms , Humans , Crohn Disease/pathology , Neutrophils/pathology , Retrospective Studies , Ileal Neoplasms/complications , Ileal Neoplasms/surgery , Duodenal Neoplasms/complications , Lymphocytes/pathology , Adenocarcinoma/pathologySubject(s)
Anemia , Duodenal Neoplasms , Hemangiosarcoma , Ileal Neoplasms , Jejunal Neoplasms , Humans , Hemangiosarcoma/complications , Hemangiosarcoma/surgery , Intestine, Small , Jejunal Neoplasms/complications , Jejunal Neoplasms/surgery , Duodenal Neoplasms/complications , Ileal Neoplasms/complications , Ileal Neoplasms/diagnosis , Ileal Neoplasms/surgery , Anemia/etiologyABSTRACT
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 â ¡B(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.