Carcinoid Tumor of the Duodenum:

Abstract

ContextDuodenal carcinoids are extremely rare, and their characteristics and biological behavior have not been fully elucidated.ObjectiveTo analyze the clinicopathological characteristics of patients with resected duodenal carcinoids.MethodsTwenty patients (12 females and 8 males) were investigated. Their average age was 66.4 ± 5.8 years old (43 to 88 years old). The data corresponding to the clinical picture, diagnosis, treatment, and prognosis of patients with duodenal carcinoid tumors subjected to resection over a period of 18 years (1993-2011) were analyzed.ResultsThe most common symptoms were dyspepsia (50%) and epigastric pain (45%) followed by weight loss (10%) and vomiting (5%). Carcinoid syndrome was not observed in any patient. The lesion was located on the first part of the duodenum in 15 (75%) patients, the second part in 4 (20%) patients, and the third part in 1 (5%) patient. The diagnosis of a carcinoid tumor was established through an endoscopic excision biopsy in 19 (95%) patients and an histopathological examination of the surgical specimen in 1 (5%) patient. The average tumor size was 1.1 cm ± 0.4 cm (0.3 cm to 6.0 cm). Nineteen (95%) patients were initially treated by endoscopic resection of the duodenal lesion. One patient (5%), whose tumor was on the third part of the duodenum underwent a duodenectomy of the third and fourth duodenal parts and duodenojejunal anastomosis. The duodenal carcinoid resection margin was involved in four (20%) patients. Four (20%) patients were subjected to a partial gastrectomy to fully remove the lesion. The tumor was restricted to the submucosal layer in 16 (80%) cases, and it penetrated into the muscular layer in 4 (20%) cases. All patients exhibited positive chromogranin A, neuron-specific enolase, and/or synaptophysin immunostaining. The average duration of the follow-up period was 39.6 months (3 to 96 months). Twelve (60%) of the 20 cases in this series are alive without any evidence of active disease. Only one (5%) patient died due to liver metastases of the duodenal carcinoid.ConclusionsDuodenal carcinoids are rare and indolent tumors usually associated with a benign progression. Duodenoscopy, computerized tomography, and endoscopic ultrasound should be performed to evaluate the tumor size, the level of wall invasion, and the presence of regional or distant lymphatic metastases. Endoscopic removal of tumors smaller than 1.0 cm without periampullary localization or evidence of muscular propria layer invasion assessed by histology and/or endoscopic ultrasound is recommended. The endoscopic resection with a carcinoid tumor size between 1.0 cm and 2.0 cm can be incomplete and require new endoscopic resection or even surgical removal. Duodenal carcinoid larger than 2.0 cm require full-thickness resection and concomitant lymphadenectomy.

Neuroendocrine tumor of the ampulla of Vater with distant cystic lymph node metastasis: a case report

“…NETs of the ampulla of Vater usually appear as submucosal masses that are small and spherical with a smooth surface and an intact duodenal mucosa. Consequently, superficial biopsies are negative and deeper biopsies are required for a diagnosis [ 12 , 13 ]. In our present case, we could get the biopsy specimen from the mass because it had an ulcerated surface.…”

Ectopic adrenocorticotropic hormone syndrome in a case of duodenal neuroendocrine tumor presenting with liver metastasis

“…Within the gastrointestinal tract, carcinoid tumors are most commonly found in the appendix, followed by the ileum, rectum, and stomach. [ 2 ] Duodenal carcinoids are extremely rare, and their characteristics and biological behavior have not been fully elucidated. Duodenal carcinoid tumors are most commonly found on the first part of the duodenum.…”

Laparoscopic and endoscopic cooperative surgery for duodenal neuroendocrine tumor (NET) G1: Report of a case

“…Waisberg et al performed endoscopic excision of duodenal G1 NETs, 10–20 mm in diameter; however, 4 of the 10 patients (40%) needed additional surgical treatment because of incomplete endoscopic resection; the authors concluded that a new endoscopic resection or surgical treatment was required for G1 NETs of that size. 5 ESD is widely accepted for early gastrointestinal tumors, including NET G1, and has the advantage of a higher probability of success for larger and more consistent resection of lesions just above the muscle layer than endoscopic mucosal resection. However, the duodenal wall is generally thinner than that of the stomach and ESD for duodenal tumors is associated with an increased perforation risk 6 ; maneuvering the flexible endoscope is also technically difficult in the tiny duodenal lumen.…”