Adenocarcinoma of the Duodenum Arising in a Tubulo-Villous Adenoma

Abstract

Villous adenoma of the duodenum is rare and has a high prevalence of cancer. We report here an unusual case of a 73-year-old man who presented with a tumour on the second part of the duodenum with moderate dysplasia of a tubulo-villous adenoma at the biopsies. A segmental duodeno-jejunal resection was performed and the resection margins were negative. The final histological analysis was a moderately differentiated invasive duodenal adenocarcinoma (pT3Nx). Management of these tumours is discussed here.

Intramucosal duodenal adenocarcinoma concomitant with Saint’s triad

“…7 Worthy of note in the present case study was the incidental diagnosis of the typical ST manifested by a hiatus hernia, gallbladder disorder, and colonic diverticula. [12][13][14] According to the literature, this report involves the unsuspected, underreported, or very infrequent association of the intramucosal duodenal adenocarcinoma with the ST. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] Personal (duodenal polypoid lesion) and family (uncle with intestinal cancer) antecedents may have a role in the origin of the duodenal malignancy herein described. Nevertheless, there were no consistent findings to confirm the diagnostic hypothesis either of hereditary nonpolyposis colorectal cancer or familial adenomatous polyposis.…”

“…Similar to previous descriptions, the histopathological pattern revealed by the initial endoscopic biopsy specimens established a benign duodenal polyp diagnosis. 1,4,6 Therefore, a significant concern in this setting is related to the possibility of pitfalls that may propitiate diagnostic mistakes and late evidence of an associated adenocarcinoma. Diagnosis of the tumor in the early stage, as found in the present case, allows less invasive surgical procedures, including endoscopic mucosal or submucosal interventions.…”

“…Duodenal adenocarcinomas are rare, represent 0.3% of gastrointestinal and 33-45% of the small bowel tumors, and with nonspecific symptoms, the diagnosis is incidental. [1][2][3][4][5][6][7][8][9][10] They are prevalent in the second duodenal portion of people between 40 and 60 years. 10 Risk factors include alcohol, smoked or salt-cured foods, red meats, refined sugars, hereditary nonpolyposis colorectal cancer, and familial adenomatous polyposis.…”

“…2,7,8 Duodenal adenocarcinoma is strongly associated with the rare tubulovillous and villous adenomas, a phenomenon favoring misdiagnosis or late cancer diagnosis. 1,[6][7][8][9] Endoscopy and imaging studies may detect the intraluminal polypoid changes. 1,4,[6][7][8][9] Minimally invasive (endoscopic mucosal resection or submucosal dissection) for the superficial and complete resection for locally advanced tumors are surgical options.…”

“…1,[6][7][8][9] Endoscopy and imaging studies may detect the intraluminal polypoid changes. 1,4,[6][7][8][9] Minimally invasive (endoscopic mucosal resection or submucosal dissection) for the superficial and complete resection for locally advanced tumors are surgical options. 10,11 Adjuvant or neoadjuvant chemotherapy are tools for patients considered inoperable.…”