Adenosquamous Carcinoma of Duodenal Bulb Mimicking Subepithelial Tumor on Computed Tomography: A Case Report

Sim, Hayan; Woo, Ji Young; Yang, Ik; Hwang, Ji Young; Moon, Jai‐Hee; Kim, Han Myeon; Kim, Hee Young; Kim, Hye Jeong; Hwang, Sook Min; Kim, Jeong Won; Hwang, Ji Woong

doi:10.3348/jksr.2018.79.2.92

Cited by 1 publication

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“…Only five cases of primary duodenal ASC of the non-ampulla of Vater have been reported in the English literature [ 6 – 10 ] (Table 2 ). NADASCs appear to affect both males and females, but the reported ratio of males to females is 5:1.…”

Section: Discussionmentioning

confidence: 99%

“…Xue et al reported only one case of NADASC in their study of 47 non-ampullary duodenal carcinomas [ 5 ]. To date, only five cases have been reported in the literature [ 6 – 10 ]. ASCs in other primary sites that normally have glandular epithelium, such as the pancreas, stomach, colon, rectum, breast, and prostate, are also rare and considered to be clinically more aggressive, with a worse prognosis than their adenocarcinoma counterparts [ 6 , 7 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

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A case of non-ampullary duodenal adenosquamous carcinoma with successful emergency pancreaticoduodenectomy for gastrointestinal hemorrhage

Miyama,

Chikaishi,

Kobayashi

et al. 2023

surg case rep

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Background Although most duodenal carcinomas are pathological adenocarcinomas, a small number of cases have been reported of adenosquamous carcinoma, characterized by variable combinations of two malignant components: adenocarcinoma and squamous cell carcinoma. However, owing to the small number of cases of non-ampullary duodenal adenosquamous carcinoma, there have been no reported cases of emergency pancreaticoduodenectomy for gastrointestinal hemorrhage due to non-ampullary duodenal adenosquamous carcinoma. Case presentation A 66-year-old Japanese male presented to the referring hospital with a chief complaint of abdominal pain, diarrhea, and dark urine that had persisted for 1 month. The patient was referred to our hospital because of liver dysfunction on a blood examination. Laboratory results of the blood on the day of admission showed that total and direct bilirubin levels (12.0 mg/dl and 9.6 mg/dl) were markedly increased. An endoscopic retrograde biliary drainage tube was inserted for the treatment of obstructive jaundice, and imaging studies were continuously performed. Contrast-enhanced computed tomography and endoscopy revealed an ill-defined lesion involving the second portion of the duodenum, predominantly along the medial wall, and measuring 60 mm in diameter. No metastases were observed by positron emission tomography. Pancreaticoduodenectomy was planned based on the pathological findings of poorly differentiated adenocarcinoma. However, 2 days before the scheduled surgery, the patient experienced hemorrhagic shock with melena. Owing to poor hemostasis after endoscopic treatment and poor control of hemodynamic circulation despite blood transfusion, radiological embolization and hemostasis were attempted but were incomplete. An emergency pancreaticoduodenectomy was performed after embolizing the route from the gastroduodenal artery and pseudoaneurysm area to reduce bleeding. The operation was completed using an anterior approach without Kocherization or tunneling due to the huge tumor. The operation time was 4 h and 32 min, and blood loss was 595 mL The pathological diagnosis was adenosquamous carcinoma. The postoperative course was uneventful with 17 day hospital stay and the patient is currently well, with no signs of recurrence 9 months after surgery. Conclusions This report presents an extremely rare case of successful emergency pancreaticoduodenectomy for gastrointestinal hemorrhage caused by non-ampullary duodenal adenosquamous carcinoma.

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Section: Discussionmentioning

confidence: 99%