Primary adenocarcinoma of the duodenum in the elderly: Clinicopathological and immunohistochemical study of 17 cases

Abstract

Seventeen cases of primary duodenal adenocarcinoma occurring in the elderly (older than 65 years) were examined to clarify their clinicopathological features and biological behavior. The mean age was 77.4 years (range, 66-104), and there was no appreciable difference in the incidence between the sexes (female: male ratio, 8: 9). Thirteen patients had tumors located in the first portion of the duodenum, three in the second portion and one in the third portion. Grossly, there were three varieties of lesions: six polypoid, four flat-elevated and seven ulcerative-invasive. Sixteen cases showed well-differentiated adenocarcinoma, three of which were difficult to distinguish from adenoma, and one was poorly differentiated adenocarcinoma. Three of 16 tumors had poor differentiation in the invasive area, whereas mucosal lesions were well differentiated. Eight tumors had invaded the duodenal wall with occasional involvement of the pancreas. Immunohistochemistry demonstrated p53 protein overexpression in two intramucosal (22.2%) and five invasive (62.5%) cancers. In the intramucosal area the mean Ki-67-positive rate (PR) of the tumors with distant metastasis was significantly higher than that of the tumors without metastasis (46.0 vs 31.6%; P < 0.05), while there was no significant difference in the association between PR and gross feature or depth of the tumors. Clinical follow-up showed three of the five patients with invasive cancer died of carcinoma within 28 months. Compared with published data from other investigators, the results of the present study indicate a proximal shift of duodenal carcinoma in the elderly. Furthermore, it is concluded that invasive duodenal adenocarcinomas with high PR should be considered as potentially aggressive tumors, although their histology may indicate a high degree of differentiation.

Mucinous Carcinoma of the Duodenum Associated with Hereditary Nonpolyposis Colorectal Cancer: Report of a Case

“…15,16 In the general population, the most common site of the primary small bowel tumors tends to be the duodenum (46%-55%), 3-7 but in HNPCC, a nearly equal distribution of the tumor throughout the small bowel and a relatively low rate in the duodenum (36%) has been reported. 17 Regarding other characteristics of small bowel tumors associated with HNPCC, a younger age distribution and a male predominance (3 : 1), which was twice the ratio reported in tumor registry studies, and a better prognosis with estimated 5-and 10-year survival rates of 44% and 33%, respectively, have been reported.…”

Dvylikapirštės žarnos adenokarcinoma: etiologija, klinika, diagnostika, gydymas, prognozė ir klinikinis atvejis

“…Pirminë dvylikapirðtës þarnos adenokarcinoma yra labai reta patologija (1 pav. ), kuri sudaro 0,3-1% visø virðkinimo trakto piktybiniø navikø [1][2][3][4][5][6], 33-45% piktybiniø plonosios þarnos navikø [5][6][7][8]. Autopsijos duomenimis, pirminë dvylikapirðtës þarnos adenokarcinoma sudaro 0,019-0,5% visø autopsijos atvejø [7][8][9][10][11].…”

“…Vienodai pasitaiko vyrams ir moterims. Serganèiøjø pikas, ávairiais literatûros duomenimis, yra nuo penkto iki aðtunto deðimtmeèio [7]. Kadangi patologija yra reta, tad literatûroje daþniausiai publikuojami vienà atvejá apraðantys straipsniai.…”

Adenocarcinoma of the small bowel

“…Jejunum/ileum 3 2 4 0 2 Arber et al 48 28 Small bowel 10 Rodriguez-Bigas et al 49 46 Small bowel 15 Arai et al 50 17 Duodenum 7 Zhu et al 51 15 Duodenum 3 Younes et al 52 12 Duodenum…”

“…Analysis of genetic abnormalities in small bowel cancer21,[44][45][46][47][48][49][50][51][52][53][54][55] …”