Primary Duodenal Adenocarcinoma

Ryder, Nova M.; Ko, Clifford Y.; Hines, Oscar J.; Gloor, Beat; Reber, Howard A.

doi:10.1001/archsurg.135.9.1070

Cited by 95 publications

(82 citation statements)

References 12 publications

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“…Although the possibility of local recurrence at the duodenal stump was challenged by our pathologic fi ndings, a review of the literature revealed that most duodenal cancers arise in the second portion of the duodenum and some occur in the third or fourth portion, but none occur in the fi rst portion [8][9][10]. In addition to recurrence, metachronous cancer may develop in gastric cancer patients.…”

Section: Discussionmentioning

confidence: 99%

Duodenal stump cancer after Billroth-II distal gastrectomy for gastric cancer

Lee

Kim

2009

Gastric Cancer

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EGC have a risk of developing a second primary (metachronous) cancer, such as colorectal, lung, or liver cancer [1][2][3].The duodenal stump after Billroth II (B-II) distal gastrectomy is a rare site for cancer recurrence unless a tumor-free margin has not been achieved. Moreover, to our knowledge, there are no previously published studies regarding the occurrence of recurrent or metachronous cancer at the duodenal stump. Here, we describe duodenal stump cancer that occurred after a B-II distal gastrectomy for advanced gastric cancer (AGC), particularly focusing on the diffi culties associated with distinguishing recurrent gastric cancer from metachronous duodenal cancer. Case reportA 68-year-old man who had undergone distal gastrectomy with B-II type gastrojejunostomy for AGC in June 2005, presented with abrupt onset of dizziness and tarry stool in June 2008. The previously removed tumor was 8.5 × 7.5 cm in size, and located in the posterior wall of the mid-body portion of the stomach, and there was no duodenal lesion on the gastrofi berscopic (GFS) examination that had been performed before the gastrectomy. Pathologic examination revealed that the gastric lesion was a poorly differentiated adenocarcinoma infi ltrating the subserosa, accompanied by multiple lymph node metastases (48 of 77 retrieved nodes were metastatic); the duodenum was resected, using a linear stapler, about 2 cm below the pyloric ring. The proximal and distal resected margins were 1.5 cm and 8.0 cm, respectively. Subsequently, six cycles of adjuvant chemotherapy, including 5-fl uorouracil (FU), epirubicin, and cisplatinum, were performed without any problems. The patient was followed up every 6 months by tumor marker analysis, ultrasonography, and computed tomography (CT) and his last checkup had been in January 2008. During Abstract Duodenal cancer is an uncommon neoplasm and it mostly arises from the periampullary area. However, metachronous or even recurrent cancer at the duodenal stump following Billroth II type distal gastrec tomy for gastric cancer is extremely rare and, to our knowledge, has not yet been reported. A 68-year-old man underwent Billroth II distal gastrectomy with D2 lymph node dissection for an advanced gastric cancer. At that time the tumor stage was T2bN3M0, with 44 of 78 retrieved lymph nodes showing metastasis. He was well without recurrence for 3 years; however, he visited our hospital because of the abrupt onset of dizziness and tarry stool. A polypoid tumor that bled easily when touched was found at the end of the afferent loop of the duodenal stump by gastrofi berscopic examination, and it was proven to be an adenocarcinoma by endoscopic biopsy. Fortunately, additional studies, including abdominal computed tomography and positron emission tomography-computed tomography, showed no other sites of recurrence. The patient underwent pancreaticoduodenectomy for local control of the recurrent tumor at the duodenal stump, and the pathologic fi ndings, based on immunohistochemical staining, strongly suggested that the du...

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Section: Discussionmentioning

confidence: 99%

Duodenal stump cancer after Billroth-II distal gastrectomy for gastric cancer

Lee

Kim

2009

Gastric Cancer

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“…Adenomatous polyps are more common at gastroduodenal junction and have 3%-5% risk of developing adenocarcinoma in life time [5] . Brunner gland adenomas are very rare tumors and less than 150 cases have been reported in the English literature [6] .…”

Section: Discussionmentioning

confidence: 99%

Primary duodenal neoplasms: A retrospective clinico-pathological analysis

Bal

Joshi²,

Vaiphei³

et al. 2007

WJG

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AIM:To analyze the clinico-pathological spectrum of primary duodenal neoplasms. METHODS:A total of 55 primary duodenal neoplasms reported in the last 10 years after excluding ampullary and periampullary tumors were included in the study. Clinical details were noted and routine hematoxylin and eosin stained paraffin sections were studied for histological subtyping of the tumors. RESULTS:On histopathological examination primary duodenal neoplasms were categorized as: epithelial tumor in 27 cases (49.0%) including 10 cases of adenoma, 15 cases of adenocarcinoma, and 2 cases of Brunner gland adenoma; mesenchymal tumor in 9 cases (16.3%) consisting of 4 cases of gastrointestinal stromal tumor, 4 cases of smooth muscle tumor and I case of neurofibroma; lymphoproliferative tumor in 12 cases (21.8%), and neuroendocrine tumor in 7 cases (12.7%). CONCLUSION:Although non-ampullary/periampullary duodenal adenocarcinomas are rare, they constitute the largest group. Histopathological examination of primary duodenal tumors is important for correct histological subtyping.

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“…A palliative bypass can be performed in non-resectable tumors with obstructive symptoms. 1,2,4,7 Chemotherapy in the treatment of duodenal adenocarcinoma is not associated with good results and more studies are required on this subject. 4 Some authors have reported a different prognosis based on the site of the tumor, which showed a better survival rate in the D3 and D4 forms.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5] Adenocarcinomas are the most common histological type of malignant neoplasms of the duodenum accounting for 50% of the cases, followed by carcinoid, leiomyosarcomas and lymphomas. 4,[6][7][8] Adenocarcinoma of the duodenum usually occurs between the sixth and seventh decades, [4][5][6] and equal sex distribution is reported in the majority of the studied series.…”

Section: Introductionmentioning

confidence: 99%