Primary Extra‐ampullary Duodenal Neuroendocrine Carcinoma in an Adult Male

Abstract

A primary extra-ampullary duodenal neuroendocrine carcinoma was found in a 40-year-old man who presented with upper abdominal pain and weight loss. Duodenoscopy and hypotonic duodenography revealed a protruding fungating mass with luminal occlusion at the third part of the duodenum (D3). Although the metastatic work-up was normal, the tumor was inoperable intraoperatively, hence a palliative bypass was carried out followed by chemotherapy with 5-fluorouracil and leucovorin. Examination of the biopsy by immunohistochemistry and ultrastructural study revealed it to be neuroendocrine in nature, expressing synaptophysin, chromogranin and cytokeratin and containing dense core cytoplasmic granules. However, there was no evidence of clinical endocrinopathy. The present case emphasizes the need for better detection, further analysis and evaluation of such rare cases to identify their clinical course and effective treatment modalities.

A Case of Duodenal Neuroendocrine Carcinoma Treated with Amrubicin as Second-line Chemotherapy

“…Gastrointestinal NEC is very rare and has a poor prognosis; therefore, standard therapy has not yet been established [1,3]. Duodenal NEC is even rarer, and there is extremely little available clinical information on duodenal NEC [2]. In general, the regimen of chemotherapy is chosen in the same way as for SCLC, regardless of the primary site of the NEC, because NEC is clinico-pathologically similar to SCLC [4].…”

“…Duodenal NECs constitute 5% of gastrointestinal NECs. Most duodenal NECs occur in the papilla [2], therefore duodenal extra-ampullary NEC is extremely rare. In general, NEC displays an aggressive behavior; at least half of the patients have distant metastases at diagnosis [3].…”

Clinical and Demographic Characteristics of Patients with Urinary Tract Hydatid Disease

“…The WHO/IWG-E classification system for CE diagnosis and treatment is based on B-mode ultrasound medical imagery and classifies hydatid cysts as stage CL, CE1, CE2, CE3a, CE3b, CE4, or CE5 (Table 3) [10], [11]. CE1 and CE2 cysts are active and fertile with viable protoscoleces; CE3a and CE3b cysts are in a transitional stage where the integrity of the cyst has been compromised; and CE4 and CE5 cysts are inactive and degenerative [13].…”

“…Although many cases of this disease have been reported in the literature, complete elucidation of pathophysiology of urinary tract CE is needed to develop accurate and rapid pre-surgical diagnoses for people who live in regions where this disease is common [11]. In the present study, we retrospectively analyzed the demographic characteristics and clinical features of patients from Northeastern China who presented with renal and urinary tract CE.…”