Somatostatinomas are rare functioning carcinoid tumors that usually arise in the pancreas and duodenum. They are seldom associated with typical clinical symptoms; their diagnosis is confirmed only by histological and immunohistochemical studies and the presence of specific hormones. Two distinct clinicopathological forms of somatostatinoma exist: duodenal and pancreatic somatostatinomas. Clinically, compared to pancreatic somatostatinomas, duodenal somatostatinomas are more often associated with nonspecific symptoms and neurofibromatosis, but less often with somatostatinoma syndrome or metastasis. Histologically, duodenal somatostatinomas frequently have psammoma bodies in the tumor cells. We report a case of duodenal somatostatinoma in 58-year-old man with vague epigastric pain and nausea. He did not have diabetes, steatorrhea, or cholelithiasis. Abdominal computed tomography showed a 25-mm mass in the duodenum and 25-mm nodule in the liver. Endoscopic retrograde cholangiopancreatography showed a duodenal submucosal tumor. Although the endoscopic biopsies were free of malignancy, the patient subsequently underwent Whipple's operation for the duodenal mass. Examination revealed as a somatostatinoma using a special stain for somatostatin.
Cholangiopancreatography, Endoscopic Retrograde ; Duodenal Neoplasms/diagnosis/*pathology/surgery ; Humans ; Male ; Middle Aged ; Somatostatinoma/diagnosis/*pathology/surgery

Duodenal gangliocytic paraganglioma derived from neural crest is a peculiar neuroendocrine tumor. It is incidentally found during radiographic studies or due to gastrointestinal hemorrhage caused by frequent ulceration of the overlying mucosa. Most lesions are pedunculated and submucosal with distinctive histology consisting of endocrine cells, ganglion cells and spindle-shaped Schwann cells. We experienced a duodenal gangliocytic paraganglioma in a 40-year-old woman presenting with episodes of melena. Esophagogastroduodenoscopy revealed a submucosal ulcerated tumor in the second portion of duodenum and a biopsy confirmed gangliocytic paraganglioma. The tumor was enucleated through a duodenotomy. It's size was 5.5 X 3 X 1.5 cm sized and revealed positive cellular reaction for chromogranin, synaptophysin, neuron-specific enolase, and neurofilament by immunohistochemistry. The majority of the reported duodenal gangliocytic paraganglioma were of benign nature. Therefore, radical surgery or a lymph node dissection could be avoided if that disease was confirmed. However, thorough investigation for lymph node metastasis and postoperative follow-up are needed. We report the first case of a duodenal gangliocytic paraganglioma in Korea with a review of literature.
Adult ; Duodenal Neoplasms/*diagnosis/pathology/surgery ; English Abstract ; Female ; Humans ; Paraganglioma/*diagnosis/pathology/surgery

OBJECTIVETo investigate the early diagnosis of primary duodenal carcinoma and its outcome after surgical procedure.

METHODSTwenty-two patients with primary duodenal carcinoma treated operatively between 1983 and 1997 were analyzed retrospectively. Eleven patients complained of epigastric pain and discomfort, 5 jaundice, 4 nausea and vomiting and 2 epigastric fullness. The correct diagnosis rate for endoscopy was 90.0% (9/10), for duodenography 86.7% (13/15), for ultrasound examination 33.3% (4/12) and for computerized tomography (CT) scanning 58.3% (7/12), respectively. All of the 22 patients received surgery including pancreaticoduodenectomy (12 patients), segmental resection (4) and bypass operation (gastrojejunostomy and cholecystojejunostomy or cholangiojejunostomy) (6).

RESULTSPrimary duodenal carcinoma was characterized nonspecifically, and the correct diagnosis was based on endoscopy and duodenography. The follow-up rate of this group was 86.4% (19/22). The 1-, 3-, 5-year survival rates of patients receiving radical resection (n = 16, 1 patient lost follow-up) were 86.7% (13/15), 46.7% (7/15), and 26.7% (4/15), respectively. The 5-year survival rate of patients receiving pancreaticoduodenectomy was 27.3% (3/11), and the 5-year survival rate of patients having segmental resection was 1/4. No patient (n = 6, 2 lost follow-up) with primary duodenal carcinoma treated by bypass procedure survived more than one year. There was a significant difference between patients receiving radical procedure and bypass operation (chi(2) = 6.84, P < 0.01).

CONCLUSIONRadical resection might improve the survival of patients with primary duodenal carcinoma.

Adult ; Aged ; Duodenal Neoplasms ; diagnosis ; mortality ; surgery ; Female ; Humans ; Male ; Middle Aged ; Prognosis ; Survival Rate

BACKGROUND/AIMS: Brunner's gland adenoma is a rare benign tumor of the duodenum. Although several cases of successful endoscopic polypectomy have been reported, the studies on the safety and usefulness of endoscopic polypectomy are extremely rare. Therefore, we report the results of 10 cases of Brunner's gland adenoma treated by endoscopic polypectomy. METHODS: Between November 1998 and January 2003, 10 cases of Brunner's gland adenoma were diagnosed. The mean age of the cases (6 male, 4 female) was 60.4 years. They were located in the bulb (9) and the second portion (1) of the duodenum. All cases were diagnosed and removed by endoscopic polypectomy. RESULTS: The size of the tumor ranged from 1.0 to 3.5 cm in diameter. Pedunculated polyps were found in three cases. In other seven cases, semipedunculated polyps were observed and, three of them were presented as submucosal tumor. All cases had no malignant foci. There was no complication such as bleeding, perforation, and pancreatitis after endoscopic polypectomy. During follow-up period (range 1~39 months) after endoscopic polypectomy, there was no complication and recurrence of the lesions. CONCLUSIONS: Endoscopic polypectomy was a safe and useful method for the treatment of duodenal Brunner's gland adenoma without complication and recurrence.
Adenoma/diagnosis/*surgery ; Adult ; Aged ; *Brunner Glands ; Duodenal Neoplasms/diagnosis/*surgery ; *Endoscopy, Gastrointestinal ; English Abstract ; Female ; Humans ; Male ; Middle Aged

OBJECTIVETo investigate the clinical characteristics, surgical procedures and prognosis of duodenal gastrointestinal stromal tumors (GISTs).

METHODSThe clinical data of 18 GIST patients, collected from 1995 to 2004, were retrospectively analyzed.

RESULTSThe lesions of duodenal GISTs mainly located in the descending duodenum (13/18), unusually in the horizontal part (2/18), ascending part (1/18), and the bulb (2/18). Pathological examination revealed 1 case of benign tumor, 2 cases of borderline tumors and 15 cases of malignant tumors, Microscopically, the tumors were composed of spindle cells (14 cases), epithelial cell (1 case), and mixed cell types (3 cases). The clinical manifestations were non-specific, mostly was melena (7/18), as well as abdominal pain (6/18), fullness (5/18), and anemia (3/18). The diagnoses were performed by upper gastrointestinal radiography, gastroscopy, endoscopic ultrasonography and CT scan. All of the 18 patients received surgical treatment, including 9 pancreaticoduodenectomies, 5 local resections, 3 segmental resections of duodenum, and 1 distal subtotal gastrectomy. 1 and 3 year survival rates were 100% and 86.7% respectively.

CONCLUSIONMost duodenal GISTs are malignant, and the choices of surgical procedures are mainly determined by the location and size of the tumors.

Adult ; Aged ; Duodenal Neoplasms ; diagnosis ; pathology ; surgery ; Female ; Gastrointestinal Stromal Tumors ; diagnosis ; pathology ; surgery ; Humans ; Male ; Middle Aged ; Retrospective Studies

Hepatocellular carcinoma (HCC) is one of the most common malignant neoplasms occuring worldwide. Surgical resection currently provides the best chance of long-term tumor free survival, but the most HCCs are not candidates for surgical excision due to poor liver function or poor medical background. Numerous noninvasive alternatives to surgical resection have been introduced to treat liver cancers. Radiofrequency thermal ablation has begun to receive much attention as an effective and minimally invasive technique for the local control of HCC. The biliary system related complications after radiofrequency ablation has rarely been reported. We report a case of biliary-duodenal fistula with liver abscess after radiofrequency ablation for HCC. The case was treated by abscess drainage and antibiotics.
Biliary Fistula/*diagnosis/etiology ; Carcinoma, Hepatocellular/diagnosis/*surgery ; Catheter Ablation/*adverse effects ; Duodenal Diseases/*diagnosis/etiology ; Duodenal Obstruction/diagnosis ; Female ; Humans ; Intestinal Fistula/*diagnosis/etiology ; Liver Neoplasms/diagnosis/*surgery ; Middle Aged ; Tomography, X-Ray Computed

Objective: To analyze the clinicopathological characteristics and prognosis of patients with small bowel tumors. Methods: This was a retrospective, observational study. We collected clinicopathological data of patients with primary jejunal or ileal tumors who had undergone small bowel resection in the Department of Gastrointestinal Surgery, West China Hospital, Sichuan University between January 2012 and September 2017. The inclusion criteria included: (1) older than 18 years; (2) had undergone small bowel resection; (3) primary location at jejunum or ileum; (4) postoperative pathological examination confirmed malignancy or malignant potential; and (5) complete clinicopathological and follow-up data. Patients with a history of previous or other concomitant malignancies and those who had undergone exploratory laparotomy with biopsy but no resection were excluded. The clinicopathological characteristics and prognoses of included patients were analyzed. Results: The study cohort comprised 220 patients with small bowel tumors, 136 of which were classified as gastrointestinal stromal tumors (GISTs), 47 as adenocarcinomas, and 35 as lymphomas. The median follow-up for all patient was 81.0 months (75.9-86.1). GISTs frequently manifested as gastrointestinal bleeding (61.0%, 83/136) and abdominal pain (38.2%, 52/136). In the patients with GISTs, the rates of lymph node and distant metastasis were 0.7% (1/136) and 11.8% (16/136), respectively. The median follow-up time was 81.0 (75.9-86.1) months. The 3-year overall survival (OS) rate was 96.3%. Multivariate Cox regression-analysis results showed that distant metastasis was the only factor associated with OS of patients with GISTs (HR=23.639, 95% CI: 4.564-122.430, P<0.001). The main clinical manifestations of small bowel adenocarcinoma were abdominal pain (85.1%, 40/47), constipation/diarrhea (61.7%, 29/47), and weight loss (61.7%, 29/47). Rates of lymph node and distant metastasis in patients with small bowel adenocarcinoma were 53.2% (25/47) and 23.4% (11/47), respectively. The 3-year OS rate of patients with small bowel adenocarcinoma was 44.7%. Multivariate Cox regression-analysis results showed that distant metastasis (HR=4.018, 95%CI: 2.108-10.331, P<0.001) and adjuvant chemotherapy (HR=0.291, 95% CI: 0.140-0.609, P=0.001) were independently associated with OS of patients with small bowel adenocarcinoma. Small bowel lymphoma frequently manifested as abdominal pain (68.6%, 24/35) and constipation/diarrhea (31.4%, 11/35); 77.1% (27/35) of small bowel lymphomas were of B-cell origin. The 3-year OS rate of patients with small bowel lymphomas was 60.0%. T/NK cell lymphomas (HR= 6.598, 95% CI: 2.172-20.041, P<0.001) and adjuvant chemotherapy (HR=0.119, 95% CI: 0.015-0.925, P=0.042) were independently associated with OS of patients with small bowel lymphoma. Small bowel GISTs have a better prognosis than small intestinal adenocarcinomas (P<0.001) or lymphomas (P<0.001), and small bowel lymphomas have a better prognosis than small bowel adenocarcinomas (P=0.035). Conclusions: The clinical manifestations of small intestinal tumor are non-specific. Small bowel GISTs are relatively indolent and have a good prognosis, whereas adenocarcinomas and lymphomas (especially T/NK-cell lymphomas) are highly malignant and have a poor prognosis. Adjuvant chemotherapy would likely improve the prognosis of patients with small bowel adenocarcinomas or lymphomas.
Humans ; Prognosis ; Intestinal Neoplasms/diagnosis* ; Duodenal Neoplasms ; Gastrointestinal Stromal Tumors ; Lymphoma ; Adenocarcinoma/surgery* ; Constipation ; Abdominal Pain ; Retrospective Studies

No abstract availble.
Aged ; Duodenal Neoplasms/*diagnosis/pathology/surgery ; Endoscopy, Gastrointestinal ; Esophagoscopy ; Female ; Helicobacter Infections/*diagnosis ; *Helicobacter pylori ; Humans ; Lymphoma, B-Cell, Marginal Zone/*diagnosis/pathology/surgery

OBJECTIVETo investigate the diagnosis and treatment of benign duodenal tumor.

METHODSClinical data of 14 patients with benign duodenal tumor confirmed pathologically or by operation from Oct.1988 to Oct.2001 were analyzed retrospectively.

RESULTSOf 14 patients, 5 had Brunner's grand adenoma, 4 mesenchymoma, 2 leiomyoma, 2 hemangioma, 1 lipoma. Upper abdominal discomfort (64% ), gastrointestinal bleeding(50% ) and abdominal pain(20% ) were common manifestations. All cases received gastroscopy and only one case was diagnosed. Five cases received duodenoscope and the diagnosis was confirmed in 4 cases. Nine cases received hypotonic duodenography and lesions were found in 8 cases. Digital subtraction angiography was performed in 3 cases and detected all lesions. Computed tomographic scan and B-ultrasound were performed in 2 cases and only one case was diagnosed. Eleven cases (79% ) got definite diagnosis before operation. Tumor resection was performed in all patients. Perioperative death occurred in one patient. No recurrence occurred in 13 cases after following up from 2 to 11 years.

CONCLUSIONUpper abdominal discomfort and gastrointestinal bleeding are common features in patients with benign duodenal tumor. Duodenoscopy and hypotonic duodenography are good diagnostic approaches. Surgical tumor resection is the first choice of treatment.

Adult ; Aged ; Duodenal Neoplasms ; diagnosis ; pathology ; surgery ; Duodenoscopy ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Retrospective Studies

OBJECTIVETo summarive the experience in diagnosis and treatment of primary small intestinal neoplasm.

METHODSThe data of 305 patients with pathologically confirmed primary small intestinal tumor collected from 6 hospitals around the Songhua River during the past 33 years were analyzed retrospectively.

RESULTSThere were 42 benign and 263 malignant tumors in this series with a ratio of 1: 6.26. The 263 malignant tumors in this series consisted of 135 adenocarcinomas, 57 malignant stromal tumors, 37 malignant lymphomas, 20 carcinoids, and etc. Chronic occult bleeding, gradual of body weight loss and mild abdominal pain (three obscurities) were the common clinical features and alerting massage of intestinal tumor. Correct preoperative diagnostic rate was only 57.0% (174/305) due to difficulty in early diagnosis, which was 67.2% (92/137) in the duodenal tumors, and 51.9% (82/168) in the jejunoileal tumors. All of the 42 benign tumors were resected completely. For the 263 patients with malignant tumors, radical dissection was performed in 153, palliative resection in 34, and gut by-pass or biopsy in 76. The median survival of the patients who underwent radical resection of their malignant tumors was 92 months, which was significantly higher than that of the other groups.

CONCLUSIONEarly diagnosis of primary small intestinal tumors is difficult and with a preoperative misdiagnosis rate of 43.0%. Total intestinal barium swallowing, endoscopy and superior mesenteric arteriography are three critical examinations for diagnosis and location. Early surgical resection is crucial in improving the prognosis. The primary small intestinal tumor should be resected as early as possible if no distant metastasis is detected.

Adenocarcinoma ; diagnosis ; secondary ; surgery ; Adenoma ; diagnosis ; pathology ; surgery ; Adult ; Aged ; Aged, 80 and over ; Carcinoid Tumor ; diagnosis ; secondary ; surgery ; Diagnostic Errors ; Digestive System Surgical Procedures ; methods ; Duodenal Neoplasms ; diagnosis ; pathology ; surgery ; Female ; Gastrointestinal Stromal Tumors ; diagnosis ; secondary ; surgery ; Humans ; Ileal Neoplasms ; diagnosis ; pathology ; surgery ; Jejunal Neoplasms ; diagnosis ; pathology ; surgery ; Liver Neoplasms ; secondary ; surgery ; Lymphatic Metastasis ; Lymphoma ; diagnosis ; pathology ; surgery ; Male ; Middle Aged ; Young Adult