Aged ; Carcinoma, Renal Cell ; pathology ; secondary ; Duodenal Neoplasms ; secondary ; surgery ; Female ; Humans ; Kidney Neoplasms ; pathology ; Nephrectomy

We report a case of pathologically proven simultaneous duodenal and colonic metastases about four years after nephrectomy for mixed clear and granular cell type renal cell carcinoma (RCC). A 76-year-old female patient who had undergone a left radical nephrectomy 4 years previously for RCC presented with a 1-month history of dyspepsia and pain in the right upper abdomen. An abdominopelvic CT scan showed circumferential wall thickening with high enhancement at the second portion of the duodenum and additional enhancement of an irregular protruding mass into the lumen of the ascending colon. A gastroscopy showed a large and ulcerative protruding mass nearly obstructing the second portion of the duodenum. A colonoscopy revealed a polypoid, nodular and purplish mass in the ascending colon. Microscopy of the biopsy specimen showed the features identical to those of the RCC which was resected 4 years earlier in this patient. We believe this to be the first case illustrating a metastatic renal cell carcinoma as simultaneous duodenal and colon masses.
Aged ; Carcinoma, Renal Cell/pathology/*secondary ; Case Report ; Colonic Neoplasms/pathology/*secondary ; Duodenal Neoplasms/pathology/*secondary ; Female ; Human ; Kidney Neoplasms ; Time Factors

Duodenal choriocarcinoma, either primary or metastatic, is very rare. Early diagnosis and prompt initiation of chemotherapy improve the prognosis of this neoplasm. We herein present, together with the referred literatures, a case of a 47-year-old female patient who visited to our hospital with upper intestinal bleeding. She was diagnosed as duodenal choriocarcinoma by operation. Brain metastasis was found soon after the operation and combination chemotherapy was done.
Brain Neoplasms/*secondary ; Choriocarcinoma/*diagnosis/secondary ; Duodenal Neoplasms/*diagnosis/pathology ; Female ; Gastrointestinal Hemorrhage/*diagnosis ; Humans ; Middle Aged

Carcinoid tumors are slow growing submucosal tumors with metastatic potential that arise from enterochromaffin cell. The annual incidence of carcinoid tumor is 2 to 3 per 100,000. Carcinoid tumor of duodenum is very rare with an incidence of about 8% among gastrointestinal carcinid tumor. As a endoscopic examination and immnohistochemical stain are developed, an rate of detection is increasing. Among the possible factor of metastatic prediction, tumor size >10 mm, central depression or ulcer, invasion below submucosa, lymphatic or venous invasion are associated with higher metastatic potential. Specially, in case of tumor size <10 mm, in duodenum, there is no report of metastasis to liver in Korea. But, recently, we experienced a rare care of duodenal carcinoid measured by less than 10 mm with liver metastsis. Thus, we report here this case with a review of literature.
Aged, 80 and over ; Carcinoid Tumor/*diagnosis/pathology ; Diagnosis, Differential ; Duodenal Neoplasms/*diagnosis/pathology ; Female ; Humans ; Liver Neoplasms/diagnosis/pathology/*secondary ; Neoplasm Metastasis ; Tomography, X-Ray Computed

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

OBJECTIVETo discuss the clinicopathological characteristics and access the immediate- and long-term outcome of radical surgery in patients with colon cancer invading duodenum.

METHODSA retrospective review of 19 patients with colon cancer invading duodenum underwent radical surgery between 1995 and 2010 was performed. There were 7 male and 12 female, age ranged from 36 to 73 years with an average of 56 years. The main manifestations were abdominal pain, loss of weight, change of stool frequency and so on. The tumors located at the hepatic flexure in 15 patients. All of the patients underwent radical surgery, and none of the patients had positive resection margins. One patient underwent pancreaticoduodenectomy combined with right hemicolectomy (RH). Two patients underwent pylorus preserving pancreaticoduodenectomy combined with RH. One patient underwent duodenectomy combined with RH. Four patients underwent RH. And the other 11 patients underwent lateral duodenectomy combined with RH.

RESULTSThere was no postoperative morbidity and mortality, and the 30-day mortality rate was 0. The median overall survival was 5.3 years. Overall 1 and 5 years survival rate were 94.4% and 70.4%, respectively. And 3 patients developed recurrence in 3 years.

CONCLUSIONSThe patients with colon cancer invading duodenum are lack of specific clinical manifestations. And the radical surgical procedure is safe, which could prolong the survival and improves the prognosis in these patients.

Adult ; Aged ; Colectomy ; Colonic Neoplasms ; pathology ; surgery ; Duodenal Neoplasms ; secondary ; surgery ; Female ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Pancreaticoduodenectomy ; Retrospective Studies ; Treatment Outcome

INTRODUCTIONBladder cancer is a common malignancy but presentation with metastatic disease is rare. This is the fi rst reported case of duodenal obstruction as a presentation of metastatic bladder cancer.

CLINICAL PICTUREA middle-aged woman presented with nausea, vomiting, weight loss and intermittent haematuria. Radiology and histology confirmed metastatic bladder cancer to the retroperitoneum encasing the duodenum and causing obstruction.

TREATMENTInsertion of a duodenal stent relieved the obstruction and palliative chemoradiotherapy was initiated.

OUTCOMEThe patient died 15 months after diagnosis.

CONCLUSIONSClinicians and radiologists should be aware of atypical presentations of common malignancies.

Adult ; Carcinoma, Transitional Cell ; drug therapy ; secondary ; Diagnosis, Differential ; Duodenal Obstruction ; diagnosis ; etiology ; surgery ; Fatal Outcome ; Female ; Humans ; Palliative Care ; Retroperitoneal Neoplasms ; complications ; diagnosis ; secondary ; Stents ; Urinary Bladder Neoplasms ; drug therapy ; pathology

OBJECTIVETo identify prognostic factors predicting survival after radical resection of ampullary carcinoma.

METHODSClinical data of sixty- five patients with cancer of the ampulla of Vater underwent pancreaticoduodenectomy and regional lymphadenectomy were analyzed retrospectively.

RESULTSA total of 1380 lymph nodes dissected from the resected specimens was examined to detect the presence of metastasis. The median follow- up period was 83 months. Univariate analysis revealed that factors associated with poor survival included the number and the location of positive nodes. Thirty- three of the 65 patients had a total of 116 positive lymph nodes, of whom 20 had 1- 3 positive regional nodes lymph and 13 had > or = 4 positive regional lymph nodes. Multivariate analysis revealed that the number of positive nodes lymph was an independent prognostic factor (P=0.007), while the locations of lymph nodes failed to remain as an independent variable. The survival rate in patients with > or = 4 positive lymph nodes was significantly lower than that in those with 1- 3 positive lymph nodes. The median survival time was 49 months with a 5- year survival rate of 43% in patients with 1- 3 positive lymph nodes, whereas all patients with > or = 4 positive nodes died of the disease within 23 months after resection (P=0.0001).

CONCLUSIONThe number of positive regional lymph nodes is an independent prognostic factor in patients with ampullary carcinoma after resection.

Adult ; Aged ; Ampulla of Vater ; pathology ; Carcinoma ; pathology ; Common Bile Duct Neoplasms ; pathology ; Duodenal Neoplasms ; diagnosis ; secondary ; Female ; Humans ; Lymph Node Excision ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Staging ; Postoperative Period ; Prognosis ; Retrospective Studies

OBJECTIVETo determine the clinicopathologic characteristics and the relationship between related gene expression and pathobiologic behavior of pancreatic mucinous noncystic adenocarcinoma.

METHODSAmong the 249 pancreatic carcinoma cases from the department files, 6 tumors were identified to meet the pathologic criteria of colloid carcinoma. Envision immunohistochemical staining technique was used to detect expression of p21(ras), p21(WAF1), p16, p33(ING1), p53, ATM, MDM2, PCNA, Cyclins (D1, D3, A, B and E). Intra- and extra- cellular mucin production were determined by AB-PAS staining. Clinically, all of 6 cases were followed to June, 2003.

RESULTSIn all 6 cases, the tumors were located in the head of the pancreas and all displayed similar microscopic findings. Duodenal invasion was seen in 4 cases and perineural invasion was seen in 1 case. Tumor metastasis in the liver was seen in 2 cases and in the regional lymph nodes in 2 cases. Positive immunostaining was seen in 5 cases with p21(ras), 3 cases with p21(WAF1), 1 case with p16, 4 cases with p33(ING1), 2 cases with p53, 3 cases with ATM, 3 cases with MDM2, 6 cases with PCNA, 3 cases with cyclinA, 3 cases with cyclinD1, 4 cases with cyclinD3, 4 cases with cyclinB and 6 cases with cyclinE. Both extracellular and intracellular mucin was strongly positive for AB-PAS staining. Clinical follow-up found that 2 patients died of their tumors at 14 and 20 months. Three patients were alive after 28, 49 and 87 months of follow-up. One case were lost contact.

CONCLUSIONSPancreatic mucinous noncystic adenocarcinoma has distinct morphologic features and biologic behavior. Multiple gene products including many cyclins may be involved in the pathogenesis of pancreatic colloid carcinoma. The tumor has an aggressive behavior with a high frequency of invasion and metastases, though the prognosis could be better than that of ordinary ductal adenocarcinoma of pancreas.

Adenocarcinoma, Mucinous ; metabolism ; pathology ; secondary ; Aged ; Cyclin-Dependent Kinase Inhibitor p16 ; metabolism ; Duodenal Neoplasms ; pathology ; Female ; Follow-Up Studies ; Humans ; Liver Neoplasms ; secondary ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Invasiveness ; Pancreatic Neoplasms ; metabolism ; pathology ; Prognosis ; Proto-Oncogene Proteins p21(ras) ; metabolism

PURPOSE: We undertook this study to analyze clinical features and surgical outcome of en bloc resections of the right side colon cancer directly invading duodenum and/or pancreatic head. MATERIALS AND METHODS: The records of all patients who underwent en bloc resection of duodenum and/or pancreas for right colon cancers were analyzed retrospectively. From September 1994 to September 2006, 1,016 patients underwent curative right hemicolectomy. Nine patients (0.9%) had en bloc resection of a right side colon cancer with duodenum or pancreatic head invasion. RESULTS: The median operative time was 320 minutes (range, 200-420) and the median blood loss was 700 mL (range, 100-2,000). The mean size of tumor was 6.6 cm (range, 3.2-10.7). The mean preoperative carcinoembryonic antigen (CEA) was 10.6 ng/mL (range, 0.2-50.8). There was no 30 day perioperative mortality. The median disease-free survival was 23.5 months [95% confidence interval (CI) 5.2-41.8] and the median overall survival was 28.1 months (95% CI 9.7-46.5). CONCLUSIONS: In patients with locally advanced right side colon cancer that directly invades the duodenum or pancreas can be safely resected with curative potential with minimum morbidity and mortality. Long term disease free survival can occur in a significant number of patients undergoing curative en bloc resection in this particular subset of patients.
Adult ; Aged ; Camptothecin/analogs & derivatives/pharmacology/therapeutic use ; Chemotherapy, Adjuvant ; Colonic Neoplasms/*complications/drug therapy/mortality/*surgery ; Disease-Free Survival ; Duodenal Neoplasms/drug therapy/mortality/*secondary/surgery ; Duodenum/drug effects/*pathology/surgery ; Female ; Fluorouracil/pharmacology/therapeutic use ; Humans ; Leucovorin/pharmacology/therapeutic use ; Male ; Middle Aged ; Organoplatinum Compounds/pharmacology/therapeutic use ; Pancreas/drug effects/*pathology/surgery ; Pancreatic Neoplasms/drug therapy/mortality/*secondary/surgery ; Retrospective Studies ; Treatment Outcome