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

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

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

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

Brunner's gland adenoma is a rare tumor of duodenum. Patients are usually aymptomatic and most are discovered incidentally during the upper gastrointestinal (GI) series or esophagogastroduodenoscopy. These lesions are most commonly located in the duodenal bulb and clinical manifestations are variable. In symptomatic patients, the most common manifestations are GI hemorrhage and duodenal obstruction. On histologic examination, Brunner's gland adenoma that causes clinical symptoms is composed of hyperplastic Brunner's glands and contains mostly an admixture of glandular, adipose, and muscular tissues. We report a case of large Brunner's gland adenoma causing upper gastrointestinal hemorrhage in a 47-year-old woman which was successfully removed by endoscopic resection without complications such as bleeding or perforation. Microscopically, it was entirely composed of variable Brunner's glands.
Adenoma/complications/*pathology/surgery ; Brunner Glands/*pathology/surgery ; Duodenal Neoplasms/complications/*pathology/surgery ; Duodenoscopy ; Female ; Gastrointestinal Hemorrhage/etiology ; Humans ; Middle Aged

Gangliocytic paragangliomas (GPs) are rare tumors of the duodenum, presenting as single sessile or pedunculated polypoid masses. Clinical manifestations of duodenal GPs can vary from an incidental finding at endoscopy to frequent upper gastrointestinal bleeding caused by mucosal ulceration and abdominal pain. GPs are considered benign, but the disease can recur and spread to regional lymph nodes. A 41-year-old female presented with abdominal pain. Upper gastrointestinal endoscopy revealed a subepithelial tumor of the ampulla of Vater in the second portion of the duodenum. The tumor was resected using the endoscopic mucosal resection technique. The tumor was diagnosed as benign GP of the duodenum using histological and immunohistochemical staining procedures.
Adult ; Ampulla of Vater/chemistry/*pathology/surgery ; Biopsy ; Duodenal Neoplasms/chemistry/*pathology/surgery ; Duodenoscopy ; Female ; Humans ; Immunohistochemistry ; Paraganglioma/chemistry/*pathology/surgery ; Treatment Outcome ; Tumor Markers, Biological/analysis

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

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 prognostic factors of primary duodenal adenocarcinoma.

METHODSThe medical records of 67 patients with primary duodenal adenocarcinoma treated in our hospital from January 1990 to December 2005 were retrospectively analyzed. Prognostic factors were analyzed by univariable and multivariable analysis.

RESULTSOf the 67 patients, 38 underwent curative resection and 29 underwent palliative resection. The overall 5-year survival rate was 22.4%. The survival was significantly higher in patients who underwent curative resection (5-year survival 39.5%) than that in those who underwent palliative resection(5-year survival 0) (P<0.05). Univariable analysis showed that T-stage, nodal metastasis and tumor stage had significant negative effects on the survival of patients who underwent curative resection. However, multivariable analysis revealed that T-stage and nodal metastasis were significantly associated with survival.

CONCLUSIONSCurative resection may improve the survival. T-stage and lymph nodes metastasis are associated with decreased survival.

Adenocarcinoma ; diagnosis ; pathology ; surgery ; Adolescent ; Adult ; Aged ; Duodenal Neoplasms ; diagnosis ; pathology ; surgery ; Female ; Humans ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Survival Rate ; Young Adult

OBJECTIVETo investigate the clinicopathological characteristics and surgical treatment of duodenal gastrointestinal stromal tumor (GIST).

METHODSClinicopathological data of 25 cases with duodenal GIST from January 2007 to July 2011 in West China hospital were retrospectively analyzed.

RESULTSAll the patients were identified by pathological examination without specific symptoms. Tumors were located in the bulb area in 2 cases, descending portion in 11 cases, transverse portion in 8 cases, and ascending portion in 4 cases. Two cases were at very low risk, 7 at low risk, 6 at intermediate risk, and 10 at high risk. All the patients received surgical resection, including 11 pancreaticoduodenectomies, 10 local tumor resections, 2 duodenal segmental resections, and 2 distal subtotal gastrectomies. Eighteen patients were followed up from 16 to 39 months and 3 patients recurred 18, 30, and 35 months after operation respectively.

CONCLUSIONSDuodenal GIST exhibits no distinct clinical characteristics. Complete removal of the tumor is the main choice of treatment.

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