BACKGROUND/AIMS: Primary non-ampullary duodenal adenocarcinomas (PNADAs) comprise <0.3% of gastrointestinal malignancies. The rarity of PNADA and poorly defined natural history often leads to a delayed correct diagnosis. This study was conducted to evaluate the clinical characteristics of PNADA and to identify its prognostic factors. METHODS: Data were collected by retrospectively reviewing the medical records of patients with PNADA managed at Gyeongsang National University Hospital from January 2000 to December 2014. Demographic, clinical, endoscopic, and pathological variables were investigated, and factors related to survival were analyzed. RESULTS: Twenty-seven patients with PNADA were identified, and their median age was 64.9+/-13.6 years with 16 (59.3%) being male. The majority of patients (25/27, 92.6%) were initially diagnosed during upper endoscopy with biopsies. The tumor was located on the 1st or 2nd portion of duodenum in 92.6% (25/27) of patients. At the time of diagnosis, 85.2% (23/27) had advanced diseases (stage III or IV); 48.2% (13/27) had distant metastasis. Median survival time was 12 months (1-93 months). One and 3-year survival rates were 48.1% and 33.3%, respectively. On multivariable analysis, total bilirubin > or =2 mg/dL (OR, 85.28; 95% CI, 3.77-1,938.79; p=0.005) and distant metastasis (OR, 26.74; 95% CI, 3.13-2,328.14; p=0.003) at the time of diagnosis were independent poor prognostic factors. CONCLUSIONS: The majority of patients were diagnosed at an advanced stage. Presence of distant metastasis was independent prognostic factor of PNADA together with elevated total bilirubin.
Adenocarcinoma/*diagnosis/mortality/pathology ; Adult ; Aged ; Aged, 80 and over ; Bilirubin/blood ; Demography ; Duodenal Neoplasms/*diagnosis/mortality/pathology ; Female ; Gastroscopy ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Neoplasm Metastasis ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Prognosis ; Retrospective Studies

No abstract available.
Adenoma/*diagnosis/pathology/ultrasonography ; Brunner Glands/pathology ; Duodenal Neoplasms/*diagnosis/pathology/ultrasonography ; Endoscopy, Gastrointestinal ; Female ; Humans ; Middle Aged ; Tomography, X-Ray Computed

Chromogranin A ; metabolism ; Diagnosis, Differential ; Duodenal Neoplasms ; metabolism ; pathology ; surgery ; Ganglioneuroma ; metabolism ; pathology ; Gastrointestinal Stromal Tumors ; metabolism ; pathology ; Humans ; Male ; Middle Aged ; Neurofibroma ; metabolism ; pathology ; Paraganglioma ; metabolism ; pathology ; surgery ; Phosphopyruvate Hydratase ; metabolism ; S100 Proteins ; metabolism

Gangliocytic paraganglioma of the duodenum is an extremely rare disease. Few cases have been reported in the literature from 1957 to 2010. We reported a 67-year-old man with gangliocytic paraganglioma of the duodenum.
Aged ; Duodenal Neoplasms ; diagnosis ; Duodenum ; pathology ; Humans ; Male ; Paraganglioma ; diagnosis

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

Neuroendocrine tumors are usually found in the ileum, appendix, rectum, colon and stomach. Ampullary neuroendocrine tumor is extremely rare and only a few cases of neuroendocrine carcinoma of the minor papilla have been reported. The preoperative diagnosis is very challenging because either asymptomatic or manifests as nonspecific abdominal pain. The tumor is relatively small and located at the deep mucosa and submucosa. Endoscopy with deep biopsy, endoscopic retrograde cholangiopancreatography and endoscopic ultrasonography are good diagnostic tools. The best therapeutic choice is surgery. We report an unusual case of a 55-year-old woman who underwent endoscopy as part of a regular health checkup and was diagnosed a neuroendocrine carcinoma in the minor papilla, which was successfully resected by pancreaticoduodenectomy.
Carcinoma, Neuroendocrine/*diagnosis/pathology/ultrasonography ; Duodenal Neoplasms/*diagnosis/pathology/ultrasonography ; Duodenoscopy ; Female ; Humans ; Middle Aged ; Neoplasm Staging ; Pancreaticoduodenectomy ; Tomography, X-Ray Computed

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

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

Adenocarcinoma ; metabolism ; pathology ; Aged ; Ampulla of Vater ; pathology ; Carcinoid Tumor ; pathology ; Carcinoma, Hepatocellular ; metabolism ; pathology ; Diagnosis, Differential ; Duodenal Neoplasms ; metabolism ; pathology ; Endodermal Sinus Tumor ; pathology ; Humans ; Male ; alpha-Fetoproteins ; metabolism

OBJECTIVETo investigate the clinicopathological features, surgical treatment and prognosis of primary carcinoma of the duodenum.

METHODSThe clinicopathological data of 86 patients with primary duodenal carcinoma from January 1996 to June 2007 were retrospectively reviewed and analyzed by SPSS 13.0.

RESULTSThe clinical manifestation includes upper abdominal pain, jaundice, anemia, gastrointestinal obstruction, melena and weight loss. Four patients had a tumor located in the first portion of the duodenum, 66 in the second portion, 12 in the third portion and 4 in the fourth portion. The preoperative correct diagnostic rate by BUS was 41.7%, by CT 69.4%, by MRI 75.0%, by duodenal endoscopy 84.0%, and by air barium double radiography 80.9%. Complete resection of the tumors was achieved in 38 patients, palliative resection in 45 cases, and exploration alone in 3 cases. The median survival time of the group with complete resection was 42 months versus 13 months in the group with palliative resection, with a significant difference between the two groups (P < 0.05).

CONCLUSIONPrimary carcinoma of the duodenum has no specific symptoms. Early diagnosis and complete resection are effective to improve prognosis.

Adult ; Aged ; Chemotherapy, Adjuvant ; Duodenal Neoplasms ; diagnosis ; drug therapy ; pathology ; surgery ; Duodenum ; pathology ; surgery ; Female ; Follow-Up Studies ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Palliative Care ; Retrospective Studies ; Survival Rate