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Primary Duodenal Adenocarcinoma without Stenosis: A Case Report with a Brief Literature Review.

Usuda D, Hashimoto Y, Muranaka E, Okamura H, Kanda T, Urashima S - Case Rep Oncol (2014)

Bottom Line: A unique finding in the two cases reported herein is that PDA did not cause stenosis and occlusion of the lumen.The majority of these tumors are found to have infiltrated the duodenal wall at presentation, with many being unresectable due to local and distal invasion.In some cases, ultrasonography or computed tomography are useful for detecting PDA and determining vascular invasion.

View Article: PubMed Central - PubMed

Affiliation: Department of Community Medicine, Himi Municipal Hospital, Kanazawa Medical University, Himi-shi, Japan.

ABSTRACT
This article focuses on the symptomatic and diagnostic problems of primary duodenal adenocarcinoma (PDA) by way of two case reports and a literature review. An 85-year-old woman with an adenocarcinoma in the 1st duodenal portion was offered palliative care. A 90-year-old woman with an adenocarcinoma in the 3rd duodenal portion was also offered palliative care. A unique finding in the two cases reported herein is that PDA did not cause stenosis and occlusion of the lumen. As no reports of PDA without stenosis have been published so far, these cases may add to our knowledge of PDA. The diagnosis of PDA is often delayed because its symptoms may be absent until the tumor has progressed, thus leading to a delay of several months. Patients typically present with a long history of variable and vague symptoms, and many are diagnosed with advanced disease. As regards clinical manifestations, abdominal pain is the most frequent symptom. The majority of these tumors are found to have infiltrated the duodenal wall at presentation, with many being unresectable due to local and distal invasion. Esophagogastroduodenoscopy and gastrointestinal barium radiography are the main diagnostic tests for PDA, detecting 88.6 and 83.3% of tumors, respectively. In some cases, ultrasonography or computed tomography are useful for detecting PDA and determining vascular invasion.

No MeSH data available.


Related in: MedlinePlus

Histopathologically verified infiltration of the duodenal muscular wall by adenocarcinoma of the duodenum. HE. ×100.
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Figure 2: Histopathologically verified infiltration of the duodenal muscular wall by adenocarcinoma of the duodenum. HE. ×100.

Mentions: An 85-year-old woman was admitted to our hospital with melena, hypotension, and a 2-month history of appetite loss. The underlying cause of her loss of body weight was unknown. Her medical history included an operation to correct a right inguinal hernia and hypertension, and her vital signs were within normal limits in the emergency room. A physical examination showed no abnormal findings. Routine blood tests showed leukocytosis, hypoalbuminemia, and elevation of C-reactive protein, aspartate aminotransferase and lactate dehydrogenase, along with an elevation of tumor markers, of which carcinoembryonic antigen, CA19-9, DU-PAN-2 and SPAN-1 antigen were subsequently confirmed. The presence of a tumor (7.9 × 6.5 × 8.5 cm) and irregular thickening of the wall, multiple metastases, multiple lymphadenopathy, and ascites were confirmed by CT scan (fig. 1). Endoscopy and histologic examination revealed a poorly differentiated adenocarcinoma of the duodenum (in the 1st portion), which did not contain hormone and was not differentiated into a neuroendocrine carcinoma (fig. 2). Helicobacter pylori infection was ruled out. The carcinoma was at an advanced stage with multiple lymph node and liver metastases. After having given informed consent, she and her family were offered palliative care.


Primary Duodenal Adenocarcinoma without Stenosis: A Case Report with a Brief Literature Review.

Usuda D, Hashimoto Y, Muranaka E, Okamura H, Kanda T, Urashima S - Case Rep Oncol (2014)

Histopathologically verified infiltration of the duodenal muscular wall by adenocarcinoma of the duodenum. HE. ×100.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4127546&req=5

Figure 2: Histopathologically verified infiltration of the duodenal muscular wall by adenocarcinoma of the duodenum. HE. ×100.
Mentions: An 85-year-old woman was admitted to our hospital with melena, hypotension, and a 2-month history of appetite loss. The underlying cause of her loss of body weight was unknown. Her medical history included an operation to correct a right inguinal hernia and hypertension, and her vital signs were within normal limits in the emergency room. A physical examination showed no abnormal findings. Routine blood tests showed leukocytosis, hypoalbuminemia, and elevation of C-reactive protein, aspartate aminotransferase and lactate dehydrogenase, along with an elevation of tumor markers, of which carcinoembryonic antigen, CA19-9, DU-PAN-2 and SPAN-1 antigen were subsequently confirmed. The presence of a tumor (7.9 × 6.5 × 8.5 cm) and irregular thickening of the wall, multiple metastases, multiple lymphadenopathy, and ascites were confirmed by CT scan (fig. 1). Endoscopy and histologic examination revealed a poorly differentiated adenocarcinoma of the duodenum (in the 1st portion), which did not contain hormone and was not differentiated into a neuroendocrine carcinoma (fig. 2). Helicobacter pylori infection was ruled out. The carcinoma was at an advanced stage with multiple lymph node and liver metastases. After having given informed consent, she and her family were offered palliative care.

Bottom Line: A unique finding in the two cases reported herein is that PDA did not cause stenosis and occlusion of the lumen.The majority of these tumors are found to have infiltrated the duodenal wall at presentation, with many being unresectable due to local and distal invasion.In some cases, ultrasonography or computed tomography are useful for detecting PDA and determining vascular invasion.

View Article: PubMed Central - PubMed

Affiliation: Department of Community Medicine, Himi Municipal Hospital, Kanazawa Medical University, Himi-shi, Japan.

ABSTRACT
This article focuses on the symptomatic and diagnostic problems of primary duodenal adenocarcinoma (PDA) by way of two case reports and a literature review. An 85-year-old woman with an adenocarcinoma in the 1st duodenal portion was offered palliative care. A 90-year-old woman with an adenocarcinoma in the 3rd duodenal portion was also offered palliative care. A unique finding in the two cases reported herein is that PDA did not cause stenosis and occlusion of the lumen. As no reports of PDA without stenosis have been published so far, these cases may add to our knowledge of PDA. The diagnosis of PDA is often delayed because its symptoms may be absent until the tumor has progressed, thus leading to a delay of several months. Patients typically present with a long history of variable and vague symptoms, and many are diagnosed with advanced disease. As regards clinical manifestations, abdominal pain is the most frequent symptom. The majority of these tumors are found to have infiltrated the duodenal wall at presentation, with many being unresectable due to local and distal invasion. Esophagogastroduodenoscopy and gastrointestinal barium radiography are the main diagnostic tests for PDA, detecting 88.6 and 83.3% of tumors, respectively. In some cases, ultrasonography or computed tomography are useful for detecting PDA and determining vascular invasion.

No MeSH data available.


Related in: MedlinePlus