A Case of G-CSF-producing Duodenal Cancer That Steroid Was Remarkably Effective to Alleviate Symptoms at the End of Life

Introduction: G-CSF producing tumors often cause various symptoms at the end of life, such as fever, fatigue, and fluid retention as a result of high cytokine status. Case: The patient was an 80-year-old woman. She was referred to our hospital because of anorexia and urine volume reduction. After a detailed examination, she was diagnosed with duodenal cancer. Although she decided not to receive anticancer treatment because of her old age and poor general condition, she felt a great distress with abdominal distension by large ascites. Furthermore, peripheral blood smear examination showed remarkably increased levels of normal neutrophils. We suspected G-CSF producing tumor and, hence, dexamethasone administration was initiated to suppress cytokine release. As a result, renal dysfunction and urine volume were improved, and ascites accumulation was not observed again since initial paracentesis. The number of neutrophils also declined, and the patient was in a good condition, even though it lasted for a short time. Conclusion: In patients with high cytokine status caused by G-CSF producing tumor, steroids may be useful for pain relief.

Se justifica el seguimiento después de una colectomía en pacientes con poliposis adenomatosa familiar / The follow up after colectomy in patients with familial adenomatous polyposis is justified

phenotypic expression is the presence of múltiple colorectal adenomatous polyps (more than 100), with high probability developing colorrectal cancer (CRC) before the fifth decade of life. Prophylactic surgery (total colectomy or restorative proctocolectomy) reduces the risk of developing CRC. However, the risk of developing tumors in other organs remains present. Objetive: Analyze the frequency and type of tumors associated with classic familial adenomatous polyposis syndrome (FAPc) patients undergoing prophylactic colectomy. Material and Methods: Cohort study. From the registry of hereditary colorrectal cancer (CRC) at our institution, we identified patients with FAPc who underwent total colectomy with ileorrectal anastomosis (TC-IRA) or restorative proctocolectomy (RTPC), from 1999 to 2014. In the follow-up we analyzed related tumors and mortality. Results: 27 patients, of whom 18 (66.7%) underwent TC-IRA and 9 (33.3%) underwent RTPC. At the time of surgery, 4 patients had CRC (15%) and 5 had extracolonic tumors (osteomas). In a mean follow-up of 49, 4 months (i: 2 y 178) the following lesions were diagnosed: digestive tract adenomas in 17 (63%) patients, of these 2 required a proctectomy and 3 resection of duodenal adenomas. Eight patients developed desmoid tumors (30%), and 3 of them underwent surgery. One patient had an extradigestive tumor (thyroid cancer) and only 8/27 (29.6%) did not develop other tumors. One patient died due to progression of his CCR. Discussion: In this series it is confirmed that most patients will develop neoplasms FAPc after colectomy. conclusion: The removal of the colon and/or rectum is able to prevent the development of CRC. However, two thirds of the patients develop other tumors in which systematic surveillance allowed early detection and treatment.

Objetivo: Analizar la frecuencia y tipo de tumores asociados en pacientes con poliposis adenomatosa familiar clásica (PAFc) sometidos a una colectomía profiláctica. Materiales y Métodos: Estudio de cohorte. Desde el registro de cáncer colorrectal (CCR) hereditario, se identificaron las familias con PAFc, y de estas a los pacientes que se les practicó una colectomía total con anastomosis íleorrectal (CT-AIR) o proctocolec-tomía restauradora (PCTR), desde 1999 al 2014. En el seguimiento se analizaron los tumores asociados y su mortalidad. Resultados: Se identificaron 27 pacientes, de los cuales 18 (66,7%) fueron sometidos a CT-AIR y 9 (33,3%) a PCTR. Al momento de la cirugía, 4 pacientes presentaban CCR (15%) y 5 tenían tumores extracolónicos (osteomas). En un seguimiento promedio de 49,4 meses (i: 2 y 178) se diagnosticaron: adenomas del tracto digestivo en 17 (63%) pacientes, de éstos 2 requirieron una proctectomía y 3 resecciones de adenomas duodenales. Ocho pacientes desarrollaron tumores desmoides (30%), y 3 de ellos fueron sometidos a una cirugía. Un paciente presentó un tumor extradigestivo (cáncer de tiroides) y sólo 8/27 (29,6%) pacientes no desarrollaron otros tumores. Un paciente falleció por progresión de su CCR. Discusión: En esta serie se confirma que la mayoría de los pacientes con PAFc seguirán desarrollando neoplasias después de su colectomía. conclusiones: La extirpación del colon y/o recto permitió evitar el desarrollo de CCR. Sin embargo, dos tercios de los pacientes presentaron otros tumores en quienes su seguimiento permitió una detección y tratamiento temprano.

Prevalence of Gastric and Duodenal Polyps and Risk Factors for Duodenal Neoplasm in Korean Patients with Familial Adenomatous Polyposis

BACKGROUND/AIMS: The prevalence of gastric polyps, duodenal adenoma and duodenal cancer has been reported as being high among familial adenomatous polyposis (FAP) patients, but there have been no reports of this association in Korea. This study evaluated the prevalence of gastric and duodenal polyps and risk factors for duodenal neoplasm in FAP patients in Korea. METHODS: We reviewed both initial and follow-up endoscopic results from FAP patients. We also investigated the treatment modality of duodenal adenomas and analyzed the risk factors of duodenal neoplasms by logistic regression analysis. RESULTS: A total of 148 patients with FAP underwent esophagogastroduodenoscopy (EGD), and the fi ndings were as follows: gastric polyp 39.9% (fundic gland polyp 25.7% and gastric adenoma 14.2%), duodenal adenoma 15.5%, gastric cancer 2.7%, and duodenal cancer 0.7%. There were two cases of gastric cancer that developed from benign gastric polyps. There were progressions of duodenal adenomatosis during follow-up, and some degree of relapse occurred after endoscopic resection. Patients with gastric polyps showed a correlation with the occurrence of duodenal neoplasm (odds ratio, 2.814; p=0.024). CONCLUSIONS: In Korean FAP patients, gastric cancer was detected more frequently, but fundic gland polyps, duodenal adenoma and duodenal cancer were detected less frequently than in Western patients. FAP patients with gastric polyps should undergo regular EGD, particularly for the early detection of duodenal neoplasia.

Adenocarcinoma de la cuarta porción delduodeno: reporte de caso / Duodenal adenocarcinoma in fourth duodenal portion: a case report

El carcinoma de duodeno constituye una patología infrecuente y por lo tanto no es tenida en cuenta en los diagnósticos diferenciales de los cuadros obstructivos altos. A continuación se presenta un caso correspondiente a este tipo de lesión manejado en el servicio de cirugía del Hospital Universitario de Santander...

The duodenal carcinoma constitutes an infrequent pathology and therefore it is not taken into account as a differential diagnosis of high obstructive symptoms. Subsequently it’s presented a case pertaining to this type of wound handled in the service of surgery of the Hospital Universitario de Santander...

Solitary Duodenal Metastasis from Breast Cancer

A 65-year-old female patient experienced melena for 10 days. Gastroduodenoscopy revealed a tumor in the duodenum, a portion of which was taken for biopsy, which showed a malignant tumor. She underwent pancreatoduodenectomy, and the final tumor pathology revealed invasive ductal carcinoma from the breast, which was confirmed using immunostaining of milk fat globule antigens. Nineteen years before, she had received a radical mastectomy due to invasive ductal carcinoma of the right breast. Hematogenous metastasis occurs in 33% of patients with breast cancer, mainly to the liver and lung, in invasive ductal carcinoma (IDC), and to the gastrointestinal tract, peritoneum, and retroperitoneum in invasive lobular carcinoma (ILC). Solitary metastatic duodenal tumors from breast cancer, especially IDC, is rare, particularly after a long time. This rare case is presented with a literature review.

A Case of Double Primary Cancer of the Esophagus and Duodenum that Induced Hematemesis / 대한소화기내시경학회지

The occurrence of double primary cancer of the esophagus and duodenum is considered to be very rare. Moreover, it is difficult to manage this type of double cancer because esophageal cancer has a biologic tendency towards early metastasis. Yet the development of endoscopy such as endoscopic ultrasonography (EUS), the new diagnostic imaging modalities such as PET/CT and advanced pathologic interpretation can lead to an early diagnosis of these multiple primary neoplasms. Appropriate intervention with various therapeutic tools then becomes possible, so these multiple primary neoplasms are not currently obstinate problems. We experienced one patient with double primary cancer; we simultaneously found esophageal cancer and duodenal cancer via endoscopy, and we wanted to treat them with chemo- radiation therapy and endoscopic submucosal dissection, but we failed to persuade the patient to accept the treatment.

Primary Duodenal Cancer Combined with Gastric Cancer after Treatment of Cervical Cancer -triple primary cancer

Multiple primary tumors are defined as cases involving primary malignant tumors of different histologic origins in one person. The absolute number of reported cases of double primary malignant tumors has increased in recent years diagnostic procedures. Primary adenocarcinoma of duodenum is a rare disease and represents less than 0.5% of all gastrointestinal malignancies. Therefore, synchronous multiple primary cancers of the stomach and duodenum are very rare. Recently, we experienced a case of triple primary malignant tumors of different site originating from the stomach, duodenum and cervix in 71- year-old woman. She had had radiation therapy and chemotherapy for squamous cell carcinoma of the uterine cervix 8 years previously. We performed subtotal gastrectomy and pancreaticoduodenectomy with radical lymph node dissection. She remained healthy without any evidence of recurrence 12 months after the operation.

Neoplasias duodenais primárias: análise de casuística e conduta cirúrgica / Primary duodenal tumors: clinicopathologic experience and surgical treatment

São apresentados 18 casos de neoplasias primárias do duodeno, salientando-se sua raridade e as dificuldades diagnósticas, a despeito dos modernos recursos endoscópicos e de identificação por imagem. A literatura revela que de 1% a 10% de todos os tumores do aparelho digestório se situam no intestino delgado. A localização duodenal é, por isso, muito pouco freqüente, possui sintomatologia indefinida e implica conduta terapêutica mais complexa do que quando o tumor se situa em outros segmentos do intestino delgado. Os sintomas mais comuns são dor, náusea, vômito e hemorragia. A presente casuística consiste de 11 neoplasias malignase sete benignas. Entre as primeiras o adenocarcinoma é o mais freqüente, sendo os lipomas os mais comuns dosneoplasmas benignos. Enquanto nestes a exérese local representa a conduta mais adequada, a duodenopancreatectomiacefálica foi a cirurgia de escolha nos tumores malignos da segunda porção duodenal, exibindo bons resultados. As lesões malignas da terceira porção e principalmente da quarta porção do duodeno foram tratadas pela ressecção duodenojejunal, também com resultados satisfatórios.

Eighteen primary duodenal tumors, including 11 malignant and 8 benign, are presented, stressing their poorly defined natural history and rare frequency. The most common histological diagnosis was adenocarcinoma. There were 6 adenocarcinomas, 2 carcinoids, 1 linfoma, 1 anaplastic and 1 neuroectodermic carcinoma. Benign lesions were occasionally found during a gastroduodenal or a biliary surgery (n = 4) and during the autopsies (n = 3). They consisted of lipomas (n = 4), adenomatous polyps (n = 2) and leiomyoma (n = 1). Concerning the malignant lesions, 6 pancreaticoduodenectomies, 3 duodenojejunal segmentary resection and one paliation consisting of gastrojejunostomy and biopsy were performed. One carcinoid lesion was found at the duodenal bulb during a gastroduodenectomy for a gastric ulcer. Pancreaticoduodenectomy can be done with acceptable risk and it seems that patients with duodenal adenocarcinoma are more likely to survive longer after radical surgery than those with cancer of the head of pancreas. Every patient of this series treated by pancreaticoduodenectomy or duodenojejunal segmentary resection had an uneventful recovery and the follow-up ranged from 16 months to 7 years. As for the duodenal carcinoids, local resection is usually followed by recurrence, so an agressive surgical management is the best approach. Benign tumors must be treated by local excision when disclosed.

A Case of Multiple Primary Cancer in Stomach and Duodenum / 대한소화기내시경학회지

Double primary cancer is defined as the case of primary malignant tumors of different site origins, which are different histologically in each other. The number of reported cases of multiple primary malignant tumors has increased in recent years, of more developed diagnostic procedure and long survival of cancer patients. Malignant tumors of the small bowel are reported to account for about 1% of all gastrointestinal carcinomas. We have experienced a case with double primary malignant tumors of gastric adenocarcinoma and duodenal adenocarcinoma. For its great rarity, we report this case with review of literatures.

Esophagus, Stomach & Intestine; Primary Duodenal Cancer Associated with Early Gastric Cancer: A Case of Double Primary Cancer / 대한소화기내시경학회지

A case of resected primary duodenal cancer associated with early gastric cancer is reported. A 67-year-old male complaining of nausea and vomiting was admitted. Endo-scopic examination showed an ulcerative lesion withblood clot in the angle of the stomach and stricture in the duodenum. The stomach lesion was proven to be signet ring cell carcinoma by biopsy. Exploratory laparotomy was done and frozen specimen of duodenum was revealed to be malignant. Subtotal gastrectomy and pancreaticoduodenectomy with lymph node dissection were done and the specimen from stricture of duodenum was proven to be adenocarcinoma. The gastric cancer was limited to the mucosa and metastasis was not recognized in regional lymph node, Furthermore, there was normal mucosa between gastric cancer and duodenal cancer. Therefore, cancers in the stomach and duodenum were considered to be a case of double prim~iary cancer.