1/42. Resection of triple synchronous cancers: a case report.We herein present a case of synchronous triple cancer, which was successfully resected in a curative manner. These cancers consisted of primary duodenal, pancreatic and lung cancers, which were diagnosed in an asymptomatic 74 year-old male, who was referred to our department on December 14, 1996. On admission, his laboratory data showed no abnormality, including tumor markers (CEA 1.0, CA 19-9 1.0, AFP 8.1 U/ml), but he did show an impaired pulmonary function (FEV1.0: 57%). Upper gastrointestinal endoscopy showed a smooth surfaced duodenal tumor measuring 4 cm in size. The second tumor was found at the head of the pancreas by computed tomography (CT), showing a hypervascular mass measuring 3.0 cm, along with neighboring multiple cysts. In endoscopic retrograde cholangiopancreatography (ERCP), marked mucous secretion was observed through the papilla, while a filling defect was found in the dilated pancreatic duct. In a routine chest X-ray, a third tumor, which measured 1.5 cm in diameter, was recognized in the right upper lobe of the lung, and a moderately differentiated squamous cell carcinoma was also detected by a percutaneous CT guided biopsy. The pancreatic and duodenal tumors were surgically resected by a pancreatoduodenectomy (Stage I) in January 1997 and, 5 months later, a lung tumor underwent partial resection (Stage I). This patient tolerated these surgical procedures well and presently leads a normal, healthy life after discharge. In summary, a successful resection of synchronous triple cancers, which has never been previously reported in this specific combination, is described.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
2/42. Heterotopic pancreas, periampullary somatostatinoma and type I neurofibromatosis: a pathogenetic proposal.This case documents the association of ectopic pancreatic tissue with a duodenal somatostatinoma in a patient with type I neurofibromatosis. pancreatic ducts have been noted within the centres of somatostatinomas, but little significance has been attached to this finding. Here we describe a patient in whom a separate proliferation of somatostatin cells occurred in association with the ectopic pancreatic ductular epithelium. This lesion bore a striking resemblance to the ductulo-insular or ductulo-endocrine complexes that are seen in nesidioblastosis in the pancreas. We therefore postulate that the ducts, which are sequestered within somatostatinomas, are of pathogenetic significance. The somatostatin-producing cells arise from these ducts, very much in the fashion of ductulo-endocrine complexes in nesidioblastosis.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
3/42. 'Pyloric gland-type adenoma' arising in heterotopic gastric mucosa of the duodenum, with dysplastic progression of the gastric type.'Pyloric gland-type adenoma' is a recently described and very rare entity. We report a case of a pedunculated polyp of the duodenal bulb showing the features of pyloric gland-type adenoma. Heterotopic gastric mucosa was found adjacent to the tumour. Immunohistochemically, the tumour cells at the surface of the polyp showed foveolar-type mucin (M1) while most other tumour cells showed deep gastric mucin (M2), displaying a pattern of differentiation similar to the normal gastric mucosa. The polyp also showed villous or papillary structures with disorganization of gastric differentiation and marked increase of proliferating in foci cells. This is the first case of pyloric gland-type adenoma found to arise in heterotopic gastric mucosa of the duodenum, showing dysplastic progression of the gastric type.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
4/42. Life-threatening digestive haemorrhage from duodenal recurrence of gastric cancer.Invasion of the duodenum by gastric carcinoma is not uncommon. The duodenal invasion by transpiloric infiltration through the submucosal layer or lymphatic spread frequently being microscopic and in minimal number of cases involving the mucosa, is generally asymptomatic and detected only in postmortem examinations. We report a case of life-threatening gastrointestinal bleeding from cancer recurrence at duodenal stump after subtotal gastrectomy for gastric carcinoma. In such cases it can be very hard to find the haemorrhagic source because of the difficulties encountered in endoscopic and radiological evaluation of the duodenal stump.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
5/42. Tracking down duodenopancreatic malignancy.BACKGROUND: Malignant tumours of the duodenum are rare and often difficult to diagnose. Due to the small clinical experience with duodenal malignancies their prognosis is unknown and resection is the treatment of choice. CASE REPORT: Adding to a small series of incidental tumours, we report the case of a 65-year-old patient with primary extranodal (MALT-) lymphoma of the duodenum infiltrating the pancreatic head. The patient was admitted because of anaemia and epigastric discomfort with a history of Helicobacter-pylori associated gastric ulceration. physical examination and bloodchemical values were otherwise normal. endoscopy revealed duodenal ulceration but the biopsies taken from the ulceration did not give any evidence of malignancy or residual helicobacter pylori infection. But MRT showed a circular intramural tumour of the duodenum. On laparotomy a large duodenal tumour adherent to the pancreatic head was found and a Whipple procedure was performed. CONCLUSION: Apart from describing the case of a rare lymphoproliferative disorder of the duodenum, this report illustrates the diagnostic difficulties with uncommon neoplasm's of the duodenopancreatic region and the value of MRT prior to resection of a duodenopancreatic mass.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
6/42. Gastric-type adenocarcinoma of the duodenal second portion histogenetically associated with hyperplasia and gastric-foveolar metaplasia of Brunner's glands.We report a case of a pedunculated polyp with a focus of gastric-type adenocarcinoma arising in the opposite side of the papilla Vater of the duodenal second portion. The carcinoma was surrounded by lobules of hyperplastic Brunner's glands. Immunohistochemically the carcinoma tissue showed both gastric foveolar-type mucin ( MUC5AC) and pyloric/Brunner's gland-type mucin ( MUC6), in which proliferating cells positive for MIB-1 (Ki-67) were scattered diffusely. Most of the hyperplastic Brunner's glands were positive for MUC6, while cells toward the lumen in the superficial layer were positive for MUC5AC and MIB-1. This directional pattern of differentiation of Brunner's glands has recently been demonstrated by our group in the histogenetic course of gastric metaplasia originating directly from Brunner's glands. Therefore the present carcinoma is thought to have developed under induction of gastric-foveolar differentiation in a manner very similar to that of gastric metaplasia in hyperplastic Brunner's glands.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
7/42. leiomyomatosis of mesenteric lymph nodes associated with duodenal adenocarcinoma.leiomyomatosis of lymph nodes is an extremely rare disease. Only a few cases have previously been reported in pelvic lymph nodes. They were related to a benign uterine leiomyoma, a metastasizing uterine leiomyoma, an endometrial adenocarcinoma, and an ovarian endometrioid carcinoma. We report on a case of leiomyomatosis of the mesenteric lymph nodes associated with a duodenal adenocarcinoma with no history of uterine leiomyoma or any gynecological malignancy. The patient, a 56-year-old woman, was found to have an adenocarcinoma of the duodenum. All mesenteric lymph nodes removed showed leiomyomatosis, which was verified by immunohistochemical study showing positive immunostaining for smooth muscle actin, desmin, and vimentin, but negative staining for HMB-45. It is necessary to make a differential diagnosis from other examples of spindle cell proliferation involving lymph nodes such as a hemorrhagic spindle cell tumor with amianthoid fibers (palisade myofibroblastoma), angiomyolipoma, lymphangiomyomatosis, inflammatory pseudotumor, and Kaposi's sarcoma.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
8/42. High-grade B-cell lymphoma arising in mucosa-associated lymphoid tissue of the duodenum.Duodenal mucosa-associated lymphoid tissue lymphoma is a rare neoplasm. We report a case of a 70-year-old man with non-Hodgkin's lymphoma located in the descending duodenum that was not associated with helicobacter pylori infection of the stomach. A surgical resection due to obstruction of the bowel lumen above the ligament of Treitz was performed. No invasion into the adjacent structure was confirmed at surgery. The pathological examination showed an infiltration of the duodenal mucosa and submucosa with B lymphocytes. Monoclonal proliferation of the lymphoid tissue was demonstrated by polymerase chain reaction. The histological appearance and the demonstration of monoclonality fulfilled the criteria for malignant high-grade B-cell lymphoma arising from mucosa-associated lymphoid tissue.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
9/42. Giant Brunneroma as an unusual cause of upper gastrointestinal hemorrhage: report of a case.Brunneroma, also known as Brunner's gland adenoma or harmartoma, is a rare, benign, proliferative lesion arising from the Brunner's glands of the duodenum, usually discovered incidentally at endoscopy. Occasionally, these lesions manifest as a rare cause of duodenal obstruction or upper gastrointestinal hemorrhage, and require excision. We report a case of an unusually large Brunneroma in a patient who presented with fresh melena and anemia. Although endoscopic polypectomy is the treatment of choice, we decided to perform surgical polypectomy through a laparotomy due to the huge dimensions of the lesion. The clinical and endoscopic features of this benign tumor and the therapeutic options are critically reviewed.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
10/42. Severe hemorrhage caused by gastrointestinal Kaposi's syndrome in patients with the acquired immunodeficiency syndrome: treatment with endoscopic injection sclerotherapy.Kaposi's sarcoma (KS) is the most common tumor among hiv-infected individuals, but its involvement in the gastrointestinal tract was reported long before the AIDS epidemic. Although most cases of gastrointestinal KS are asymptomatic, advanced lesions may occasionally result in a severe and life-threatening hemorrhage that requires immediate treatment. At the NYU Medical Center, we have seen three AIDS patients present with severe upper tract bleeding (> 8 U/48 h) from KS lesions of the antrum, fundus, and duodenum. The last patient was also bleeding from an ulcerated rectal KS lesion. Because all three patients had a coexisting thrombocytopenia (platelets < 50,000/mm3) and were poor operative risks, injection sclerotherapy was performed. All four KS lesions stopped bleeding, and three out of the four lesions decreased in size. To our knowledge, this is the first report of successfully using sclerotherapy to treat severe hemorrhage due to gastrointestinal KS.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
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