A Rare Cause of a Subepithelial Periampullary Duodenal Lesion

Introduction. Adenocarcinomas account for approximately 40% of small bowel cancers. They are typically mucosal lesions with distinctive features on endoscopy. We describe a rare case of duodenal adenocarcinoma presenting as a subepithelial lesion which posed a diagnostic challenge. Case. An 85-year-old male patient presented for investigation of iron deficiency anaemia. Initial upper endoscopy found a subepithelial duodenal lesion with central depression but otherwise normal appearing mucosa. Superficial biopsies of the duodenal lesion were unremarkable. Subsequent antegrade single balloon enteroscopy revealed active bleeding from the lesion which was refractory to endoscopic treatment. A complete local excision of the lesion via laparotomy was necessary to achieve haemostasis. Histopathology from the lesion showed a moderately differentiated duodenal adenocarcinoma with invasion into the submucosa but no evidence of lymphovascular spread. Conclusion. Duodenal adenocarcinomas are rare gastrointestinal tumours associated with a poor prognosis. This case report outlines a rare presentation of duodenal adenocarcinoma and highlights the importance of judicious assessment of lesions found on endoscopy. Advances in endoscopic diagnostic modalities could facilitate early diagnosis and improve therapeutic outcomes.

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Use of pyloric exclusion with a double jejunostomy in the treatment of a serious duodenal lesion in a child

Pediatric Surgery International ◽

10.1007/s00383-002-0778-3 ◽

2003 ◽

Vol 19 (1) ◽

pp. 122-123 ◽

Cited By ~ 1

Author(s):

A. Mello Filho ◽

J. Martins ◽

V. Marinho ◽

E. Martins

Keyword(s):

Duodenal Lesion ◽

Pyloric Exclusion

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Duodenal Pyloric Gland Adenoma in a 59-Year-Old Asian Male

Case Reports in Gastrointestinal Medicine ◽

10.1155/2018/9287843 ◽

2018 ◽

Vol 2018 ◽

pp. 1-3

Author(s):

Mia Manabat ◽

Matthew Jackson ◽

Kha Ngo ◽

Laurence Stawick

Keyword(s):

Pyloric Gland ◽

Low Grade ◽

Invasive Adenocarcinoma ◽

Duodenal Lesion ◽

Pyloric Gland Adenoma ◽

Low Grade Dysplasia ◽

Asian Male ◽

Long Term Behavior

Pyloric gland adenomas (PGAs) are rare precancerous tumors typically arising from the stomach. Even more rarely do they arise in extragastric sites such as the duodenum and gallbladder. The identification of PGAs is important because they possess a risk of developing into invasive adenocarcinoma. This case report describes a 59-year-old male who presented to our office for a follow-up of a nonspecific duodenal lesion. Endoscopic ultrasound and pathology revealed a PGA with low grade dysplasia and some areas of focal high grade dysplasia. It is important that gastroenterologists are aware of these lesions and their risk of malignant transformation. More studies are needed to describe the long-term behavior of pyloric gland adenomas and to recommend appropriate endoscopic surveillance of these lesions.

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