Intramucosal duodenal adenocarcinoma concomitant with Saint’s triad

Duodenal tubulovillous adenomas are rare and have malignant potential. Their successful management depends on the preoperative diagnosis and adequate excision. Endoscopic mucosal resection or submucosal dissection can control superficial tumors. Adenocarcinoma of the duodenum may originate in tubular or tubulovillous adenoma, and possible diagnostic challenges occur concerning the endoscopic biopsy findings. We report a 62-year-old female with chronic epigastric burning and a bolus sensation. Upper gastrointestinal endoscopy showed a non-ampullary duodenal tumor, and the biopsy study diagnosed a tubulovillous adenoma. Further mucosectomy revealed an intramucosal adenocarcinoma in a tubulovillous adenoma with a tumor-free pedicle. Besides the intestinal neoplasms, the patient had the diagnosis of classical Saint’s triad; and the manifestations were hiatus hernia, gallbladder disorder, and colonic diverticula. The objective is to report two scarcely described conditions and comment on controversial points of view about the concomitance of Saint’s triad and malignancy. Case reports can reduce late diagnosis, enhancing the suspicion index on rare diseases.

Successful Extensive Multiorgan Resection of Malignant Duodenal Tumor: A Case Report

SummaryDuodenal adenocarcinoma is one of the rarest tumours of all gastrointestinal malignancies. Due to rarity and late symptoms, duodenal cancers are diagnosed in late stage, but overall survival rate is high. We present a case of locally advanced duodenal adenocarcinoma with successful surgical treatment including multiorgan resection.

Protruded duodenal tumor arising from Santorini’s duct of the pancreas: a rare case of intraductal papillary mucinous neoplasm mimicking a duodenal polypoid tumor

Background We experienced a rare case of intraductal papillary mucinous neoplasm arising from Santorini’s duct (SD) forming a tumor protruding into the duodenum . Case presentation A 71-year-old woman was incidentally diagnosed with a 3 cm type Isp polypoid tumor in the second portion of the duodenum at another hospital. Enhanced CT and endoscopic ultrasound revealed that the origin of this protruding tumor was arising from SD and that the tumor mimicked a pedunculated duodenal tumor. Our preoperative diagnosis was a malignant pancreatic tumor arising from SD with invasion into the duodenum. She underwent a subtotal stomach-preserving pancreaticoduodenectomy, and the resected specimen showed a 25 mm tumor protruding into the duodenum with a villous surface. The pathological findings revealed that the tumor was intraductal papillary mucinous adenoma (IPMA) arising from SD. Conclusions To the best of our knowledge, this is the first case of IPMA protruding into the duodenal lumen from SD, although most of the tumors arising from SD have been reported to be malignant.

DUODENAL TUMOR IN GASTROINTESTINAL STROMAL TUMORS: A RARE CASE

Gastrointestinal stromal tumors are commonly developed in gastrointestinal tract but in duodenum is less than 3% of all gastrointestinal neoplasm. The early diagnostic criteria are very difficult in these tumors in worldwide and being a challenge for medical team due to difficult anatomical structure of duodenum. The study’s aim is to know the incident rate of duodenal gastrointestinal stromal tumors. The average age of these tumors is more than 40 years but in the current case, 19-years old female patient present with complaint of melena and anemia. Her family history was negative. She was diagnosed by scope test of oral gastric duodenum with biopsy, abdominal x-rays, computerized tomography scan and histopathology. The patient was treated by Classic Whipple’s procedure. According to the oncologist, patient has low risk of duodenal tumor from gastrointestinal stromal tumor. These tumors have no need to treat with adjuvant therapy: chemotherapy (Glavic) and radiation therapy after surgical resection.