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.

Primary Duodenal Adenocarcinoma: Case report and literature review

Primary adenocarcinoma of the duodenum is a rare clinical condition, accounting for only 5% of all gastrointestinal neoplasms and 0.5% of all intestinal neoplasms. Nonspecific clinical presentation contributes to the majority of cases being diagnosed in advanced stages. The prognosis is poor, with a median survival of five years, varying from 23% to 57% in patients undergoing curative surgery (cephalic duodenopancreatectomy).

Pseudocapillaria tomentosa, Mycoplasma spp., and intestinal lesions in experimentally infected zebrafish Danio rerio

Intestinal neoplasms and preneoplastic lesions are common in zebrafish research facilities. Previous studies have demonstrated that the neoplasms are caused by a transmissible agent, and two candidate agents have been implicated: a Mycoplasma sp. related to M. penetrans and the intestinal parasitic nematode, Pseudocapillaria tomentosa, and both agents are common in zebrafish facilities. To elucidate the role of these two agents in the occurrence and severity of the neoplasm and other intestinal lesions, we conducted two experimental inoculation studies. Exposed fish were examined at various time points over an 8 mo. period for intestinal histpathologic changes and the burden of Mycoplasma and nematodes. Fish exposed to a Mycoplasma isolate from zebrafish were associated with preneoplastic lesions. Fish exposed to the nematode alone or with the Mycoplasma isolate developed severe lesions and neoplasms. Both inflammation and neoplasm scores were associated with an increase in Mycoplasma burden. These results support the conclusions that P. tomentosa is a strong promoter of intestinal neoplasms in zebrafish, and that Mycoplasma alone can also cause intestinal lesions and accelerate cancer development in the context of nematode infection.

APPENDIX MUCINOUS TUMOR CURSING WITH PERITONEAL PSEUDOMIXOMA: A CASE REPORT

Since appendiceal neoplasms have a rare incidence within the spectrum of intestinal neoplasms, they have an important differential diagnosis for patients in the fifth and sixth decade, especially those with a clinical picture suggestive of appendicitis. Mass radiological findings in the periapendicular region, metastatic implants, and ascites may suggest the diagnosis, but it is only confirmed after the surgical approach and biopsy. This case report presents a case of low-grade mucinous appendage tumor with peritoneal pseudomyxoma. It is importance due to its low incidence and, therefore, highlight the main aspects found in the surgery that are fundamental for intraoperative macroscopic diagnosis, choice of treatment technique and treatment. Key-words: Cecal Appendix; Peritoneal Pseudomyxoma; Mucinous Tumor.

The Intestinotrophic Effects of Glucagon-Like Peptide-2 in Relation to Intestinal Neoplasia

Context Glucagon-like peptide-2 (GLP-2) is a gastrointestinal hormone with intestinotrophic and antiapoptotic effects. The hormone’s therapeutic potential in intestinal diseases and relation to intestinal neoplasia has raised great interest among researchers. This article reviews and discusses published experimental and clinical studies concerning the growth-stimulating and antiapoptotic effects of GLP-2 in relation to intestinal neoplasia. Evidence Acquisition The data used in this narrative review were collected through literature research in PubMed using English keywords. All studies to date examining GLP-2’s relation to intestinal neoplasms have been reviewed in this article, as the studies on the matter are sparse. Evidence Synthesis GLP-2 has been found to stimulate intestinal growth through secondary mediators and through the involvement of Akt phosphorylation. Studies on rodents have shown that exogenously administered GLP-2 increases the growth and incidence of adenomas in the colon, suggesting that GLP-2 may play an important role in the progression of intestinal tumors. Clinical studies have found that exogenous GLP-2 treatment is well tolerated for up to 30 months, but the tolerability for even longer periods of treatment has not been examined. Conclusion Exogenous GLP-2 is currently available as teduglutide for the treatment of short bowel syndrome. However, the association between exogenous GLP-2 treatment and intestinal neoplasia in humans has not been fully identified. This leads to a cause for concern regarding the later risk of the development or progression of intestinal tumors with long-term GLP-2 treatment. Therefore, further research regarding GLP-2’s potential relation to intestinal cancers is needed.