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At least 523 records · Page 29Linked to original sources
PubMed2006

Sporadic versus hereditary gastrinomas of the duodenum and pancreas: distinct clinico-pathological and epidemiological features.

Gastrinomas are defined as gastrin secreting tumors that are associated with Zollinger-Ellison syndrome (ZES). ZES is characterized by elevated fasting gastrin serum levels, positive secretin stimulation test and clinical symptoms such as recurrent peptic ulcer disease, gastroesophageal reflux disease and occasional diarrhea. Genetically, nonhereditary (sporadic) gastrinomas are distinguished from hereditary gastrinomas, which are associated with multiple endocrine neoplasia type 1 (MEN1) syndrome. In general, duodenal gastrinomas are small and solitary if they are sporadic and multiple as well as hereditary. The sporadic gastrinomas occur in the duodenum or in the pancreas while the hereditary gastrinomas almost all occur in the duodenum. Our series of 77 sporadic duodenal neuroendocrine tumors (NETs) includes 18 patients (23.4%) with gastrinomas and ZES. Of 535 sporadic NETs in the pancreas collected from the NET archives of the departments of pathology in Zurich, Switzerland, and Kiel, Germany, 24 patients (4.5%) suffered from sporadic pancreatic gastrinomas and ZES. These NETs have to be distinguished from tumors with immunohistochemical positivity for gastrin but without evidence of ZES. An additional 19 patients suffered from MEN1 and ZES. These patients showed exclusively duodenal gastrinomas, but not pancreatic gastrinomas. The prognosis of sporadic and MEN1-associated duodenal gastrinomas is better than that of pancreatic gastrinomas, since they progress slowly to liver metastasis. In summary, sporadic and MEN1-associated gastrinomas in the duodenum and pancreas show different clinico-pathological and genetic features. The incidence of sporadic duodenal gastrin-producing tumors is increasing, possibly due to optimized diagnostic procedures. In contrast, pancreatic MEN1-associated gastrinomas seem to be extremely rare. A considerable subset of tumors with immunohistochemical expression of gastrin but without evidence of ZES should be designated as functionally inactive NETs expressing gastrin, but not as gastrinomas.

Duodenal Neoplasms↗
PubMed2004

High prevalence of multiple strain colonization of Helicobacter pylori in Korean patients: DNA diversity among clinical isolates from the gastric corpus, antrum and duodenum.

BACKGROUND: The aims of our study were to determine the correlation of the strain variation and degree of homogeneity of infecting Helicobacter pylori (H. pylori) with their disease outcomes, and the relevance of duodenal H. pylori expression of cagA and/or vacA gene to the development of duodenal ulcer in Korean patients. METHODS: One hundred and twenty bacterial colonies isolated from different anatomical sites of the stomach and duodenum were used. The study population was consisted of 40 Korean patients, 21 with duodenal ulcer, 7 with gastric ulcer, 3 with combined gastric and duodenal ulcer, and 9 with chronic gastritis. Genomic characteristics of each strain were analyzed by random amplified polymorphic DNA (RAPD) fingerprinting. The cagA and vacA genes were detected by polymerase chain reaction (PCR). RESULTS: PCR-based RAPD was proved to be a reliable method for the discrimination of individual bacterial genomic characteristics. Genomic fingerprinting showed a varying degree of inter- and intra-patient variation. Thirteen patients (32.5%) were colonized by a single strain throughout the corpus, antrum and duodenum, whereas the other 27 (67.5%) harbored multiple H. pylori strains. Thirty-six isolates (90.0%) each from the corpus and antrum, and 34 (85.0%) from the duodenum, expressed the cagA gene. The prevalence of duodenal H. pylori expression of the cagA gene was not different between patients with chronic gastritis and those with duodenal ulcer. All isolates were positive for both genes vacA s1 and vacA s1a. CONCLUSION: These results suggested that many of the H. pylori-infected Korean patients were actually colonized with mixed populations of different H. pylori strains and that the prevalence of duodenal H. pylori expression of the cagA and/or vacA gene was not correlated with the development of duodenal ulcer in Korean patients.

Adolescent↗
PubMedDate not supplied

A case of primary adenosquamous/squamous cell carcinoma of gallbladder directly invaded duodenum.

A rare case of primary gallbladder carcinoma is reported. A 67 year-old woman was admitted to our hospital for treatment of suspected duodenal carcinoma. A series of radiographic examinations demonstrated a giant tumor involving the duodenum, gallbladder, pancreatic head, and transverse colon. These extensions made it difficult to identify the primary origin of the carcinoma. Pancreatoduodenectomy, cholecystectomy, and resection of the transverse colon were performed. Macroscopically, ulcerative lesions were seen in both the gallbladder and the duodenum. Microscopic examination revealed adenosquamous cell carcinoma of the gallbladder, invasive of the adjacent organs, including circumferential invasion of the second portion of the duodenum. The patient tolerated the operation well and was discharged 28 days post-operatively, but died of liver metastasis 4 months after surgery. Local invasion of the surrounding tissues is characteristic of adenosquamous/squamous cell carcinoma of the gallbladder. Although surgery for cure is deemed possible, the rapid growth rate of this type of tumor may cast doubt on the value of extensive radical surgery.

Aged↗
PubMedDate not supplied

A case of Zollinger-Ellison syndrome produced by gastrinoma in the duodenum accompanied with multiple endocrine neoplasia type 1.

A case of Zollinger-Ellison syndrome produced by gastrinoma in the duodenum accompanied by multiple endocrine neoplasia type-1 (MEN-1) is reported. A 46 year-old female underwent distal gastrectomy due to gastric ulcer 5 years ago. As ulceration of the residual stomach recurred, further examination was performed. Hyperprolactinemia, hypergastrinemia, primary hyperparathyroidism, pancreatic tumor, and duodenal carcinoid were evident, and the diagnoses of Zollinger-Ellison syndrome and MEN-1 were established. The origin of the gastrin secretion was suspected to be from the pancreatic tumor, so sampling of the portal blood was performed. As lesion on the gastrinoma in the pancreas could not be identified, total parathyroidectomy was performed for primary hyperparathyroidism. The level of the gastrin secretion, however, remained high. Partial resection of the duodenum for the duodenal carcinoid and a distal pancreatectomy were carried out concurrently. Immunohistochemical study of the anti-gastrin antibody revealed duodenal tumor cells. Initially, the gastrinoma was thought to be in the pancreas, however, the lesion accompanied with MEN-1 and the Zollinger-Ellison syndrome had occurred in the duodenum.

Duodenal Neoplasms↗
PubMed1999

[Natural killer-like T-cell lymphoma appearing in the duodenum with recurrence in a variety of extranodal organs].

A 48-year-old man was admitted to Keio University Hospital in April 1995 with complaints of right abdominal pain and weight loss. Hypotonic duodenography showed a mass located in the 3rd portion of the duodenum. Endoscopic biopsy specimens disclosed diffuse large cell non-Hodgkin's lymphoma of the duodenum. The patient was initially treated with 2 courses of CHOP, albeit with no response. A pancreatoduodenectomy and radiotherapy yielded a complete remission. A year later, lymphoma recurred in the right mandible salivary gland, and a second complete remission was obtained after 6 courses of CHOP and radiation. However lymphomas also recurred in the intestine, and lungs, and the patient died of disease progression 38 months after diagnosis. Lymphoma cells were surface CD3 and CD56 positive. An examination of resected intestinal tissues disclosed lymphoma cells morphologically resemble large granular lymphocytes with rearranged TcR genes. These findings indicated the diagnosis of natural killer-like (NK-like) T-cell lymphoma. Compared with previously reported cases of NK-like T-cell lymphoma, this case was noteworthy for an unusual clinical course characterized by initial appearance in the duodenum, recurrence in a variety of extranodal organs, and the relatively long-term survival of the patient.

Duodenal Neoplasms↗
PubMed2000

[Motor and secretion function of stomach and duodenum, duodenogastric reflux in patients with duodenal ulcer].

Gastric secretion, motor function and tonicity of the stomach and duodenum, duodenogastric reflux were studied in inpatients with two clinicopathogenetic types of duodenal ulcer: observed at young age (type 1) and in later life (type 2). The examination included pH-metry with simultaneous balloon cimography, chromogastroduodenoscopy with Kongo-red, tests for Helicobacter pylori conducted on the biopsy samples. All the patients were found to have continuous acid production. High acid production was more frequently registered in males with the disease type 1, the lowest production was in females with the disease type 2. Duration of the acid inflow into the duodenum in patients with the disease type 2 was greater than that in young subjects. Mild ulcer was associated with moderate acidity in the duodenum, in severe ulcer the acidity was very high. Males with the disease 1 and 2 and females with type 2 had hyperkinetic, hypertonic gastric motor function. In duodenal ulcer prevalent is hypertonic, hyperkinetic type of duodenal motor function being most frequent among males with the disease type 2. Duodenogastric reflux occurs more often in patients with intensive acid production associated with hypotonic, hypokinetic motor type and duodenal tone.

Adult↗
PubMedDate not supplied

Radical surgery of colon cancers directly invading the duodenum, pancreas and liver.

BACKGROUND/AIMS: Adjacent organ invasion is observed in 5-12% of the colorectal cancers and is rarely faced with invasion of the duodenum, pancreas or liver. METHODOLOGY: We reviewed 4 patients with invasion of the duodenum, pancreas or liver or more than one at the same time, to emphasize the importance of aggressive radical procedures. RESULTS: Three patients underwent en bloc pancreaticoduodenectomy with right hemicolectomy, and one patient underwent en bloc pancreaticoduodenectomy with right hemicolectomy and 5th and 6th hepatic segments resection. Perioperative need for blood transfusion was 3-5 units. There was no postoperative morbidity and mortality, except for the patient who had a bile leakage which got well with medical treatment. Although malignant invasion was proved by pathologic evaluation, only one patient had lymph node involvement. While one patient was lost at the 8th postoperative month, 3 patients are living disease free within a range of 14-41 months. CONCLUSIONS: The chances of longer survival can be given to the patient by en bloc radical resections of locally advanced right colon tumors accompanied by invasion of duodenum, pancreas and liver, with low morbidity and mortality rates.

Adult↗
PubMed2001

[A case of relapsed small cell lung cancer recognized by simple metastasis to the duodenum].

We describe a case of relapsed small cell lung cancer (SCLC) recognized by a duodenal tumor, its probable metastasis. A 69-year-old man was admitted to Keio University Hospital complaining of persistent sputum production in September, 1996. A diagnosis of SCLC of the left lung invading the mediastinum was based on a transesophageal biopsy. Chemotherapy consisting of CDDP and VP-16 followed by thoracic irradiation at a total dose of 50 Gy was performed from October 1996 to August 1997, resulting in CR (Complete Response) of the tumor. In April of 1999, a mass surrounding the duodenum was found through an abdominal CT survey for tumor relapse, but no other tumors were detected in a series of CT scans or inbone scintigraphy. Subsequent fiberscopy of the upper gastrointestinal tract revealed an ulcerative tumor extensively invading the mucosa of the duodenal bulb. Biopsy specimens obtained from the duodenal tumor showed small-cell carcinoma with features similar to those of SCLC found in 1996, suggesting that SCLC of the left lung metastasized to the duodenal wall. Chemoradiotherapy with 4 cycles of CDDP and VP-16 followed by abdominal irradiation at a dose of 30 Gy was given again from May to September 1999, producing good PR (Partial Response). Although metastasis of SCLC to the duodenum seldom occurs, this report indicates that its early detection and effective treatment may prevent serious symptoms caused by obstruction of the duodenum or the papilla Vater.

Aged↗
PubMedDate not supplied

Multiple mucosal lesions in the duodenum: exploring the potential clinical backgrounds and concurrent diseases.

BACKGROUND/AIMS: Multiple mucosal lesions of the duodenum (MMLD), presenting with multiple mucosal redness and ulcers with or without blood clots in the proximal duodenum, may be occasionally discovered during gastroduodenal endoscopy. This study was undertaken to investigate the clinical implications of MMLD. METHODOLOGY: Endoscopic pictures and charts of patients with MMLD were retrospectively reviewed. The endoscopic features of MMLD were recorded for both location and severity. The endoscopic severity of MMLD was defined as follows: Grade I: multiple mucosal redness; Grade II: multiple ulcers with clear base; Grade III: multiple ulcers with reddish base or fresh blood clot coating. RESULTS: A total of 229 (1.08%) MMLD events in 207 patients were identified out of a total of 21,223 upper gastrointestinal endoscopies. Common backgrounds of patients with MMLD included diabetes, hypertension, and some chemical exposure, such as cigarettes, alcohol, nonsteroidal anti-inflammatory drugs and anti-Helicobacter pyloric regimens. Common concurrent diseases included peptic disease, sepsis, malignancy, renal insufficiency, and portal hypertension. MMLD associated with sepsis usually involved only the second portion of the duodenum, but when associated with nonsteroidal anti-inflammatory drugs was less often only involved with the second portion. MMLD with renal insufficiency was less prone to involve the bulb alone. Diabetes-related MMLD tended to present with mild severity as defined by Grade I, H. pylori infection with Grade II, and renal insufficiency and portal hypertension with higher severity such as Grade III. Nine patients had fatal outcomes due to uncontrolled concurrent diseases, other than MMLD. CONCLUSIONS: MMLD, an uncommon occurrence in endoscopy, can develop from several clinical settings. When encountering MMLD while performing endoscopy, the best policy is to search and correct the concurrent diseases as early as possible.

Adult↗
PubMed2001

[Evaluation of non-surgical therapy for the malignant lymphomas located mainly in the stomach and duodenum].

We evaluated the effects of the conservative treatment to 29 patients with non-Hodgkin lymphomas located mainly in stomach and duodenum. We could induce complete remission in all the cases of stage I, II, and III including MALT lymphomas by the combination therapy of Helicobacter pylori (H. pylori) eradication, chemotherapy, and radiation, and the complete remission persisted in all except for the three cases who died of other causes. Even in stage IV lymphomas mainly located in stomach and duodenum, we could induce complete remission in 50% of them. Considering the quality of life of patients with lymphomas located mainly in stomach and duodenum, the conservative treatment may be of benefit more than the surgical approach.

Adult↗
PubMed2000

[Benign tumor of duodenum: report of 8 cases].

OBJECTIVE: To investigate the problems of diagnosis and treatment in patients with benign tumor of duodenum. METHOD: Clinico pathological data of 8 patients with benign tumors of duodenum treated surgically in our department from 1989 to 2000 were analyzed retrospectively. RESULTS: Of the 8 patients, 3 had a Brunner's grand adenoma, 2 leiomyoma, 2 mesenchymoma, and 1 lipoma. In general, the patients were asymptomatic and the lesions were discovered incidentally. Gastrointestinal bleeding might be the main symptom even if it was nonspecific. Bleeding might be melena or hematemesis and the patients might develop signs of anemia. Upper gastrointestinal tract examination and gastroduodenoscopy was performed before operation in 7 patients. The tumor was removed through longitudinal incision during duodenotomy. CONCLUSIONS: Gastrointestinal bleeding is common in patients with benign tumor of duodenum. The upper gastrointestinal tract examination and gastroduodenoscopy are major methods for diagnosis. The best treatment of choice is local resection.

Duodenal Neoplasms↗
PubMed1976

[Effects of proximal gastric vagotomy (PVG) and total vagotomy (TV) on the coordination of the interdigestive myoelectric acitivity of the canine stomach and duodenum].

Interdigestive myoelectrical activity of the canine stomach and duodenum is organized in complexes of high-amplitude action potentials originating simultaneously in the stomach and duodenum every 80-180 minutes. This type of activity has been described as the "interdigestive myoelectrical complex" (IDMEC) by Szurszewski. The present work was undertaken to elucidate the role of the vagus nerve in control of the IDMEC. Dogs were prepared with chronically implanted Ag-AgCl-electrodes on the stomach and duodenum. Fasting myoelectrical activity was recorded in the normal animal, after proximal gastric vagotomy (PGV), and after truncal vagotomy (TV). PGV did not affect the IDMEC, but TV abolished the pattern for the period of observation (3 months). The authors discuss the possible role of interference by TV with gastrodeuodenal interdigestive motor activity in the pathogenesis of reflux gastritis after vagotomy and drainage.

Action Potentials↗
PubMed1992

[Mucous membrane of the gastric antrum in late periods after selective proximal vagotomy with surgical drainage of the stomach and duodenum].

A clinicomorphological analysis was performed of the gastric antrum mucous membrane of 60 patients after selective proximal vagotomy because of stenosing duodenal ulcer. The patients were subdivided into two randomized groups depending on the type of the draining operation. The first group had a gastroduodenoanastomosis for the gastric drainage and the second group underwent duodenum plasty (drainage of the duodenum). Discontinuation of the pylorus function in the gastric drainage operation resulted in higher incidence and intensity of duodenum-gastric reflux and made more severe antrum gastritis; reflux-gastritis developed frequently. Morphological signs of reflux-gastritis in 95% of cases coincided with the results of the radionuclide method. Duodeno-gastric reflux decreased as a rule Helicobacter pylori (HP) contamination of the mucous membrane but did not eliminate it completely in all cases. The combination of these two factors resulted in more severe gastritis than that provoked by each of them separately. The etiology of gastritis and its intensity may be determined only by morphological examination of gastric mucous membrane. The results of endoscopic and histologic methods coincided in 70% of cases. Duodenal-gastric reflux, HP and high acid production play a certain role in ulcer recurrence.

Anastomosis, Surgical↗
PubMed2003

[Immunogenetic features of patients with ulcer disease of the stomach and duodenum and the significance of genetic markers in prognosis of complications of stomach and duodenal ulcers in Azerbaijan].

The work has shown that patients with ulcer disease of the stomach and duodenum have immunogenetic features. In particular, genetic markers were detected for ulcer disease of the stomach and duodenum whose presence allows to predict with certain probability the development of ulcer disease of the stomach and duodenum. The presence of antigen HA-At and haploids--AxB18 and HLA--A10B27 is prognostically unfavorable factors for the development of complications of this disease.

Adult↗
PubMedDate not supplied

[Frequency dynamics of stomach and duodenum ulcer found in liquidators of consequence of Chernobyl accident (according to the data of long-term observation)].

The authors have studied the frequency dynamics of stomach and duodenum ulcer occurrence revealed in liquidators of consequence of Chernobyl accident (1986-1987) after long-term medical observation with age and radiation absorbed dose variations. According to the findings, duodenum ulcer incidence prevails over stomach ulcer in all scale of age. The connection between the frequency dynamics of duodenum ulcer and age of the patients wasn't found.

Adult↗
PubMed2005

A case of Cushing syndrome secondary to ectopic adrenocorticotropic hormone producing carcinoid of the duodenum.

Cushing syndrome caused by adrenocorticotropic hormone (ACTH) production from solid tumors can result in life-threatening hypercortisolemia. Ectopic ACTH production is most commonly associated with bronchial carcinoids and squamous cell carcinoma of the lung. We report a case of Cushing syndrome caused by ectopic ACTH production from a carcinoid of the duodenum. The patient presented to an outside hospital in hypertensive crisis and diabetic ketoacidosis. After stabilization, diagnostic studies including a serum cortisol level, and computed tomography (CT) scans of the head, chest, abdomen, and pelvis revealed hypercortisolemia and a large mass in the head of the pancreas. Pancreaticoduodenectomy was performed. Pathologic investigation revealed a 1-cm carcinoid of the duodenum with two large metastatic lymph nodes near the head of the pancreas. This is the first reported case in the English literature of Cushing syndrome caused by ectopic ACTH production from a carcinoid of the duodenum.

ACTH Syndrome, Ectopic↗
PubMed1992

Adenoma and carcinoma of the duodenum and papilla of Vater: a clinicopathologic study.

In a retrospective study (1982-1990), 12 adenomas, 35 carcinomas of the papilla of Vater, and 21 duodenal adenomas were examined. All patients had endoscopicbioptic examinations (5-10 forceps biopsies, snare biopsy or forceps-biopsies after endoscopic sphincterotomy). Special attention was paid to malignant transformation of adenomas and of residual adenomatous tissue in surgical resected cancer. Follow-up data were gained by reexamination or questionnaires. In papillary adenomas, an adenocarcinoma was found in 30% at operation or by follow-up. In 41.2% of the operated cases, residual adenomatous tissue was found, more often in well-differentiated adenocarcinomas than in other histological types. A transformation from duodenal adenomas to adenocarcinomas was seen less frequently (9.5%). Therefore, the risk of malignancy in ampullary adenomas is greater than elsewhere in the duodenum. In eight of 11 patients (72.7%) with duodenal adenomas, one or more simultaneously developed colonic adenomas were found (in four cases a Gardner syndrome not known before). We conclude that there is strong evidence that most ampullary and duodenal carcinomas develop in preexisting adenomas, with an adenoma-cancer sequence similar to that accepted for colorectal carcinoma. This has to be kept in mind for diagnostic as well as therapeutic reasons. When either an adenoma of the ampulla or duodenum is diagnosed, colonoscopy is mandatory to find or exclude colonic adenomas. In patients with familiar adenomatosis, the duodenum and the papilla of Vater have to be examined endoscopically.

Adenocarcinoma↗
PubMed1991

Abdominal ultrasonography in the diagnosis of extrinsic endoscopic compressions of stomach and duodenum.

Extrinsic compressions of stomach or duodenum (ECSD) are occasionally found during endoscopic examination. Ultrasonography is usually performed in order to explain the significance of this feature. We have prospectively assessed the prevalence of ECSD and the diagnostic role of US in this context. ECSD were found in 37 out of 6604 gastroduodenoscopies. An abdominal US was performed after endoscopy in all these patients. The extrinsic compressions were in the gastric anterior wall in 7 patients in the gastric posterior wall in 10 patients, and in the lesser curvature in 9 patients and in the duodenum in 11 patients. In 20 patients the compression was due to neoplastic lesions, in another 15 non neoplastic conditions were found (hepatomegaly, splenomegaly, gallbladder hydrops, pancreatic pseudocyst, vascular malformations). Ultrasonography was demonstrated to have an elevated sensitivity (87.5%) and an elevated specificity (100%) when technically adequate. We conclude that extrinsic compressions of stomach and duodenum detected at endoscopy are frequently associated to neoplastic lesions. Abdominal ultrasonography is an accurate tool, when technically adequate, as an initial screening test for such lesions. Endosonography, CT scan or other invasive tests must be performed in doubtful cases.

Aged↗