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Cazacu SM, Cârțu D, Popescu M, Streba L, Ungureanu BS, Iovănescu VF, Cimpoeru M, Mirea CS, Surlin VM, Mogoantă S, Florescu MM. Small Bowel Tumors: A 7-Year Study in a Tertiary Care Hospital. Cancers (Basel) 2025; 17:1465. [PMID: 40361397 PMCID: PMC12071178 DOI: 10.3390/cancers17091465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2025] [Revised: 04/17/2025] [Accepted: 04/24/2025] [Indexed: 05/15/2025] Open
Abstract
(1) Background: Tumors of the small bowel represent 3-6% of gastrointestinal neoplasms and 3-6% of GI malignancies. The difficulties regarding the diagnosis are associated with larger tumors at the moment of the diagnosis and with advanced forms of malignant tumors, associated with a dismal prognosis. (2) Methods: We performed an observational, retrospective, cohort study that included patients with small bowel tumors admitted to the Craiova County Emergency Clinic Hospital between 1 January 2017 and 31 December 2023. The data were collected from the analysis of the patient's discharge documents from the Hippocrates computer system of the hospital and the evaluation of endoscopy databases. Patients under 16 years of age, those with no pathological confirmation of the malignancy, and those with insufficient data were excluded. (3) Results: A total of 80 cases of small bowel tumors were diagnosed; 72.5% were malignant, of which 10.3% were metastases. The most frequent primary malignant small bowel tumor was adenocarcinoma; two squamous cell carcinomas were noted. CT scans and upper digestive endoscopy represent the most frequent imaging methods for the diagnosis. The prognosis for malignant tumors was poor, with a 41% 5-year survival rate. (4) Conclusions: Small bowel tumors are rarely encountered, with 72.5% being malignant, and were diagnosed at large dimensions and in advanced stages for malignant tumors, with a dismal prognosis.
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Affiliation(s)
- Sergiu Marian Cazacu
- Gastroenterology Department, University of Medicine and Pharmacy, 200349 Craiova, Romania; (S.M.C.); (B.S.U.); (V.F.I.)
| | - Dan Cârțu
- Surgery Department, University of Medicine and Pharmacy, 200349 Craiova, Romania; (D.C.); (C.S.M.); (V.M.S.); (S.M.)
| | - Mihai Popescu
- Imaging Department, University of Medicine and Pharmacy, 200349 Craiova, Romania;
| | - Liliana Streba
- Oncology Department, University of Medicine and Pharmacy, 200349 Craiova, Romania
| | - Bogdan Silviu Ungureanu
- Gastroenterology Department, University of Medicine and Pharmacy, 200349 Craiova, Romania; (S.M.C.); (B.S.U.); (V.F.I.)
| | - Vlad Florin Iovănescu
- Gastroenterology Department, University of Medicine and Pharmacy, 200349 Craiova, Romania; (S.M.C.); (B.S.U.); (V.F.I.)
| | - Mihai Cimpoeru
- Gastroenterology Department, Clinical Emergency Hospital, Tabaci Street No. 1, 200642 Craiova, Romania;
| | - Cecil Sorin Mirea
- Surgery Department, University of Medicine and Pharmacy, 200349 Craiova, Romania; (D.C.); (C.S.M.); (V.M.S.); (S.M.)
| | - Valeriu Marian Surlin
- Surgery Department, University of Medicine and Pharmacy, 200349 Craiova, Romania; (D.C.); (C.S.M.); (V.M.S.); (S.M.)
| | - Stelian Mogoantă
- Surgery Department, University of Medicine and Pharmacy, 200349 Craiova, Romania; (D.C.); (C.S.M.); (V.M.S.); (S.M.)
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Zhang XY, Li C, Lin J, Zhou Y, Shi RZ, Wang ZY, Jiang HB, Wang YY. Intestinal obstruction caused by early stage primary ileum adenocarcinoma: A case report and review of literature. World J Gastrointest Oncol 2025; 17:104919. [PMID: 40235870 PMCID: PMC11995343 DOI: 10.4251/wjgo.v17.i4.104919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2025] [Revised: 02/06/2025] [Accepted: 02/25/2025] [Indexed: 03/25/2025] Open
Abstract
BACKGROUND Ileum adenocarcinoma (IA), a type of small bowel adenocarcinoma, is a rather uncommon factor associated with obstruction in small bowel. Owing to its location and indefinite clinical symptoms, the diagnosis of IA is difficult, and survival is usually poor. With respect to the rarity of this disease, very few studies have reported such cases to provide a reference for treatment. CASE SUMMARY In this manuscript, a case of a 48-year-old man presented with chronic right lower abdominal pain and distention, queasiness and emesis. A computed tomography scan revealed intestinal wall thickening and an intestinal obstruction in the terminal ileum. He was diagnosed with inflammatory bowel disease. However, his symptoms were not relieved after conservative treatment. The patient subsequently underwent exploratory laparotomy, and a tumour in the ileum measuring approximately 2.0 cm × 2.0 cm that was located 20 cm from the ileocolic valve was discovered incidentally and was operatively resected along with the enlarged lymph nodes. Pathological examination revealed a stage IIA (T3N0M0) ulcerative IA. Along with imaging examinations, a diagnosis of primary IA with no lymph or distant metastases was considered. The patient was discharged and recovered well as of the writing of this manuscript. CONCLUSION IA should be considered as a differential diagnosis in cases of intestinal obstruction, and the recommended method for local disease treatment is surgery.
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Affiliation(s)
- Xiao-Yue Zhang
- Gastrointestinal Disease Center, The First Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
| | - Chao Li
- Gastrointestinal Disease Center, The First Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
| | - Jie Lin
- Gastrointestinal Disease Center, The First Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
| | - Yan Zhou
- Gastrointestinal Disease Center, The First Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
| | - Rui-Zhe Shi
- Gastrointestinal Disease Center, The First Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
| | - Zhong-Yu Wang
- Gastrointestinal Disease Center, The First Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
| | - Hai-Bo Jiang
- Gastrointestinal Disease Center, The First Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
| | - Yuan-Yuan Wang
- Gastrointestinal Disease Center, The First Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
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Giannakodimos I, Bekiaris E, Ziogou A, Giannakodimos A, Mitakidi E, Psalla K, Fragkiadis E, Kaltsas A, Kratiras Z, Chrisofos M. Primary Adenocarcinoma of the Upper Urinary Tract: A Systematic Review of the Literature on a Rare Entity. J Clin Med 2025; 14:2010. [PMID: 40142817 PMCID: PMC11943348 DOI: 10.3390/jcm14062010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2025] [Revised: 03/03/2025] [Accepted: 03/09/2025] [Indexed: 03/28/2025] Open
Abstract
Background: Only a few published cases of primary adenocarcinoma of the upper urinary tract have been described in the literature. The aim of this systematic review was to collect all published cases of primary adenocarcinoma of the upper UT and identify prognostic factors and useful diagnostic modalities for their optimal treatment. Methods: Systematic research in the PubMed/Medline and Scopus databases concerning primary adenocarcinoma of the upper urinary tract was performed by two independent investigators. A total of 85 studies were included in the review. Results: In total, 84 patients were included, consisting of 54 males (64.29%) and 30 females (35.71%). Out of the available data, 24.71% reported a history of lithiasis, 16.47% episodes of pyelonephritis and 10.59% a history of hydronephrosis. Concerning histologic findings on excised tumors, 52.44% of neoplasms were mucinous, 19.51% tubulovilous, 18.29% papillary, 4.88% mixed mucinous-papillary and 4.88% poorly differentiated. Concerning anatomical origin, 62.34% of tumors were found in the renal pelvis, 22.08% in the ureter and 12.99% in both the renal pelvis and the ureter. Surgical treatment was the preferred therapeutic option and was performed in 96.39% of the included patients. In multivariable analysis, a statistically significant relationship was found between a clinical cure and ureter origin of the lesion (OR: 0.17, 95% CI: 0.00-0.22, p = 0.002), the presence of an abdominal mass (OR: 0.08, 95% CI: 0.01-0.63, p: 0.034) and a poorly differentiated histological type (OR: 0.02, 95% CI: 0.00-0.91). In multivariable time-to-event analysis, the male sex (HR: 0.12, 95% CI: 0.02-1.01, p: 0.019) and poorly differentiated histological type (HR: 91.06, 95% CI: 7.31-1134.32, p: 0.002) had statistically significant impacts on overall survival. Conclusions: Selection of the optimal surgical management, via either nephrectomy or nephroureterectomy, depends on the origin of the primary lesion and represents the mainstay of treatment. A suspicion from the urologist is needed for the identification and optimal treatment of these rare tumors.
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Affiliation(s)
- Ilias Giannakodimos
- Third Department of Urology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.K.); (Z.K.); (M.C.)
| | - Evripidis Bekiaris
- Department of Urology, Geniko Kratiko Nikaias General Hospital, 18454 Athens, Greece;
| | - Afroditi Ziogou
- Department of Medical Oncology, Metaxa Cancer Hospital, 18537 Athens, Greece; (A.Z.); (A.G.)
| | - Alexios Giannakodimos
- Department of Medical Oncology, Metaxa Cancer Hospital, 18537 Athens, Greece; (A.Z.); (A.G.)
| | - Evangelia Mitakidi
- Departement of Anesthesiology, General Hospital of KAT, 14561 Athens, Greece;
| | - Konstantina Psalla
- Second Departement of Surgery, Geniko Kratiko Nikaias General Hospital, 18454 Athens, Greece;
| | - Evangelos Fragkiadis
- Departement of Urology, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece;
| | - Aris Kaltsas
- Third Department of Urology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.K.); (Z.K.); (M.C.)
| | - Zisis Kratiras
- Third Department of Urology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.K.); (Z.K.); (M.C.)
| | - Michael Chrisofos
- Third Department of Urology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.K.); (Z.K.); (M.C.)
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Xie QF, Long LS, Luo YY, Lu MT, Ming WK, Zhao LY, Liu H. Long-term survival outcomes of duodenal adenocarcinoma: A cohort study with 15-year single-center experience. World J Gastrointest Surg 2025; 17:101365. [DOI: 10.4240/wjgs.v17.i2.101365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2024] [Revised: 10/25/2024] [Accepted: 11/25/2024] [Indexed: 01/22/2025] Open
Abstract
BACKGROUND Duodenal adenocarcinoma (DA), a rare gastrointestinal malignancy, lacks clear natural history and management strategies. This study aimed to investigate the long-term outcomes of patients with DA, focusing on long-term survival and the impact of tumor characteristics, surgery, and adjuvant therapy.
AIM To bridge this knowledge gap, we conducted a hospital-based cohort study in our 15-year experience with DA aimed at investigating the long-term outcomes of the patients with DA, along with analyzing the impact of the tumor characteristics, operations and adjuvant therapy on survival outcomes.
METHODS A retrospective analysis of 208 patients diagnosed with non-ampullary DA at a single institution between 2009 and 2023 was performed. This study used SPSS 26.0 software to make a comprehensive statistical analysis of demographic characteristics, clinical presentation, treatment modalities, and survival outcomes. The effectiveness of surgical resection and adjuvant therapy in 5-year oval survival (OS) and disease-free survival was evaluated using Kaplan-Meier survival curves, the Cox proportional hazards model, and statistical comparisons of survival distributions.
RESULTS The median OS time for the cohort was 39 months, with 3- and 5-year OS rates of 51.2% and 43.6%, respectively. Radical resection was performed in 82.6% of cases, and was significantly associated with an improved 5-year OS, with a rate of 57.8%. Adjuvant therapy showed a survival benefit in the specific patient subsets, particularly in tumor stage II or III tumors, with an improved OS. Adjuvant therapy (hazard ratio= 2.71, 95% confidence interval: 1.30-5.62, P = 0.008), pancreatic invasion and advanced tumor stage were identified as significant predictors of OS in multivariate analyses.
CONCLUSION Radical operation for DA is associated with a remarkable improvement in the 5-year OS. Importantly, postoperative adjuvant therapy can significantly prolong the OS time in patients with radical operation, especially in patients with stage III. It highlights the necessity for early diagnosis, tailored surgical approaches, and a nuanced understanding of the role of adjuvant therapy.
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Affiliation(s)
- Qing-Feng Xie
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Lian-Sheng Long
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
- Department of General Surgery, General Hospital of Southern Theater Command, Guangzhou 510515, Guangdong Province, China
| | - Yang-Yang Luo
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Meng-Ting Lu
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Wai-Kit Ming
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong 999077, China
| | - Li-Ying Zhao
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Hao Liu
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
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Zhang D, Zheng Y, Wang T, Zeng Y, Ma W, Liu M, Lv F, Lu J. Lymph node ratio-based model for predicting survival and assessing the benefit of adjuvant chemotherapy in postoperative duodenal adenocarcinoma. Surgery 2025; 178:108847. [PMID: 39384475 DOI: 10.1016/j.surg.2024.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Revised: 08/28/2024] [Accepted: 09/11/2024] [Indexed: 10/11/2024]
Abstract
BACKGROUND This study aimed to evaluate the prognostic significance of lymph node ratio in postoperative duodenal adenocarcinoma and develop a nomogram-based model for prognosis assessment and treatment optimization. METHODS Clinical information of patients with duodenal adenocarcinoma were retrieved from the Surveillance, Epidemiology, and End Results database, and prognostic factors were identified by univariate and multivariable analyses. Prognostic factors influencing patient outcomes were identified using univariate and multivariable Cox analyses. Subsequently, a novel nomogram and risk stratification system were developed based on these identified factors. RESULTS A total of 943 eligible patients were included, with 656 in the training cohort and 287 in the validation cohort. Lymph node ratio ≥0.12 were associated with poorer overall survival (hazard ratio 1.562, 95% confidence interval 1.195-2.041, and P = .001 for lymph node ratio = 0.12-0.30; hazard ratio 2.431, 95% confidence interval 1.847-3.199, and P < .001 for lymph node ratio >0.30). Prognostic factors including age at diagnosis, race, T stage, lymph node ratio, and tumor size were integrated into the nomogram. Patients in the low-risk group demonstrated significantly better overall survival compared with those in the high-risk group. Additionally, adjuvant chemotherapy significantly improved overall survival in the high-risk subgroup, whereas low-risk patients might be exempt from adjuvant chemotherapy. CONCLUSIONS This study represented the pioneering endeavor in introducing a lymph node ratio-based nomogram model for prognosis stratification and adjuvant chemotherapy decision-making protocol for patients with duodenal adenocarcinoma, thereby guiding personalized treatment strategies and minimizing overtreatment.
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Affiliation(s)
- Di Zhang
- Department of Medical Oncology, Qilu Hospital of Shandong University, Jinan, Shandong, China; Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yuan Zheng
- Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Tengkai Wang
- Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yunqing Zeng
- Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Wenlong Ma
- Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Mingru Liu
- Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Fenxiao Lv
- Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jiaoyang Lu
- Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China; Medical Integration and Practice Center, Cheeloo College of Medicine, Shandong University, Jinan, China.
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Døssing RH, Broman JJA, O'Rourke CJ, Tabaksblat EM, Andersen JB, Hansen CP, Poulsen TS, Høgdall EVS, Schou JHV, Høgdall D. Molecularly redefining small bowel adenocarcinoma to accelerate precision patient care - protocol of a multicenter observational cohort biomarker study. BMC Cancer 2025; 25:22. [PMID: 39773121 PMCID: PMC11707884 DOI: 10.1186/s12885-024-13369-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 12/19/2024] [Indexed: 01/11/2025] Open
Abstract
BACKGROUND Small Bowel Adenocarcinoma (SBA) is a rare gastrointestinal cancer with a limited understanding of the molecular pathology. This study aims to bridge the knowledge gap, providing a robust molecular foundation for SBA and addressing the clinical challenges inherent in treating this orphan disease. The study proposes to redefine the clinical management for SBA patients through advanced molecular profiling techniques to improve potential precision medicine. METHODS/DESIGN This National multicenter, observational cohort study combines retrospective and prospective analyses across Danish University Hospitals. The study enrolls patients diagnosed with SBA, retrospectively from 2009 and prospectively from 2022 onwards. Molecular profiling, including DNA, RNA, and T-cell receptor sequencing, will be conducted on SBA tissue samples. The primary outcome is to categorize SBA into consensus molecular-guided subgroups. Secondary outcomes include correlating these subgroups with clinical features, treatment responses, and patient outcomes. Machine learning algorithms will be employed for bioinformatic analyses to interpret molecular data. Ethical approval has been obtained, and patient consent will be secured for the retrospective study component. DISCUSSION The molecular and clinical characterization of SBA is expected to add novel insights into the heterogeneity of this rare disease. By identifying molecular subgroups, the research could enable the development of personalized treatment strategies, a paradigm shift within SBA. The study acknowledges the challenges of working with orphan diseases, including limited patient numbers and diverse clinical presentations. However, its findings will have the potential to substantially impact future clinical practices and guide targeted therapies for SBA patients. TRIAL REGISTRATION ClinicalTrials.gov NCT06234306.
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Affiliation(s)
- Rasmus Haunstrup Døssing
- Department of Oncology, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls Vej 1, Herlev, 2730, Denmark.
| | - Julia Johanna Almer Broman
- Department of Oncology, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls Vej 1, Herlev, 2730, Denmark
| | - Colm J O'Rourke
- Department of Health and Medical Sciences, Biotech Research and Innovation Center, University of Copenhagen, Ole Maaløes Vej 5, 4th Floor, Copenhagen N, 2200, Denmark
| | | | - Jesper Bøje Andersen
- Department of Health and Medical Sciences, Biotech Research and Innovation Center, University of Copenhagen, Ole Maaløes Vej 5, 4th Floor, Copenhagen N, 2200, Denmark
| | - Carsten Palnæs Hansen
- Department Surgical Gastroenterology, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, Copenhagen Ø, 2100, Denmark
| | - Tim Svenstrup Poulsen
- Department of Pathology, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls Velj 1, Herlev, 2730, Denmark
| | - Estrid V S Høgdall
- Department of Pathology, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls Velj 1, Herlev, 2730, Denmark
| | - Jakob Hagen Vasehus Schou
- Department of Oncology, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls Vej 1, Herlev, 2730, Denmark
| | - Dan Høgdall
- Department of Oncology, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls Vej 1, Herlev, 2730, Denmark.
- Department of Health and Medical Sciences, Biotech Research and Innovation Center, University of Copenhagen, Ole Maaløes Vej 5, 4th Floor, Copenhagen N, 2200, Denmark.
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Szkudlarek D, Skórkowska-Telichowska K, Wiatrak B. Diagnostic Challenges of Medullary Carcinoma of the Small Intestine During the COVID-19 Pandemic. J Clin Med 2025; 14:298. [PMID: 39860304 PMCID: PMC11765944 DOI: 10.3390/jcm14020298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2024] [Revised: 12/21/2024] [Accepted: 12/31/2024] [Indexed: 01/27/2025] Open
Abstract
Background: Medullary carcinoma of the small intestine is an exceptionally rare subtype of gastrointestinal cancer, characterized by its solid growth pattern and lack of glandular structures, which complicate timely diagnosis. During the COVID-19 pandemic, diagnostic delays for rare cancers became increasingly common due to the prioritization of COVID-related cases and patient reluctance to seek medical attention. Methods and Result: We present the case of a 70-year-old male initially misdiagnosed with COVID-19, whose persistent symptoms led to the eventual discovery of medullary carcinoma. Imaging studies revealed focal lesions in the liver, spleen, and thickened small intestinal walls, prompting surgical resection of a 16 cm intestinal segment. Histopathological examination confirmed medullary carcinoma with lymph node and liver metastases, supported by immunohistochemistry, which showed positive markers (calretinin, pancytokeratin, cytokeratin 7) and excluded other malignancies. Conclusions: The diagnostic delay, exacerbated by the pandemic, highlights the challenges of distinguishing rare cancers from more common conditions during global health crises. This case underscores the importance of advanced diagnostic techniques, such as immunohistochemistry, for accurate identification. Maintaining robust cancer diagnostic pathways during emergencies is crucial to avoid delays in treatment. Future research should focus on improving screening methods for rare cancers and developing resilient healthcare systems to mitigate similar challenges in future crises.
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Affiliation(s)
- Danuta Szkudlarek
- Pathology Department, Provincial Hospital Center of the Jelenia Góra Valley, 58-506 Jelenia Góra, Poland
| | - Katarzyna Skórkowska-Telichowska
- Department of Non-Surgical Clinical Sciences, Faculty of Medicine, Wrocław University of Science and Technology, Wybrzeże Wyspiańskiego 27, 50-370 Wrocław, Poland
- Department of Endocrinology, Jerzy Gromkowski Regional Specialist Hospital, Koszarowa 5 Str., 51-149 Wrocław, Poland
| | - Benita Wiatrak
- Department of Pharmacology, Faculty of Medicine, Wrocław Medical University, 50-345 Wrocław, Poland
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Fujii H, Shoji H, Hirano H, Hirose T, Okita N, Takashima A, Kato K. Exploring novel therapeutic targets in small bowel adenocarcinoma: insights from claudin 18.2, nectin-4, and HER3 expression analysis. ESMO Open 2025; 10:104098. [PMID: 39754977 PMCID: PMC11758419 DOI: 10.1016/j.esmoop.2024.104098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2024] [Revised: 11/23/2024] [Accepted: 11/29/2024] [Indexed: 01/06/2025] Open
Abstract
BACKGROUND Small bowel adenocarcinoma (SBA) is a rare malignancy with few established chemotherapy options and a dismal prognosis. We investigated the expression of claudin 18.2, nectin-4, human epidermal growth factor receptor 3 (HER3), and programmed death-ligand 1 (PD-L1) in SBA to identify potential antibody drug targets and analyzed associated clinicopathological features and prognosis. MATERIALS AND METHODS We retrospectively reviewed patients diagnosed with SBA who underwent adjuvant or palliative chemotherapy at our hospital between July 2010 and July 2023. Pathological samples were immunohistochemically stained for claudin 18.2, nectin-4, HER3, and PD-L1. Overall survival (OS) was assessed in patients receiving palliative chemotherapy to examine its association with the expression of each protein, excluding those with microsatellite instability-high who were treated with immunotherapy. RESULTS Pathological samples and clinical data were available for 51 patients. The primary lesion was in the duodenum in 49% of these patients and in the jejunum or ileum in 51%. Positive rates for claudin 18.2, nectin-4, and HER3 were 35%, 82%, and 88%, respectively. All cases expressed at least one of the proteins, and 25% expressed all three proteins. The PD-L1 combined positive score (CPS) was <1, 1-5, and ≥5 in 33%, 32%, and 35%, respectively; nectin-4-positive samples showed higher CPS. Neither claudin 18.2 nor HER3 positivity was associated with OS. However, nectin-4 positivity was associated with significantly shorter OS [12.6 versus 43.2 months, hazard ratio (HR) 5.12, P = 0.006]. Similarly, PD-L1 CPS ≥5 was associated with shorter OS relative to CPS <5 (9.7 versus 18.0 months, HR 2.60, P = 0.028). Multivariate analysis identified nectin-4 positivity (HR 4.55, P = 0.020) as an independent adverse prognostic factor for OS. CONCLUSIONS Claudin 18.2, nectin-4, and HER3 are potential therapeutic targets in SBA, and nectin-4 positivity is independently associated with an unfavorable prognosis. These proteins may represent new therapeutic targets for SBA.
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Affiliation(s)
- H Fujii
- Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan; Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - H Shoji
- Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan; Department of Experimental Therapeutics, National Cancer Center Hospital, Tokyo, Japan.
| | - H Hirano
- Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - T Hirose
- Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - N Okita
- Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - A Takashima
- Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - K Kato
- Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
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Obleagă CV, Streba CT, Mirea CS, Vîlcea ID, Florescu DN, Ciorbagiu MC, Turcu T, Florescu MM, Șerbănescu MS, Mehedințeanu AM, Vere CC. Primitive Resectable Small Bowel Cancer Clinical-Pathological Analysis: A 10-Year Retrospective Study in a General Surgery Unit. Cancers (Basel) 2024; 16:3713. [PMID: 39518149 PMCID: PMC11545816 DOI: 10.3390/cancers16213713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2024] [Revised: 10/22/2024] [Accepted: 10/27/2024] [Indexed: 11/16/2024] Open
Abstract
Introduction: Small bowel cancer is very rare; although the incidence of adenocarcinoma and other anatomopathological forms has increased recently, the diagnosis and treatment of this disease are still debatable because of the clinical heterogeneity and the absence of studies including a large number of patients. Materials and Methods: We performed a retrospective study over 10 years in which we analyzed the clinical, imaging, and anatomopathological data of 46 patients hospitalized in a surgery clinic and diagnosed with small bowel cancer (duodenum, jejunum, and ileum). Results: After clinical assessment of these patients, including complications (occlusion, bleeding, and perforation), the CT scan established the diagnosis in over 90% of the cases of the complicated form of the disease. Surgery has a curative role in localized cancers; tumor location, local invasion, the presence of locoregional lymph nodes, and the number of multiple tumors influence the type of surgery. The conventional pathological exam was completed via immunohistochemical staining. Adjuvant oncological treatment was performed after surgery (according to the guidelines); in patients with exceptional histopathological forms, the therapy was personalized. Conclusions: Most small bowel cancers were diagnosed with complications (occlusion and bleeding); the tumor type, location, and presence of multiple bowel cancers significantly influenced its management. Independently of the surgical resection (R0/R1 or R2), the prognosis of the disease depends on the tumor aggressivity, location (single/multiple), and locoregional node invasion.
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Affiliation(s)
| | - Costin Teodor Streba
- Pneumology Department, University of Medicine and Pharmacy, 200349 Craiova, Romania;
| | - Cecil Sorin Mirea
- Surgery Department, University of Medicine and Pharmacy, 200349 Craiova, Romania
| | - Ionică Daniel Vîlcea
- Surgery Department, University of Medicine and Pharmacy, 200349 Craiova, Romania
| | - Dan Nicolae Florescu
- Gastroenterology Department, University of Medicine and Pharmacy, 200349 Craiova, Romania
| | | | - Tudor Turcu
- Pathology Department, University Emergency Hospital Bucharest, 050098 Bucharest, Romania
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10
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Alden SL, Early C, Browner IS, Gelber AC, Chilazi MJ. Relieving Intestinal Obstruction: Overcoming Diagnostic Roadblocks from Progressive Abdominal Pain with Iterative Reevaluation. Am J Med 2024; 137:1067-1071. [PMID: 39074677 DOI: 10.1016/j.amjmed.2024.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 07/11/2024] [Accepted: 07/15/2024] [Indexed: 07/31/2024]
Affiliation(s)
- Stephanie L Alden
- The Thayer Firm, Osler Medical Service, Johns Hopkins Hospital, and Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Caroline Early
- Division of Pathology, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Ilene S Browner
- The Thayer Firm, Osler Medical Service, Johns Hopkins Hospital, and Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md; Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Allan C Gelber
- The Thayer Firm, Osler Medical Service, Johns Hopkins Hospital, and Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md.
| | - Michael J Chilazi
- The Thayer Firm, Osler Medical Service, Johns Hopkins Hospital, and Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md
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11
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Chung C, Stovall S, Biehl SR, Rocha F, Wancata L, Helton S, Biehl T. Pancreas preserving duodenectomy (PPrD). Am J Surg 2024; 237:115746. [PMID: 38641448 DOI: 10.1016/j.amjsurg.2024.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 04/02/2024] [Accepted: 04/13/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND Pancreaticoduodenectomy has been the standard of care for managing duodenal neoplasms, but recent studies show similar overall and disease-specific survival after pancreas-preserving duodenectomy (PPrD) with potentially less morbidity. METHODS Retrospective cohort of all adult (age >18) patients who underwent PPrD with curative intent of a neoplasm in or invading into the duodenum at our institution from 2011 to 2022 (n = 29), excluding tumors involving the Ampulla of Vater or the pancreas. Statistical analyses were performed using STATA. RESULTS R0 resection was achieved in 93 % patients. Ten (34.4 %) experienced postoperative complications (13.7 % within Clavien-Dindo III-V). PPrD patients had lower rates of pancreatic leak, delayed gastric emptying, and deep surgical site infection. CONCLUSIONS In this case series, we demonstrate PPrD is safe and effective, with a high rate of complete resection and lower complication rate than that seen in pancreaticoduodenectomy.
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Affiliation(s)
- Christine Chung
- Virginia Mason Franciscan Health (VMFH), 1100 9th Ave, Seattle, WA, 98101, USA.
| | - Stephanie Stovall
- Virginia Mason Franciscan Health (VMFH), 1100 9th Ave, Seattle, WA, 98101, USA.
| | - Stella R Biehl
- Colorado College, 14 E Cache La Poudre St, Colorado Springs, CO, 80903, USA.
| | - Flavio Rocha
- Oregon Health & Science University Hospital (OHSU), 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA.
| | - Lauren Wancata
- Virginia Mason Franciscan Health (VMFH), 1100 9th Ave, Seattle, WA, 98101, USA.
| | - Scott Helton
- Virginia Mason Franciscan Health (VMFH), 1100 9th Ave, Seattle, WA, 98101, USA.
| | - Thomas Biehl
- Virginia Mason Franciscan Health (VMFH), 1100 9th Ave, Seattle, WA, 98101, USA.
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12
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Lima Capela T, Ferreira AI, Cúrdia Gonçalves T, Magalhães J, Rosa B, Cotter J. Unusual Location of a Rare Complication of Celiac Disease. GE - PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2024:1-8. [DOI: 10.1159/000541310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2025]
Abstract
Introduction: Celiac disease has been associated with gastrointestinal malignancies, most commonly gastrointestinal lymphoma. Nevertheless, rarer malignancies have also been reported, such as small bowel adenocarcinoma, mainly located in the duodenum or jejunum. Case Presentation: We report a case of a female patient with celiac disease with poor adherence to a gluten-free diet who presented with small bowel obstruction due to a primary ileal adenocarcinoma. The patient remains asymptomatic, adherent to the gluten-free diet, and without clinical, biochemical, or imaging evidence of cancer recurrence. Discussion/Conclusion: This case should raise awareness about the importance of the gluten-free diet and the early diagnosis and appropriate management of rare small bowel malignant complications of celiac disease, namely, adenocarcinoma.
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13
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Paredes González EJ, Gonzalez Benitez KM, Tavarez Reynoso LJ, Tapia Garcia L. Adenocarcinoma in the Jejunum Presenting as Acute Abdomen and Melena in an Otherwise Healthy Patient: A Case Report. Cureus 2024; 16:e72011. [PMID: 39434934 PMCID: PMC11492811 DOI: 10.7759/cureus.72011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2024] [Indexed: 10/23/2024] Open
Abstract
A jejunal adenocarcinoma is a rare form of cancer that is difficult to diagnose due to its vague and non-specific symptoms, often leading to delayed treatment and poor outcomes. In this case, we report a 43-year-old male who presented with acute abdominal pain, weight loss, and melena. A CT scan revealed a mass in the small intestine, and subsequent exploratory laparotomy confirmed the presence of a tumor, which was surgically excised. Histopathological analysis confirmed jejunal adenocarcinoma with positive CDX2 staining, ruling out other adenocarcinoma subtypes. This case underscores the importance of including jejunal adenocarcinoma in differential diagnoses of acute abdomen and highlights the critical role of early surgical intervention in improving patient outcomes.
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14
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Stancu B, Ciocan RA, Teodorescu MG, Crişan D, Mihăileanu FV, Ursu Ş, Tartacovschi L, Popa ŞL, Gherman CD, Andercou OA. Adenocarcinoma of the ileum: literature insights on pyloric gland metaplasia. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY = REVUE ROUMAINE DE MORPHOLOGIE ET EMBRYOLOGIE 2024; 65:593-598. [PMID: 39957020 PMCID: PMC11924899 DOI: 10.47162/rjme.65.4.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2024] [Accepted: 01/15/2025] [Indexed: 02/18/2025]
Abstract
Adenocarcinoma (ADK) of the ileum is an infrequent cancer that poses significant diagnostic and treatment difficulties. This article analyses the existing case literature to investigate the correlation between pyloric gland metaplasia (PGM) and the onset of ileal ADK. PGM, defined by the atypical transformation of intestinal epithelial cells into gastric-type mucosa, has been recognized as a possible precursor lesion in the spectrum of several gastrointestinal malignancies. We intend to clarify the clinical characteristics, histological results, and outcomes linked to ileal ADK originating from PGM through an exhaustive examination of recorded cases. Our findings indicate that early identification of metaplastic alterations may be essential for enhancing prognosis and informing therapeutic choices. This study emphasizes the need for additional research to elucidate the mechanisms driving this transition and to improve diagnostic precision in clinical practice.
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Affiliation(s)
- Bogdan Stancu
- Department of Surgery-Practical Abilities, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania;
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15
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Jin B, Lv B, Yan Z, Li W, Song H, Cui H, Liu Y, Zhong B, Shen X, Li X, Zhang B, Chen S, Zheng W, Liu J, Luo F, Luo Z. Molecular characterization of Chinese patients with small bowel adenocarcinoma. Clin Transl Oncol 2024; 26:2205-2216. [PMID: 38512449 DOI: 10.1007/s12094-024-03441-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/04/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE Small bowel adenocarcinoma (SBA) is a rare malignancy of the gastrointestinal tract, and its unique location within the small intestine presents difficulties in obtaining tissue samples from the lesions. This limitation hinders the research and development of effective clinical treatment methods. Circulating tumor DNA (ctDNA) analysis holds promise as an alternative approach for investigating SBA and guiding treatment decisions, thereby improving the prognosis of SBA. METHODS Between January 2017 and August 2021, a total of 336 tissue or plasma samples were obtained and the corresponding mutation status in tissue or blood was evaluated with NGS. RESULTS AND CONCLUSIONS The study found that in SBA tissues, the most commonly alternated genes were TP53, KRAS, and APC, and the most frequently affected pathways were RTK-RAS-MAPK, TP53, and WNT. Notably, the RTK-RAS-MAPK pathway was identified as a potential biomarker that could be targeted for treatment. Then, we validated the gene mutation profiling of ctDNA extracted from SBA patients exhibited the same characteristics as tissue samples for the first time. Subsequently, we applied ctDNA analysis on a terminal-stage patient who had shown no response to previous chemotherapy. After detecting alterations in the RTK-RAS-MAPK pathway in the ctDNA, the patient was treated with MEK + EGFR inhibitors and achieved a tumor shrinkage rate of 76.33%. Our study utilized the largest Chinese SBA cohort to uncover the molecular characteristics of this disease, which might facilitate clinical decision making for SBA patients.
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Affiliation(s)
- Bryan Jin
- Department of Digestive Diseases, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai, 200040, China
| | - Bin Lv
- Department of Digestive Diseases, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai, 200040, China
| | - Zhengqing Yan
- The Medical Department, 3D Medicines Inc., Shanghai, 200120, China
| | - Wenshuai Li
- Department of Digestive Diseases, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai, 200040, China
| | - Huan Song
- Department of Digestive Diseases, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai, 200040, China
| | - Haoshu Cui
- Department of Digestive Diseases, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai, 200040, China
| | - Yao Liu
- Department of Digestive Diseases, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai, 200040, China
| | - Bin Zhong
- Department of Digestive Diseases, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai, 200040, China
| | - Xin Shen
- Department of Digestive Diseases, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai, 200040, China
| | - Xiao Li
- Department of Digestive Diseases, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai, 200040, China
| | - Bei Zhang
- The Medical Department, 3D Medicines Inc., Shanghai, 200120, China
| | - Shiqing Chen
- Department of Clinical and Translational Medicine, 3D Medicines Inc., Shanghai, 200120, China
| | - Wanwei Zheng
- Department of Digestive Diseases, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai, 200040, China.
| | - Jie Liu
- Department of Digestive Diseases, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai, 200040, China.
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, China.
| | - Feifei Luo
- Department of Digestive Diseases, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai, 200040, China.
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, China.
| | - Zhongguang Luo
- Department of Digestive Diseases, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai, 200040, China.
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16
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Li CJ, Lee PC, Huang KW, Huang KJ, Chang TE, Chang CC, Wang SE, Shyr YM, Li CP, Luo JC, Hou MC. Postoperative prognostic nutrition index predicts survival in patients with small bowel adenocarcinoma after surgical resection. J Chin Med Assoc 2024; 87:819-827. [PMID: 39017659 DOI: 10.1097/jcma.0000000000001134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND Surgical resection (SR) is the main treatment for small bowel adenocarcinoma (SBA), but it increases metabolic demand, systemic inflammation, and digestive dysfunction, resulting in major impacts on the postoperative outcomes of patients. In this study, we aimed to investigate the role of the postoperative prognostic nutritional index (PNI), a surrogate marker of inflammation and nutrition, in patients with SBA after resection. METHODS From June 2014 to March 2022, 44 consecutive patients who underwent SR for SBA in Taipei Veterans General Hospital were retrospectively reviewed. Factors associated with survival including PNI were analyzed. RESULTS PNI decreased in patients after SR for SBA (median change: -1.82), particularly in those who underwent Whipple operation or developed postoperative pancreatic fistula. Postoperative PNI <45.2 best predicted overall survival (OS) (area under the receiver operating characteristic curve [AUROC]: 0.826, p = 0.001). Patients with lower postoperative PNI had significantly worse OS compared to those with higher postoperative values (median OS: 19.3 months vs not reached, p < 0.001). Low postoperative PNI (hazard ratio [HR]: 11.404, p = 0.002), tumoral lymphovascular invasion (HR: 8.023, p = 0.012), and adjuvant chemotherapy (HR: 0.055, p = 0.002) were independent risk factors for OS. Postoperative PNI also significantly predicted recurrence-free survival independent of lymphovascular invasion and adjuvant chemotherapy (HR: 6.705, p = 0.001). CONCLUSION PNI commonly decreases in patients with SBA who undergo Whipple surgery or develop postoperative pancreatic fistula. Postoperative PNI independently predicts survival and may serve as a clinical marker to optimize patient outcomes.
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Affiliation(s)
- Chia-Ju Li
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Holistic and Multidisciplinary Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Pei-Chang Lee
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Kuo-Wei Huang
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Gastroenterology, Department of Medicine, Taipei City Hospital, Yangming Branch, Taipei, Taiwan, ROC
| | - Kuan-Jung Huang
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Tien-En Chang
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ching-Chih Chang
- Division of Holistic and Multidisciplinary Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Shin-E Wang
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yi-Ming Shyr
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chung-Pin Li
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Clinical Skills Training, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Jiing-Chyuang Luo
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Ming-Chih Hou
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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17
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Kobayahshi K, Nojiri K, Suwa H, Yoshida K, Masui H. Radical Resection of Small Bowel Adenocarcinoma With Multiple Liver Metastases Following Neoadjuvant Chemotherapy: A Case Report. Cureus 2024; 16:e69776. [PMID: 39429309 PMCID: PMC11490939 DOI: 10.7759/cureus.69776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2024] [Indexed: 10/22/2024] Open
Abstract
Small bowel adenocarcinoma (SBA) is a relatively rare disease that is difficult to detect in the early stages; therefore, it often has a poor prognosis. We present a rare case of SBA and multiple liver metastases in a patient who underwent curative resection combined with neoadjuvant chemotherapy (NAC). A 70-year-old woman presented to the emergency department complaining of abdominal pain and bloating. She was diagnosed with bowel obstruction due to a primary jejunal tumor and was admitted to the hospital. After further imaging and histopathological examination, the patient was diagnosed with primary jejunal adenocarcinoma with multiple liver metastases, all of which were considered resectable. Since she had developed bowel obstruction due to the primary tumor, jejunal resection with draining lymph node removal was initially performed. The remaining multiple liver metastases were treated with four courses of capecitabine and oxaliplatin (CAPEOX) with bevacizumab as NAC, followed by hepatectomy. After NAC, the patient underwent radical liver resection. Based on a pathological examination, the five liver tumors were all diagnosed as liver metastases from jejunal adenocarcinoma. Six months after the liver resection, a single recurrence was observed in segment V of the liver. Therefore, four courses of CAPEOX with bevacizumab were administered again as NAC, and liver resection was performed again. At the time of writing this report, she has survived for more than four years after the first surgery, with no apparent recurrence. This is a rare case of a patient who underwent radical resection of SBA with multiple liver metastases following CAPEOX and bevacizumab as NAC.
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Affiliation(s)
- Kei Kobayahshi
- Department of Gastrointestinal Surgery, Yokosuka Kyosai Hospital, Yokosuka, JPN
| | - Kazunori Nojiri
- Department of Gastrointestinal Surgery, Yokosuka Kyosai Hospital, Yokosuka, JPN
| | - Hirokazu Suwa
- Department of Gastrointestinal Surgery, Yokosuka Kyosai Hospital, Yokosuka, JPN
| | - Kenichi Yoshida
- Department of Gastrointestinal Surgery, Yokosuka Kyosai Hospital, Yokosuka, JPN
| | - Hidenobu Masui
- Department of Gastrointestinal Surgery, Yokosuka Kyosai Hospital, Yokosuka, JPN
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Nishioka Y, Matsumoto Y, Murakami K, Endo S, Toyozumi T, Otsuka R, Shiraishi T, Iida S, Morishita H, Makiyama T, Hu J, Maiyulan A, Matsubara H. Establishment of a novel small bowel adenocarcinoma cell line using patient‑derived xenografts, which produces CEA and CA19‑9. Oncol Lett 2024; 28:360. [PMID: 38881709 PMCID: PMC11177170 DOI: 10.3892/ol.2024.14493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 05/15/2024] [Indexed: 06/18/2024] Open
Abstract
Small bowel adenocarcinoma (SBA) is a rare tumor with a poor prognosis. Due to its rarity, the research infrastructure for SBA, including cell lines, is inadequate. The present study established a novel SBA cell line, SiCry-15X, using patient-derived xenografts of SBA. The following criteria were defined for establishment: Long-term culturability, tumorigenicity and similarity with the original tumor. The biological characteristics of the cell line, its sensitivity to anticancer drugs and its ability to produce tumor markers carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) were evaluated. SiCry-15X cells adhered and grew as a monolayer, with a population doubling time of 37 h. Polymerase chain reaction results confirmed the human origin of the cell line, and short tandem repeat analysis revealed that the cells were genetically identical to the original tumor. The 50% inhibitory concentrations of 5-fluorouracil, paclitaxel, irinotecan, oxaliplatin and cisplatin for SiCry-15X were 104.05, 0.24, 63.3, 146.55 and 49.29 µM, respectively. CEA and CA19-9 concentrations in the culture media were markedly elevated. In addition, CEA and CA19-9 levels in the serum of cell-derived xenograft model mice were elevated. Moreover, CEA and CA19-9 were produced by SiCry-15X cells and distributed throughout the blood. Furthermore, increases in serum CEA and CA19-9 of cell-derived xenograft model mice were consistent with the clinical course of the disease. The newly established SBA cell line, SiCry-15X, could be an effective tool for conducting further studies on SBA.
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Affiliation(s)
- Yuri Nishioka
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba 260-8670, Japan
| | - Yasunori Matsumoto
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba 260-8670, Japan
| | - Kentaro Murakami
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba 260-8670, Japan
| | - Satoshi Endo
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba 260-8670, Japan
| | - Takeshi Toyozumi
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba 260-8670, Japan
| | - Ryota Otsuka
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba 260-8670, Japan
| | - Tadashi Shiraishi
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba 260-8670, Japan
| | - Shinichiro Iida
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba 260-8670, Japan
| | - Hiroki Morishita
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba 260-8670, Japan
| | - Tenshi Makiyama
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba 260-8670, Japan
| | - Jie Hu
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba 260-8670, Japan
| | - Abula Maiyulan
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba 260-8670, Japan
| | - Hisahiro Matsubara
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba 260-8670, Japan
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19
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Xu D, He Y, Liao C, Tan J. Identifying risk and prognostic factors for synchronous liver metastasis in small bowel adenocarcinoma: a predictive analysis using the SEER database. Front Surg 2024; 11:1437124. [PMID: 39136035 PMCID: PMC11317383 DOI: 10.3389/fsurg.2024.1437124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 07/19/2024] [Indexed: 08/15/2024] Open
Abstract
Background Small bowel adenocarcinoma (SBA) is a rare gastrointestinal malignancy with an increasing incidence and a high propensity for liver metastasis (LM). This study aimed to investigate the risk factors for synchronous LM and prognostic factors in patients with LM. Methods Utilizing the Surveillance, Epidemiology, and End Results (SEER) database, this study analyzed data from 2,064 patients diagnosed with SBA between 2010 and 2020. Logistic regression was used to determine risk factors for synchronous LM. A nomogram was developed to predict the risk of LM in SBA patients, and its predictive performance was assessed through receiver operating characteristic (ROC) curves and calibration curves. Kaplan-Meier and Cox regression analyses were conducted to evaluate survival outcomes for SBA patients with LM. Results Synchronous LM was present in 13.4% of SBA patients (n = 276). Six independent predictive factors for LM were identified, including tumor location, T stage, N stage, surgical intervention, retrieval of regional lymph nodes (RORLN), and chemotherapy. The nomogram demonstrated good discriminative ability, with an area under the curve (AUC) of 83.8%. Patients with LM had significantly lower survival rates than those without LM (P < 0.001). Survival analysis revealed that advanced age, tumor location in the duodenum, surgery, RORLN and chemotherapy were associated with cancer-specific survival (CSS) in patients with LM originating from SBA. Conclusions This study highlights the significant impact of LM on the survival of SBA patients and identifies key risk factors for its occurrence. The developed nomogram aids in targeted screening and personalized treatment planning.
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Affiliation(s)
- Duogang Xu
- Department of General Surgery, Yan'an Hospital Affiliated to Kunming Medical University, Kunming, China
- Key Laboratory of Tumor Immunological Prevention and Treatment of Yunnan Province, Kunming, China
| | - Yulei He
- The First School of Clinical Medicine, Yunnan University of Chinese Medicine, Kunming, China
| | - Changkang Liao
- Department of General Surgery, Yan'an Hospital Affiliated to Kunming Medical University, Kunming, China
- Key Laboratory of Tumor Immunological Prevention and Treatment of Yunnan Province, Kunming, China
| | - Jing Tan
- Department of General Surgery, Yan'an Hospital Affiliated to Kunming Medical University, Kunming, China
- Key Laboratory of Tumor Immunological Prevention and Treatment of Yunnan Province, Kunming, China
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Wu S, Yu H, Liu Y, Zhou H, Zhou Y. Small bowel adenocarcinoma of the jejunum detected by double contrast enhanced ultrasound: a case report of a novel ultrasound modality. Front Oncol 2024; 14:1288041. [PMID: 38962263 PMCID: PMC11219900 DOI: 10.3389/fonc.2024.1288041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 06/04/2024] [Indexed: 07/05/2024] Open
Abstract
Background Small Bowel Adenocarcinoma (SBA) is rare, occult and life-threatening malignancy in digestive system. Given low incidence and nonspecific symptoms, SBA is frequently detected in later stages. Double contrast enhanced ultrasound (DCEUS) is an innovative imaging technique applied to visualize the gastrointestinal tract, merging intravenous contrast-enhanced ultrasound with oral contrast-enhanced ultrasound. In this case, DCEUS was utilized and successfully detected an SBA of the jejunum. Case presentation A Chinese woman, aged 64, sought consultation in the gastroenterology department at our hospital, reporting symptoms of abdominal pain. Three months before entering the hospital, she underwent gastroscopy and colonoscopy which suggested chronic gastritis, and she was treated with oral drugs. However, her symptoms were not relieved, and even worsened. To further investigate, DCEUS was performed. The oral contrast agent dilated the luminal space of the upper gastrointestinal tract, resolving the hindrance caused by gas in the gastrointestinal tract and creating an acoustic window for scanning. Through this acoustic window, oral agent contrast-enhanced ultrasound (OA-CEUS) revealed a localized thickening of jejunal intestinal wall measuring 4x3 cm. Following intravenous injection of ultrasound contrast agent, the jejunal lesion exhibited faster enhancement and heterogeneous hyper-enhancement. Finally, the patient underwent jejunal tumor resection. Pathological examination revealed a jejunal adenocarcinoma. Conclusion The timely diagnosis of SBA can be challenging. DCEUS may have the potential to contribute to diagnosis and detailed evaluation of SBA, particularly in cases involving jejunum. Further researches are needed to fully explore the benefits of DCEUS in the standard diagnostic approach for small bowel diseases.
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Affiliation(s)
| | | | | | | | - Yang Zhou
- Department of Medical Ultrasound, Affiliated Hospital of Southwest Jiaotong University, The Third People’s Hospital of Chengdu, Chengdu, Sichuan, China
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An J, Fontenelle B, Chaudhari R, Mulloy R, El Djouzi S. An Unexpected Challenge: Marked Small Bowel Obstruction Arising From a Poorly Differentiated Metastatic Mucinous Adenocarcinoma of the Distal Ileum in a Risk-Free Healthy Patient. Cureus 2024; 16:e61528. [PMID: 38957234 PMCID: PMC11218847 DOI: 10.7759/cureus.61528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2024] [Indexed: 07/04/2024] Open
Abstract
Adenocarcinoma, while constituting the predominant variant among small bowel cancers, is a component of the broader category of primary small bowel malignancies, which are notably infrequent in occurrence. The diagnosis of such malignancies is often markedly delayed, a consequence of their insidious onset and the nonspecific nature of the abdominal symptoms presented. A 69-year-old Caucasian male presented to the emergency department manifesting acute, sharp, and colicky abdominal pain accompanied by a single episode of vomiting, all developing over one day. His medical history was notable for gastroesophageal reflux disease (GERD) and regionally confined prostate adenocarcinoma, which was under meticulous surveillance by the urological team. The patient's lifestyle was characterized by abstention from alcohol and tobacco, adherence to a nutritious diet, and a commitment to regular physical activity. Subsequent examination and surgical excision of an abnormal mass, as delineated on computed tomography (CT), culminated in the diagnosis of a stage IV, poorly differentiated adenocarcinoma. We have reported this case to spark research regarding early diagnostic techniques for small bowel adenocarcinoma (SBA). In this case, a healthy individual presented with vague abdominal pain and a single episode of vomiting. Diagnosis required the surgical resection of the tumor, where metastasis was also visualized. Due to the rare nature of SBA, we believe different diagnostic measures and adjuvant therapy should be researched for earlier diagnosis and subsequently better patient outcomes.
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Affiliation(s)
- Jennie An
- Medicine, St. James School of Medicine, Park Ridge, USA
| | | | | | - Rob Mulloy
- Medicine, St. James School of Medicine, Park Ridge, USA
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Yamashita K, Oka S, Yamada T, Mitsui K, Yamamoto H, Takahashi K, Shiomi A, Hotta K, Takeuchi Y, Kuwai T, Ishida F, Kudo SE, Saito S, Ueno M, Sunami E, Yamano T, Itabashi M, Ohtsuka K, Kinugasa Y, Matsumoto T, Sugai T, Uraoka T, Kurahara K, Yamaguchi S, Kato T, Okajima M, Kashida H, Akagi Y, Ikematsu H, Ito M, Esaki M, Kawai M, Yao T, Hamada M, Horimatsu T, Koda K, Fukai Y, Komori K, Saitoh Y, Kanemitsu Y, Takamaru H, Yamada K, Nozawa H, Takayama T, Togashi K, Shinto E, Torisu T, Toyoshima A, Ohmiya N, Kato T, Otsuji E, Nagata S, Hashiguchi Y, Sugihara K, Ajioka Y, Tanaka S. Clinicopathological features and prognosis of primary small bowel adenocarcinoma: a large multicenter analysis of the JSCCR database in Japan. J Gastroenterol 2024; 59:376-388. [PMID: 38411920 PMCID: PMC11033235 DOI: 10.1007/s00535-024-02081-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 01/18/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND The clinicopathological features and prognosis of primary small bowel adenocarcinoma (PSBA), excluding duodenal cancer, remain undetermined due to its rarity in Japan. METHODS We analyzed 354 patients with 358 PSBAs, between January 2008 and December 2017, at 44 institutions affiliated with the Japanese Society for Cancer of the Colon and Rectum. RESULTS The median age was 67 years (218 males, 61.6%). The average tumor size was 49.9 (7-100) mm. PSBA sites consisted of jejunum (66.2%) and ileum (30.4%). A total of 219 patients (61.9%) underwent diagnostic small bowel endoscopy, including single-balloon endoscopy, double-balloon endoscopy, and capsule endoscopy before treatment. Nineteen patients (5.4%) had Lynch syndrome, and 272 patients (76.8%) had symptoms at the initial diagnosis. The rates for stages 0, I, II, III, and IV were 5.4%, 2.5%, 27.1%, 26.0%, and 35.6%, respectively. The 5-year overall survival rates at each stage were 92.3%, 60.0%, 75.9%, 61.4%, and 25.5%, respectively, and the 5-year disease-specific survival (DSS) rates were 100%, 75.0%, 84.1%, 59.3%, and 25.6%, respectively. Patients with the PSBA located in the jejunum, with symptoms at the initial diagnosis or advanced clinical stage had a worse prognosis. However, multivariate analysis using Cox-hazard model revealed that clinical stage was the only significant predictor of DSS for patients with PSBA. CONCLUSIONS Of the patients with PSBA, 76.8% had symptoms at the initial diagnosis, which were often detected at an advanced stage. Detection during the early stages of PSBA is important to ensure a good prognosis.
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Affiliation(s)
- Ken Yamashita
- Department of Gastroenterology, Hiroshima University Hospital, 1-2-3, Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Shiro Oka
- Department of Gastroenterology, Hiroshima University Hospital, 1-2-3, Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan.
| | - Takeshi Yamada
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan
| | - Keigo Mitsui
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan
| | - Hironori Yamamoto
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Tochigi, Japan
| | - Keiichi Takahashi
- Department of Colorectal Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Akio Shiomi
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kinichi Hotta
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Yoji Takeuchi
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Toshio Kuwai
- Department of Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Hiroshima, Japan
| | - Fumio Ishida
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Shin-Ei Kudo
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Shoichi Saito
- Department of Lower Gastrointestinal Medicine, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masashi Ueno
- Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan
| | - Eiji Sunami
- Department of Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Tomoki Yamano
- Division of Lower Gastrointestinal Surgery, Department of Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Michio Itabashi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kazuo Ohtsuka
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yusuke Kinugasa
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takayuki Matsumoto
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, Iwate, Japan
| | - Tamotsu Sugai
- Department of Diagnostic Pathology, Iwate Medical University, Iwate, Japan
| | - Toshio Uraoka
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Koichi Kurahara
- Division of Gastroenterology, Matsuyama Red Cross Hospital, Ehime, Japan
| | - Shigeki Yamaguchi
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Tomohiro Kato
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Masazumi Okajima
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Hiroshi Kashida
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Yoshito Akagi
- Department of Surgery, Kurume University School of Medicine, Fukuoka, Japan
| | - Hiroaki Ikematsu
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
| | - Masaaki Ito
- Department of Colorectal Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Motohiro Esaki
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Masaya Kawai
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Takashi Yao
- Department of Human Pathology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Madoka Hamada
- Department of Gastrointestinal Surgery, Kansai Medical University Hospital, Osaka, Japan
| | - Takahiro Horimatsu
- Department of Clinical Oncology, Kyoto University Hospital, Kyoto, Japan
| | - Keiji Koda
- Department of Surgery, Teikyo University Chiba Medical Center, Chiba, Japan
| | - Yasumori Fukai
- Department of Gastroenterology, Maebashi Red Cross Hospital, Gunma, Japan
| | - Koji Komori
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Aichi, Japan
| | - Yusuke Saitoh
- Department of Gastroenterology, Asahikawa City Hospital, Asahikawa, Hokkaido, Japan
| | - Yukihide Kanemitsu
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | | | - Kazutaka Yamada
- Department of Surgery, Coloproctology Center Takano Hospital, Kumamoto, Japan
| | - Hiroaki Nozawa
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Tetsuji Takayama
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Kazutomo Togashi
- Department of Coloproctology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | - Eiji Shinto
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Takehiro Torisu
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akira Toyoshima
- Department of Colorectal Surgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Naoki Ohmiya
- Department of Advanced Endoscopy, Fujita Health University School of Medicine, Aichi, Japan
| | - Takeshi Kato
- Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Eigo Otsuji
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shinji Nagata
- Department of Gastroenterology, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima, Japan
| | - Yojiro Hashiguchi
- Department of Surgery, Japanese Red Cross Omori Hospital, Tokyo, Japan
| | | | - Yoichi Ajioka
- Division of Molecular and Diagnostic Pathology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Shinji Tanaka
- Department of Gastroenterology, Hiroshima University Hospital, 1-2-3, Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
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Martinov Nestorov J, Sokic-Milutinovic A, Pavlovic Markovic A, Krstic M. Could Capsule Endoscopy Be Useful in Detection of Suspected Small Bowel Bleeding and IBD-10 Years of Single Center Experience. Diagnostics (Basel) 2024; 14:862. [PMID: 38732278 PMCID: PMC11083052 DOI: 10.3390/diagnostics14090862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 04/12/2024] [Accepted: 04/14/2024] [Indexed: 05/13/2024] Open
Abstract
A retrospective study in patients who underwent video capsule endoscopy (VCE) between 2006 and 2016 was conducted in the Clinic for gastroenterology and Hepatology, University Clinical Center of Serbia. A total of 245 patients underwent VCE. In 198 patients the indication was obscure gastrointestinal bleeding (OGIB), with 92 patients having overt and the other 106 occult bleeding. The remaining 47 patients underwent VCE due to suspected small bowel (SB) disease (i.e., Von Hippel-Lindau syndrome, familial adenomatous polyposis, Peutz Jeghers syndrome, Crohn's disease, prolonged diarrhea, abdominal pain, congenital lymphangiectasia, protein-losing enteropathy, tumors, refractory celiac disease, etc.). VCE identified a source of bleeding in 38.9% of patients (in the obscure overt group in 48.9% of patients, and in the obscure occult group in 30.2% of patients). The most common findings were angiodysplasias, tumors, Meckel's diverticulum and Crohn's disease. In the smaller group of patients with an indication other than OGIB, 38.3% of patients had positive VCE findings. The most common indication is OGIB, and the best candidates are patients with overt bleeding; patients with IBD should be evaluated in this setting.
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Affiliation(s)
- Jelena Martinov Nestorov
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (A.S.-M.); (A.P.M.); (M.K.)
- Clinic for Gastroenterology and Hepatology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Aleksandra Sokic-Milutinovic
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (A.S.-M.); (A.P.M.); (M.K.)
- Clinic for Gastroenterology and Hepatology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Aleksandra Pavlovic Markovic
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (A.S.-M.); (A.P.M.); (M.K.)
- Clinic for Gastroenterology and Hepatology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Miodrag Krstic
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (A.S.-M.); (A.P.M.); (M.K.)
- Clinic for Gastroenterology and Hepatology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
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Li L, Zhang S, Fu G. Trending of small bowel adenocarcinoma research from 2000 to 2022: A bibliometric analysis. Medicine (Baltimore) 2024; 103:e37795. [PMID: 38608051 PMCID: PMC11018234 DOI: 10.1097/md.0000000000037795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 03/14/2024] [Indexed: 04/14/2024] Open
Abstract
Small bowel adenocarcinoma (SBA) is a rare tumor entity with a relatively poor prognosis. Diagnosis and management of SBA are still challenging despite recent advancement of diagnostic methods and publication of guidelines. This study aimed to analyze and visualize the trending of SBA research in the past 22 years in the 21st century through bibliometric analysis. Our study collected 1270 publication records of SBA from 2000 Jan 1st to 2022 December 31 from Web of Science and used VOSviewer and CiteSpace to analyze countries, institutions, journals, authors, references and keywords to present the latest trends in SBA research. The USA was the most productive country in terms of the total number of publications (n = 418). The Mayo Clinic (n = 22) and University of Texas MD Cancer Center (n = 22) were the institutions with top publications. The "World Journal Of Gastroenterology" (n = 30) had the largest publications. Overman Michael J (n = 17) was the most active and prolific author. The "small bowel adenocarcinoma" was the most frequent keyword. Our bibliometric analysis provides a comprehensive overview of the trends and gaps in the research of SBA. Despite the challenges faced, researchers from USA, Japan and China have made significant contributions to the field of SBA research, and further research is necessary to develop evidence-based guidelines, and advance the understanding and management of SBA.
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Affiliation(s)
- Li Li
- The First Affiliated Hospital, Department of Gastrointestinal Surgery, Hengyang Medical School, University of South China, Hengyang, China
| | - Shao Zhang
- The First Affiliated Hospital, Department of Gastrointestinal Surgery, Hengyang Medical School, University of South China, Hengyang, China
| | - Guang Fu
- The First Affiliated Hospital, Department of Gastrointestinal Surgery, Hengyang Medical School, University of South China, Hengyang, China
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Tahmasbi H, Kashani P, Haghbin Toutounchi A, Sadeghmousavi S, Hasanzade A, Aghaei M. Jejunal adenocarcinoma; a case report and literature review. Int J Surg Case Rep 2024; 116:109372. [PMID: 38387372 PMCID: PMC10943634 DOI: 10.1016/j.ijscr.2024.109372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 02/24/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Small bowel carcinoma (SBC) is a rare malignancy comprising mainly of adenocarcinoma and carcinoid tumors. Among SBCs, small bowel adenocarcinoma (SBA) accounts for 30-40 % and is predominantly found in the duodenum, while jejunal and ileal presence considered rare. CASE PRESENTATION We have presented a case of jejunal adenocarcinoma in a patient with obstruction symptoms. Prior to the obstruction, the patient mainly suffered from weakness and weight loss, in addition to iron deficiency anemia. During the investigation of underlying causes, we observed evidence of mass. However, before any additional evaluation could take place, the obstruction necessitated surgical intervention. CLINICAL DISCUSSION Small bowel adenocarcinomas, particularly in the jejunum and ileum, are exceedingly rare and often present with complications such as obstruction, gastrointestinal bleeding, or perforation. Due to the non-specific symptoms, SBAs are challenging to diagnose before complications occur. SBAs are frequently diagnosed at advanced stages, so early diagnosis is crucial, as it can significantly impact patient survival. Thus, efforts should be made to expedite the diagnosis process to avoid complications and improve survival rates. CONCLUSION SBAs are a rare condition, often diagnosed by related complications. Recognizing the importance of early diagnosis and its positive influence on patient survival, physicians and surgeons should consider SBA in patients presenting with relevant symptoms or cases of obstruction.
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Affiliation(s)
- Hamed Tahmasbi
- Department of General Surgery, Imam Hosein Medical and Educational Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Parvin Kashani
- Department of Emergency Medicine, Imam Hosein medical and Educational Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Alireza Haghbin Toutounchi
- Department of General Surgery, Imam Hosein Medical and Educational Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Shaghayegh Sadeghmousavi
- Department of General Surgery, Imam Hosein Medical and Educational Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Arman Hasanzade
- Department of General Surgery, Imam Hosein Medical and Educational Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mohammad Aghaei
- Department of General Surgery, Imam Hosein Medical and Educational Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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26
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Nishikawa Y, Horimatsu T, Oka S, Yamada T, Mitsui K, Yamamoto H, Takahashi K, Shiomi A, Hotta K, Takeuchi Y, Kuwai T, Ishida F, Kudo SE, Saito S, Ueno M, Sunami E, Yamano T, Itabashi M, Ohtsuka K, Kinugasa Y, Matsumoto T, Sugai T, Uraoka T, Kurahara K, Yamaguchi S, Kato T, Okajima M, Kashida H, Fujita F, Ikematsu H, Ito M, Esaki M, Kawai M, Yao T, Hamada M, Koda K, Fukai Y, Komori K, Saitoh Y, Kanemitsu Y, Takamaru H, Yamada K, Nozawa H, Takayama T, Togashi K, Shinto E, Torisu T, Toyoshima A, Ohmiya N, Kato T, Otsuji E, Nagata S, Hashiguchi Y, Sugihara K, Ajioka Y, Tanaka S. Outcomes of Metastatic and Unresectable Small Bowel Adenocarcinoma in Japan According to the Treatment Strategy: A Nationwide Observational Study. JCO Glob Oncol 2024; 10:e2300392. [PMID: 38330276 PMCID: PMC10860990 DOI: 10.1200/go.23.00392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 11/20/2023] [Indexed: 02/10/2024] Open
Abstract
PURPOSE Limited information is available regarding the characteristics and outcomes of stage IV small bowel adenocarcinoma (SBA) in Japan. This study examined the clinical and pathological characteristics and outcomes according to the treatment strategies in patients with stage IV SBA. METHODS This retrospective observational study used the data of patients with jejunal or ileal adenocarcinoma collected by the Small Bowel Malignant Tumor Project of the Japanese Society for Cancer of the Colon and Rectum. Descriptive statistics were expressed as the mean (standard deviation) or median (range). Survival analysis was performed using Kaplan-Meier curves and pairwise log-rank tests. RESULTS Data from 128 patients were analyzed. The treatment strategies were chemotherapy alone (26 of 128, 20.3%), surgery alone (including palliative surgery; 21 of 128, 16.4%), surgery + chemotherapy (74 of 128, 57.8%), and best supportive care (7 of 128, 5.5%). The median (range) overall survival was 16 (0-125) months overall, and 11 (1-38) months, 8 (0-80) months, 18 (0-125) months, and 0 (0-1) months for the chemotherapy, surgery, surgery + chemotherapy, and best supportive care groups, respectively. Three main categories of chemotherapeutic regimen were used: a combination of fluoropyrimidine and oxaliplatin (F + Ox), fluoropyrimidine and irinotecan (F + Iri), and single-agent fluoropyrimidine. Among patients treated with chemotherapy, the median (range) OS was 16 (1-106) months overall, and 17 (1-87) months, 29 (7-39) months, and 16 (1-106) months in patients treated with fluoropyrimidine, F + Iri, and F + Ox, respectively. CONCLUSION Patients treated with surgery, chemotherapy, or both had a better prognosis than those who received best supportive care. Among patients who received chemotherapy, survival did not differ according to the chemotherapeutic regimen.
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Affiliation(s)
- Yoshitaka Nishikawa
- Department of Clinical Oncology, Kyoto University Hospital, Kyoto, Japan
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Takahiro Horimatsu
- Department of Clinical Oncology, Kyoto University Hospital, Kyoto, Japan
| | - Shiro Oka
- Department of Gastroenterology, Hiroshima University Hospital, Hiroshima, Japan
| | - Takeshi Yamada
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan
| | - Keigo Mitsui
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan
| | - Hironori Yamamoto
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Tochigi, Japan
| | - Keiichi Takahashi
- Department of Colorectal Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Akio Shiomi
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kinichi Hotta
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Yoji Takeuchi
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Toshio Kuwai
- Department of Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Hiroshima, Japan
| | - Fumio Ishida
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Shin-Ei Kudo
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Shoichi Saito
- Department of Lower Gastrointestinal Medicine, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masashi Ueno
- Department of Gastroenterological and Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Eiji Sunami
- Department of Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Tomoki Yamano
- Division of Lower Gastrointestinal Surgery, Department of Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Michio Itabashi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kazuo Ohtsuka
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yusuke Kinugasa
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takayuki Matsumoto
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, Iwate, Japan
| | - Tamotsu Sugai
- Department of Diagnostic Pathology, Iwate Medical University, Iwate, Japan
| | - Toshio Uraoka
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Koichi Kurahara
- Division of Gastroenterology, Matsuyama Red Cross Hospital, Ehime, Japan
| | - Shigeki Yamaguchi
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Tomohiro Kato
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Masazumi Okajima
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Hiroshi Kashida
- Department of Gastroenterology and Hepatology, Kindai University, Osaka, Japan
| | - Fumihiko Fujita
- Department of Surgery, Kurume University School of Medicine, Fukuoka, Japan
| | - Hiroaki Ikematsu
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
| | - Masaaki Ito
- Department of Colorectal Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Motohiro Esaki
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Masaya Kawai
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Takashi Yao
- Department of Human Pathology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Madoka Hamada
- Department of Gastrointestinal Surgery, Kansai Medical University Hospital, Osaka, Japan
| | - Keiji Koda
- Department of Surgery, Teikyo University Chiba Medical Center, Chiba, Japan
| | - Yasumori Fukai
- Department of Gastroenterology, Maebashi Red Cross Hospital, Gunma, Japan
| | - Koji Komori
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Aichi, Japan
| | - Yusuke Saitoh
- Department of Gastroenterology, Asahikawa City Hospital, Asahikawa, Japan
| | - Yukihide Kanemitsu
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | | | - Kazutaka Yamada
- Department of Surgery, Coloproctology Center Takano Hospital, Kumamoto, Japan
| | - Hiroaki Nozawa
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Tetsuji Takayama
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Kazutomo Togashi
- Department of Coloproctology, Aizu Medical Center Fukushima Medical University, Fukushima, Japan
| | - Eiji Shinto
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Takehiro Torisu
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akira Toyoshima
- Department of Colorectal Surgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Naoki Ohmiya
- Department of Advanced Endoscopy, Fujita Health University School of Medicine, Aichi, Japan
| | - Takeshi Kato
- Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Eigo Otsuji
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shinji Nagata
- Department of Gastroenterology, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima, Japan
| | - Yojiro Hashiguchi
- Department of Surgery, Japanese Red Cross Omori Hospital, Tokyo, Japan
| | | | - Yoichi Ajioka
- Division of Molecular and Diagnostic Pathology Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Mani H, Hossain A, Lee E, Rizvi M. A Rare Case of Duodenal Adenocarcinoma With Brain Metastasis. Cureus 2024; 16:e54202. [PMID: 38496115 PMCID: PMC10942815 DOI: 10.7759/cureus.54202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2024] [Indexed: 03/19/2024] Open
Abstract
Small bowel malignancies are relatively rare, accounting for only 3% of all gastrointestinal cancers. Duodenum is the most common location among small bowel cancers, followed by Jejunum and then Ileum. Duodenal adenocarcinoma produces vague symptoms, leading to late presentation and a poor prognosis compared to similarly staged colon cancer. It is rare to have brain metastasis in duodenal adenocarcinoma, and not many case reports have been reported. Only approximately 6% of patients with gastrointestinal malignancy have brain metastasis. Here, we present a case of a 64-year-old female patient diagnosed initially with stage IV duodenal adenocarcinoma presenting with duodenal mass, abdominal lymphadenopathy, and liver metastasis. She had excellent systemic control for over two years with systemic chemotherapy, with a close to complete response on follow-up imaging. She presented with a 2 cm left frontal mass biopsy consistent with duodenal adenocarcinoma metastasis. She underwent resection of the left frontal tumor and gamma knife to the resection cavity. She continues to have good systemic control of disease. This case highlights the rare possibility of brain metastasis with duodenal adenocarcinoma, especially in patients who have good systemic control with chemotherapy.
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Affiliation(s)
| | - Alisha Hossain
- Hematology and Medical Oncology, Lehigh Valley Cancer Institute, Allentown, USA
| | - Elsie Lee
- Pathology, Lehigh Valley Health Network, Allentown, USA
| | - Muhammad Rizvi
- Hematology and Oncology, Lehigh Valley Cancer Institute, Allentown, USA
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28
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He X, Chen S, Zhou Y, Teichmann AT, Ding S, Fan J, Xiao X, Zhao D, Cai L, Jiang Y, Deng X, Yang H. Non‑synchronous bilateral metastatic ovarian cancer originating from small bowel adenocarcinoma with multidisciplinary treatment: A case report. Oncol Lett 2024; 27:49. [PMID: 38192656 PMCID: PMC10773190 DOI: 10.3892/ol.2023.14182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 10/04/2023] [Indexed: 01/10/2024] Open
Abstract
Primary small bowel adenocarcinoma (SBA) is a rare gastrointestinal cancer with a low incidence of ovarian metastasis. Differential diagnosis of metastatic and primary ovarian cancer is often challenging. The present study reported the case of a 45-year-old woman with jejunal adenocarcinoma who presented with right ovarian, left ovarian, abdominopelvic implant and local recurrent bowel wall metastases successively after primary tumor resection. The ovarian masses of the patient originated from SBA, which was confirmed by immunohistochemical results. Following four comprehensive evaluations by an experienced multidisciplinary team (MDT) during the disease period, the patient underwent four operations, 28 cycles of chemotherapy, 24 cycles of targeted therapy and maintenance therapy for 8 months. As of February 2023, the patient has survived for 73 months and has a high quality of life. It is suggested that when a patient with SBA presents with an ovarian mass, the differential diagnosis between metastatic ovarian cancer and primary ovarian cancer mainly relies on immunohistochemistry. After a comprehensive evaluation by an experienced MDT, surgical resection is the primary treatment for advanced SBA, thus demonstrating some benefits for patients.
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Affiliation(s)
- Xingting He
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Shuang Chen
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Yejiang Zhou
- Department of Gastrointestinal Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Alexander Tobias Teichmann
- Sichuan Provincial Center for Gynecology and Breast Diseases (Gynecology), Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Shugui Ding
- Sichuan Provincial Center for Gynecology and Breast Diseases (Gynecology), Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Juan Fan
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Xiuli Xiao
- Department of Pathology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Dongmei Zhao
- Department of Radiology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Liang Cai
- Department of Nuclear Medicine, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Yifan Jiang
- Department of Gastrointestinal Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Xuemei Deng
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Hongru Yang
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
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29
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Bhatt H, Mathis KL. Small Bowel Carcinoma in the Setting of Inflammatory Bowel Disease. Clin Colon Rectal Surg 2024; 37:46-52. [PMID: 38188070 PMCID: PMC10769580 DOI: 10.1055/s-0043-1762929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Small bowel carcinomas are rare in the general population, but the incidence is increasing. Patients with inflammatory bowel diseases (IBDs) are at significantly higher risk of small bowel adenocarcinomas than their non-IBD counterparts, with Crohn's patients having at least a 12-fold increased risk and ulcerative colitis patients with a more controversial and modest 2-fold increased risk compared with the general population. IBD patients with small bowel carcinomas present with nonspecific symptoms that overlap with typical IBD symptoms, and this results in difficulty making a preoperative diagnosis. Cross-sectional imaging is rarely diagnostic, and most cancers are found incidentally at the time of surgery performed for an IBD indication. As such, most small bowel carcinomas are found at advanced stages and carry a poor prognosis. Oncologic surgical resection is the treatment of choice for patients with locoregional disease with little evidence available to guide adjuvant therapy. Patients with metastatic disease are treated with systemic chemotherapy, and surgery is reserved for palliation in this population. Prognosis is poor with few long-term survivors reported.
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Affiliation(s)
- Himani Bhatt
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
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30
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Suman S, Varshney VK, Varshney B, Bharti JN, Yadav T. Jejunal mucinous adenocarcinoma: Unusual presentation of a rare pathology. Med J Armed Forces India 2023; 79:S329-S332. [PMID: 38144664 PMCID: PMC10746788 DOI: 10.1016/j.mjafi.2022.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/21/2022] [Indexed: 11/24/2022] Open
Abstract
Mucinous adenocarcinoma of jejunum is a rare tumor of the gastrointestinal tract. Patients usually present after fifth decade of their life with non-specific symptoms. Delayed diagnosis is commonplace and often the reason for advanced disease and poor prognosis. These tumors may masquerade as other common malignancies, with a conclusive diagnosis only after the final histopathological examination. We present a case of jejunal mucinous adenocarcinoma, disguised as cecal malignancy, in an old female patient, managed with radical resection and adjuvant chemotherapy. The report reiterates that the mucinous variant of jejunal adenocarcinoma is a rare pathology with an unusual advanced presentation.
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Affiliation(s)
- Sunita Suman
- Senior Resident (Surgical Gastroenterology), All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Vaibhav Kumar Varshney
- Associate Professor (Surgical Gastroenterology), All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Bharti Varshney
- Senior Resident (Pathology), All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Jyotsna Naresh Bharti
- Associate Professor (Pathology), All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Taruna Yadav
- Associate Professor (Diagnostic & Interventional Radiology), All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Nishioka Y, Matsumoto Y, Imanishi S, Endo S, Toyozumi T, Kurata Y, Sasaki T, Ohira G, Hayano K, Matsubara H. Small bowel adenocarcinomas with favorable prognoses by radical resection and adjuvant chemotherapy: a case series of five cases. Surg Case Rep 2023; 9:188. [PMID: 37899355 PMCID: PMC10613602 DOI: 10.1186/s40792-023-01771-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 10/22/2023] [Indexed: 10/31/2023] Open
Abstract
BACKGROUND Small bowel cancer is very rare, accounting for less than 5% of all gastrointestinal cancers, and small bowel adenocarcinoma accounts for approximately 40% of all small bowel cancers. Small bowel adenocarcinoma is often found in advanced stages, with only 40-65% of cases being curatively resectable. The prognosis is poor, with a 5-year survival rate of 14-33% for all patients and 40-60% for those who are curatively resectable. In Japan, practice guidelines for duodenal cancer were instituted in 2021. However, evidence-based standard treatments have not been established for jejunal and ileal cancers. In particular, chemotherapeutic options are limited, and there are only a few reports on multidisciplinary treatments, including adjuvant chemotherapy. CASE PRESENTATION We report five cases of jejunal or ileal lesions that were treated with adjuvant chemotherapy after radical resection. Three patients were male and two were female, with a median age of 67 years. Tumor localization was observed in the jejunum in all cases. Clinical staging was as follows: stage IIIA in two cases and stage IIIB in three cases. Laparotomy was then performed in all cases, employing partial resection with lymph node dissection. Pathological staging in all cases was as follows: stage IIB in two cases, stage IIIA in one case, and stage IIIB in two cases. In all cases, the regimen for adjuvant chemotherapy was selected based on the colorectal cancer guidelines. No serious complications arose from adjuvant therapy; however, adverse events occurred in patients receiving multi-agent chemotherapy. No recurrence was observed in any of the cases, and all the patients survived, with a median survival time of 32 months. As a representative case, we present a case of adjuvant chemotherapy for jejunal adenocarcinoma staged as pT3N2M0, pStage IIIB, with no recurrence at 32 months postoperatively. CONCLUSIONS In general, favorable outcomes were achieved with adjuvant therapy applied in accordance with the criteria for colorectal cancer. These favorable outcomes suggest that it is necessary to identify the risk factors and indications for adjuvant therapy, specifically for small bowel adenocarcinoma.
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Affiliation(s)
- Yuri Nishioka
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670, Japan
| | - Yasunori Matsumoto
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670, Japan.
| | - Shunsuke Imanishi
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670, Japan
| | - Satoshi Endo
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670, Japan
| | - Takeshi Toyozumi
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670, Japan
| | - Yoshihiro Kurata
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670, Japan
| | - Takuma Sasaki
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670, Japan
| | - Gaku Ohira
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670, Japan
| | - Koichi Hayano
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670, Japan
| | - Hisahiro Matsubara
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670, Japan
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Song JH, Choi JE, Kim JS. Mucocutaneous ulcer positive for Epstein-Barr virus, misdiagnosed as a small bowel adenocarcinoma: A case report. World J Gastrointest Surg 2023; 15:2362-2366. [PMID: 37969717 PMCID: PMC10642452 DOI: 10.4240/wjgs.v15.i10.2362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/18/2023] [Accepted: 08/31/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Epstein-Barr virus (EBV)-positive mucocutaneous ulcers (MCUs) are an uncommon disorder characterized by ulcerative lesions in the skin, oral cavity or gastrointestinal tract in patients with iatrogenic or aging-induced immunosuppression. The nonspecific lesions are difficult to differentiate from small bowel adenocarcinomas. We present the case of a 69-year-old woman who was initially misdiagnosed with a small bowel adenocarcinoma but was later surgically diagnosed with and treated for EBV-MCU. Through this case, we aim to emphasize the importance of accurately distinguishing between the two conditions. CASE SUMMARY The patient presented with an incidental finding of a small bowel tumor during computed tomography (CT) examination performed for hematuria. The CT scan showed irregular thickening of the distal ileum, which was suggestive of a malignant small bowel tumor. An exploratory laparotomy revealed an 8-cm mass in the distal ileum; thus, a segment of the small intestine, including the mass, was resected. Histopathological analysis revealed an ulceroinfiltrative mass-like lesion with luminal narrowing, marked inflammatory cell infiltration, and large atypical lymphoid cells (positive for EBV-encoded small RNA). A final diagnosis of an EBV-MCU was established. The postoperative course was uneventful, and the patient was discharged on postoperative day 7. The patient remained recurrence-free until 12 mo after surgery. CONCLUSION This case highlights the diagnostic challenges for EBV-MCUs and emphasizes the importance of comprehensive evaluation and accurate histopathological analysis.
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Affiliation(s)
- Ji Hyeong Song
- Department of Surgery, Chungnam National University Sejong Hospital, Sejong 30099, South Korea
| | - Ji Eun Choi
- Department of Pathology, Chungnam National University Sejong Hospital, Sejong 30099, South Korea
| | - Jin Soo Kim
- Department of Surgery, Chungnam National University Sejong Hospital, Sejong 30099, South Korea
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33
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Suliman T, Thompson EC, Denning DA. Perforated Small Bowel Adenocarcinoma: An Interesting Presentation of a Rare Disease. Cureus 2023; 15:e45094. [PMID: 37842490 PMCID: PMC10569080 DOI: 10.7759/cureus.45094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2023] [Indexed: 10/17/2023] Open
Abstract
Primary small bowel adenocarcinoma (SBA) is a rare disease with no clear guidelines on screening, diagnosis, or treatment. It has been associated with hereditary cancer syndromes; however, most cases are sporadic and frequently associated with inflammatory bowel disease. We present the case of a 43-year-old male who presented with abdominal pain, nausea, and vomiting and was initially diagnosed with a Crohn's disease flare. He subsequently developed a small bowel perforation and was taken to the operating room for resection of the inflamed segment of the ileum; this was later found to be secondary to an obstructing small bowel adenocarcinoma. He developed an anastomotic leak, which mandated re-exploration and allowed for the completion of an oncologic resection. Small bowel adenocarcinoma is difficult to diagnose and treat due to the absence of clear guidelines and the lack of randomized controlled trials in the setting of a very low incidence.
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Affiliation(s)
- Toufeeq Suliman
- General Surgery, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Errington C Thompson
- Trauma and Surgical Critical Care, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - David A Denning
- General Surgery, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
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Huang J, Chan SC, Fung YC, Mak FY, Lok V, Zhang L, Lin X, Lucero-Prisno DE, Xu W, Zheng ZJ, Elcarte E, Withers M, Wong MCS. Incidence, Risk Factors, and Temporal Trends of Small Intestinal Cancer: A Global Analysis of Cancer Registries. Gastroenterology 2023; 165:600-612. [PMID: 37277079 DOI: 10.1053/j.gastro.2023.05.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 04/13/2023] [Accepted: 05/05/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND & AIMS Small intestinal cancer is a rare cancer, with limited studies exploring its epidemiology. To our knowledge, this study is the first effort to comprehensively analyze the incidence, risk factors, and trends for small intestinal cancer by sex, age, and country. METHODS Global Cancer Observatory, Cancer Incidence in Five Continents Plus, and Global Burden of Disease were accessed to estimate the age-standardized rates of small intestinal cancer incidence (International Classification of Diseases, 10th Revision, Clinical Modification: C17) and prevalence of lifestyle risk factors, metabolic risk factors, and inflammatory bowel disease (IBD). Risk factor associations were assessed by linear and logistic regressions. Average annual percent change was calculated using joinpoint regression. RESULTS A total of 64,477 small intestinal cancer cases (age-standardized rate, 0.60 per 100,000) were estimated globally in 2020, with a higher disease burden found in North America (1.4). Higher small intestinal cancer incidence was associated with higher human development index; gross domestic product; and prevalence of smoking, alcohol drinking, physical inactivity, obesity, diabetes, lipid disorder, and IBD (β = 0.008-0.198; odds ratios, 1.07-10.01). There was an overall increasing trend of small intestinal cancer incidence (average annual percent change, 2.20-21.67), and the increasing trend was comparable among the 2 sexes but more evident in the older population aged 50-74 years than in the younger population aged 15-49 years. CONCLUSION There was a substantial geographic disparity in the burden of small intestinal cancer, with higher incidence observed in countries with higher human development index; gross domestic product; and prevalence of unhealthy lifestyle habits, metabolic disorders, and IBD. There was an overall increasing trend in small intestinal cancer incidence, calling for the development of preventive strategies.
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Affiliation(s)
- Junjie Huang
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China; Center for Health Education and Health Promotion, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Sze Chai Chan
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yat Ching Fung
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Fung Yu Mak
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Veeleah Lok
- Department of Global Public Health, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Lin Zhang
- The School of Public Health and Preventive Medicine, Monash University, Victoria, Australia; School of Public Health, The Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xu Lin
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Don Eliseo Lucero-Prisno
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Wanghong Xu
- School of Public Health, Fudan University, Shanghai, China
| | - Zhi-Jie Zheng
- Department of Global Health, School of Public Health, Peking University, Beijing, China
| | - Edmar Elcarte
- University of the Philippines, Manila, the Philippines
| | - Mellissa Withers
- Department of Population and Health Sciences, Institute for Global Health, University of Southern California, Los Angeles, California
| | - Martin C S Wong
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China; Center for Health Education and Health Promotion, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China; School of Public Health, The Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Global Health, School of Public Health, Peking University, Beijing, China.
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Zaanan A, Henriques J, Turpin A, Manfredi S, Coriat R, Terrebonne E, Legoux JL, Walter T, Locher C, Dubreuil O, Pernot S, Vernet C, Bouché O, Hautefeuille V, Gagniere J, Lecomte T, Tougeron D, Grainville T, Vernerey D, Afchain P, Aparicio T. Adjuvant chemotherapy benefit according to T and N stage in small bowel adenocarcinoma: a large retrospective multicenter study. JNCI Cancer Spectr 2023; 7:pkad064. [PMID: 37774004 PMCID: PMC10582691 DOI: 10.1093/jncics/pkad064] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/14/2023] [Accepted: 08/24/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND Small bowel adenocarcinoma is a rare cancer, and the role of adjuvant chemotherapy for localized disease is still debated. METHODS This retrospective multicenter study included all consecutive patients who underwent curative surgical resection for localized small bowel adenocarcinoma between 1996 and 2019 from 3 French cohort studies. Prognostic and predictive factors of adjuvant chemotherapy efficacy were analyzed for disease-free survival and overall survival. The inverse probability of treatment weighting method was applied in the Cox regression model using the propensity score derived from multivariable logistic regression. RESULTS A total of 354 patients were included: median age, 63.5 years; duodenum location, 53.5%; and tumor stage I, II, and III in 31 (8.7%), 144 (40.7%), and 179 (50.6%) patients, respectively. The adjuvant chemotherapy was administered in 0 (0%), 66 (48.5%), and 143 (80.3%) patients with stage I, II, and III, respectively (P < .0001). In the subgroup analysis by inverse probability of treatment weighting method, a statistically significant disease-free survival and overall survival benefit in favor of adjuvant chemotherapy was observed in high-risk stage II (T4 and/or <8 lymph nodes examined) and III (T4 and/or N2) but not for low-risk stage II (T3 and ≥8 lymph nodes examined) and III (T1-3/N1) tumors (Pinteraction < .05). Furthermore, tumor location in jejunum and ileum was also a statistically significant predictive factor of response to adjuvant chemotherapy in stage II and III tumors (Pinteraction < .05). CONCLUSION In localized small bowel adenocarcinoma, adjuvant chemotherapy seems to provide a statistically significant survival benefit for high-risk stage II and III tumors and for jejunum and ileum tumor locations.
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Affiliation(s)
- Aziz Zaanan
- Department of Digestive Oncology, European Georges Pompidou Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Université Paris Cité, Paris Cancer Institute CARPEM, Paris, France
| | - Julie Henriques
- Methodology and Quality of Life Unit in Oncology, centre hospitalier universitaire (CHU) Besançon, Hôpital Jean Minjoz, Besançon, France
- Bourgogne Franche-Comté University, INSERM, Etablissement Français du Sang Bourgogne Franche-Comté, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France
| | - Anthony Turpin
- Department of Medical Oncology, centre hospitalier universitaire (CHU) Lille—Hôpital Claude Huriez, Lille, France
| | - Sylvain Manfredi
- Department of Hepato-Gastroenterology and Digestive Oncology, Dijon University Hospital, EPICAD LNC UMR 1231, University of Burgundy, Dijon, France
| | - Romain Coriat
- Gastroenterology and Oncology Department, Hôpital Cochin AP-HP, Université Paris Cité, Paris, France
| | - Eric Terrebonne
- Gastroenterology Department, CIC 1401, centre hospitalier universitaire (CHU) Haut Lévèque, Pessac, France
| | - Jean-Louis Legoux
- Department of Hepato-Gastroenterology and Digestive Oncology, Centre Hospitalier Régional d’Orléans, Orléans, France
| | - Thomas Walter
- Department of Medical Oncology, Hospices Civils de Lyon, Lyon, France
| | - Christophe Locher
- Gastroenterology and Digestive Oncology Department, Meaux Hospital, Meaux, France
| | - Olivier Dubreuil
- Department of Digestive Oncology, Groupe hospitalier Diaconesses Croix Saint Simon, Paris, France
| | - Simon Pernot
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - Chloé Vernet
- Department of Digestive Oncology, Hôpital Privé Jean Mermoz, Lyon, France
| | - Olivier Bouché
- Department of Digestive Oncology and Gastroenterology, University of Reims Champagne-Ardenne (URCA), centre hospitalier universitaire (CHU) Reims, Reims, France
| | - Vincent Hautefeuille
- Department of Hepato-Gastroenterology and Digestive Oncology, Amiens University Hospital, Amiens, France
| | - Johan Gagniere
- Department of Digestive and Hepatobiliary Surgery, University Hospital of Clermont-Ferrand, U1071 INSERM, Clermont-Auvergne University, Clermont-Ferrand, France
| | - Thierry Lecomte
- Department of Hepato-Gastroenterology and Digestive Oncology, University Hospital of Tours, Tours University, U1069 INSERM “Nutrition, Croissance et Cancer”, Tours, France
| | - David Tougeron
- Department of Hepato-Gastroenterology, centre hospitalier universitaire (CHU) de Poitiers, Poitiers, France
| | - Thomas Grainville
- Department of Gastroenterology, Pontchaillou Hospital, Rennes 1 University; INSERM U1242, Rennes, France
| | - Dewi Vernerey
- Methodology and Quality of Life Unit in Oncology, centre hospitalier universitaire (CHU) Besançon, Hôpital Jean Minjoz, Besançon, France
- Bourgogne Franche-Comté University, INSERM, Etablissement Français du Sang Bourgogne Franche-Comté, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France
| | - Pauline Afchain
- Department of Oncology, Saint Antoine Hospital, Paris, France
| | - Thomas Aparicio
- Gastroenterology and Digestive Oncology Department, Saint Louis Hospital, AP-HP, Université Paris Cité, Paris, France
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Aydin D, Kefeli U, Ozcelik M, Erdem GU, Sendur MA, Yildirim ME, Oven BB, Bilici A, Gumus M. The Prognostic Utility of the Metastatic Lymph Node Ratio and the Number of Regional Lymph Nodes Removed from Patients with Small Bowel Adenocarcinomas. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1472. [PMID: 37629761 PMCID: PMC10456871 DOI: 10.3390/medicina59081472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 08/05/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023]
Abstract
Background and Objectives: Small bowel adenocarcinomas (SBAs) are rare tumors of the gastrointestinal system. Lymph node metastasis in patients with curatively resected SBAs is associated with poor prognosis. In this study, we determined the prognostic utility of the number of removed lymph nodes and the metastatic lymph node ratio (the N ratio). Materials and Methods: The data of 97 patients who underwent curative SBA resection in nine hospitals of Turkey were retrospectively evaluated. Univariate and multivariate analyses of potentially prognostic factors including the N ratio and the numbers of regional lymph nodes removed were evaluated. Results: Univariate analysis showed that perineural and vascular invasion, metastatic lymph nodes, advanced TNM stage, and a high N ratio were significant predictors of poor survival. Multivariate analysis revealed that the N ratio was a significant independent predictor of disease-specific survival (DSS). The group with the lowest N ratio exhibited the longest disease-free survival (DFS) and DSS; these decreased significantly as the N ratio increased (both, p < 0.001). There was no significant difference in either DFS or DSS between groups with low and high numbers of dissected lymph nodes (i.e., <13 and ≥13) (both, p = 0.075). Conclusions: We found that the N ratio was independently prognostic of DSS in patients with radically resected SBAs. The N ratio is a convenient and accurate measure of the severity of lymph node metastasis.
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Affiliation(s)
- Dincer Aydin
- Department of Medical Oncology, University of Health Sciences, Derince Training and Research Hospital, Kocaeli 41900, Turkey
| | - Umut Kefeli
- Department of Medical Oncology, Faculty of Medicine, Kocaeli University, Kocaeli 41100, Turkey;
| | - Melike Ozcelik
- Department of Medical Oncology, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul 34764, Turkey;
| | - Gokmen Umut Erdem
- Department of Medical Oncology, University of Health Sciences, Cam and Sakura City Hospital, Istanbul 34480, Turkey;
| | - Mehmet Ali Sendur
- Department of Medical Oncology, University of Health Sciences, Ankara City Hospital, Ankara 06800, Turkey;
| | - Mahmut Emre Yildirim
- Department of Medical Oncology, University of Health Sciences, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul 34865, Turkey;
| | - Basak Bala Oven
- Department of Medical Oncology, Faculty of Medicine, Yeditepe University, Istanbul 34752, Turkey;
| | - Ahmet Bilici
- Department of Medical Oncology, Faculty of Medicine, Medipol University, Istanbul 34214, Turkey;
| | - Mahmut Gumus
- Department of Medical Oncology, Faculty of Medicine, Medeniyet University, Istanbul 34722, Turkey;
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Teufel A, Meindl-Beinker NM, Hösel P, Gerken M, Roig A, Ebert MP, Herr W, Scheiter A, Pauer A, Schlitt HJ, Klinkhammer-Schalke M. Characteristics and outcome of patients with small bowel adenocarcinoma (SBA). J Cancer Res Clin Oncol 2023; 149:4579-4590. [PMID: 36163558 PMCID: PMC10349691 DOI: 10.1007/s00432-022-04344-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/31/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Small bowel adenocarcinoma (SBA) remains a rare malignancy accounting for less than 5% of all the gastrointestinal tract cancers. However, only limited data and expert guidelines are available for this entity. As a result, treatment concepts are predominantly derived from colorectal cancer. METHODS To substantiate data on the course of disease, diagnosis and treatment of SBA, we performed a population-based analysis from a Bavarian population of 2.2 million people. RESULTS We identified 223 patients with SBA. Mean age at diagnosis was 67.8 years and patients were diagnosed rather late (34.5% UICC stage IV). Largest proportion of these patients were diagnosed with adenocarcinoma of the duodenum (132 patients, 59.2%) and most patients were diagnosed with late stage cancer, stage IV (70 patients, 31.4%). With respect to treatment, most patients underwent primary surgery (187 patients, 84.6%). Systemic therapy seemed to have an impact in UICC stage IV patients but not in UICC stage IIB or III. The 5-year survival rate was 29.0%. This was significantly less compared to colon cancer in the same cohort, which was 50.0%. Furthermore, median survival of patients with small bowel cancer was only 2.0 years (95% CI 1.4-2.5) compared to 4.9 years (95% CI 4.8-5.1) of patients with colon cancer. CONCLUSION SBA showed a distinct epidemiology compared to colon cancer. Thus, data acquisition particularly on systemic treatment are paramount, with the objective to complement the available guidelines.
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Affiliation(s)
- Andreas Teufel
- Division of Hepatology, Division of Clinical Bioinformatics, Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
- Clinical Cooperation Unit Healthy Metabolism, Center for Preventive Medicine and Digital Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| | - Nadja M Meindl-Beinker
- Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Pauline Hösel
- DKFZ-Hector Cancer Institute at the University Medical Center, Mannheim, Germany
| | - Michael Gerken
- Bavarian Cancer Registry, Regional Center Regensburg, Bavarian Health and Food Safety Authority, Regensburg, Germany
- Regensburg Tumor Center, Institute for Quality Assurance and Health Services Research at the University of Regensburg, Regensburg, Germany
| | - Ana Roig
- Division of Hepatology, Division of Clinical Bioinformatics, Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Matthias P Ebert
- Clinical Cooperation Unit Healthy Metabolism, Center for Preventive Medicine and Digital Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- DKFZ-Hector Cancer Institute at the University Medical Center, Mannheim, Germany
- Mannheim Institute for Innate Immunoscience (MI3), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Wolfgang Herr
- Department of Internal Medicine III, University Medical Center Regensburg, Regensburg, Germany
| | | | - Armin Pauer
- Regensburg Tumor Center, Institute for Quality Assurance and Health Services Research at the University of Regensburg, Regensburg, Germany
| | - Hans J Schlitt
- Department of Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Monika Klinkhammer-Schalke
- Bavarian Cancer Registry, Regional Center Regensburg, Bavarian Health and Food Safety Authority, Regensburg, Germany
- Regensburg Tumor Center, Institute for Quality Assurance and Health Services Research at the University of Regensburg, Regensburg, Germany
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Bhatt A, Mishra S, Glehen O. Histopathological Evaluation and Molecular Diagnostic Tests for Peritoneal Metastases with Unknown Primary Site-a Review. Indian J Surg Oncol 2023; 14:15-29. [PMID: 37359927 PMCID: PMC10284789 DOI: 10.1007/s13193-022-01612-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 07/26/2022] [Indexed: 11/25/2022] Open
Abstract
Cancer of unknown primary (CUP) is a well-studied entity with guidelines available for the management of patients with CUP. The peritoneum represents one of the metastatic sites in CUP, and peritoneal metastases (PM) could present as CUP. PM of unknown origin remains a poorly studied clinical entity. There is only one series of 15 cases, one population-based study, and few other case reports on this subject. Studies on CUP, in general, cover some common tumour histological types like adenocarcinomas and squamous carcinomas. Some of these tumours may have a good prognosis though majority have high-grade disease with a poor long-term outcome. Some of the histological tumour types commonly seen in the clinical scenario of PM like mucinous carcinoma have not been studied. In this review, we divide PM into five histological types-adenocarcinomas, serous carcinomas, mucinous carcinomas, sarcomas and other rare varieties. We provide algorithms to identify the primary tumour site using immunohistochemistry when imaging, and endoscopy fails to establish the primary tumour site. The role of molecular diagnostic tests for PM or unknown origin is also discussed. Current literature on site-specific systemic therapy based on gene expression profiling does not show a clear benefit of this approach over empirical systemic therapies.
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Affiliation(s)
- Aditi Bhatt
- Dept. of Surgical Oncology, Zydus Hospital, Thaltej, Ahmedabad 380054 India
| | - Suniti Mishra
- Dept. of Pathology, Sparsh Hospital, Bangalore, India
| | - Olivier Glehen
- Dept. of Surgical Oncology, Centre Hospitalier Lyon-Sud, Lyon, France
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Lee JG, Lee SP, Jang HJ, Kae SH. Underwater Versus Conventional Endoscopic Mucosal Resection for Superficial Non-ampullary Duodenal Epithelial Tumors: A Systematic Review and Meta-Analysis. Dig Dis Sci 2023; 68:1482-1491. [PMID: 36346490 DOI: 10.1007/s10620-022-07715-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/29/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND/AIMS Duodenal underwater endoscopic mucosal resection (UEMR) has been suggested as a feasible treatment option for superficial non-ampullary duodenal epithelial tumors (SNADETs). However, its efficacy and safety have not been fully established yet. Thus, the objective of this systematic review and meta-analysis was to determine the efficacy and safety of UEMR as compared with conventional endoscopic mucosal resection (CEMR) in the treatment of SNADETs. METHODS We conducted a comprehensive literature search in PubMed, EMBASE, the Cochrane Library. Studies comparing CEMR and UEMR for the resection of SNADET were included. Outcomes included en-bloc and complete resection rates, adverse events, and procedure time. RESULTS A total of six studies with 2454 lesions were included in the quantitative synthesis. En-bloc and complete resection rates were not significantly different between UEMR and CEMR (OR for en-bloc resection: 0.997 [95% CI 0.439-2.266]; OR for complete resection: 0.960 [95% CI 0.628-1.468]). There was no significant risk difference for perforation (risk difference: - 0.002; 95% CI - 0.009 to 0.005) or delayed bleeding (risk difference: - 0.001; 95% CI - 0.014 to 0.011). Procedure time was significantly shorter in the UEMR (standardized mean difference: - 1.294; 95% CI - 2.461 to - 0.127). The risk of recurrence was not significantly different between UEMR and CEMR (risk difference: 0.001; 95% CI - 0.041 to 0.044). CONCLUSION Although our results did not show any superiority of UEMR over CEMR in the treatment of SNADETs, UEMR showed equivalent efficacy and safety as compared with CEMR and was associated with a shorter procedure time.
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Affiliation(s)
- Jae Gon Lee
- Division of Gastroenterology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, 7 Keunjaebong-gil, Hwaseong, 18450, Korea
| | - Sang Pyo Lee
- Division of Gastroenterology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, 7 Keunjaebong-gil, Hwaseong, 18450, Korea.
| | - Hyun Joo Jang
- Division of Gastroenterology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, 7 Keunjaebong-gil, Hwaseong, 18450, Korea
| | - Sea Hyub Kae
- Division of Gastroenterology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, 7 Keunjaebong-gil, Hwaseong, 18450, Korea
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Alshamsan B, Aseafan M, Badran A, Shaheen A, Elshenawy MA, Bazarbashi S, Aljubran AH. Characteristics and outcomes of small bowel adenocarcinoma: 14 years of experience at a single tertiary hospital in Saudi Arabia. Mol Clin Oncol 2023; 18:17. [PMID: 36798464 PMCID: PMC9926043 DOI: 10.3892/mco.2023.2613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 12/22/2022] [Indexed: 01/28/2023] Open
Abstract
Small bowel adenocarcinoma (SBA) is an extremely rare cancer type. In the present study, the patient characteristics and clinical outcomes of patients diagnosed and treated for SBA at a single tertiary hospital were reported. All patients diagnosed and managed between 2007 and 2020 were reviewed. Regression analysis was used to assess variables associated with the metastatic stage at diagnosis. The Kaplan-Meier method was used to estimate survival and the log-rank test was used to determine factors associated with survival outcomes. Out of 137 cases of small bowel primary tumor, 43 consecutive patients with SBA were diagnosed with a median age of 53 years and the majority (76.7%) were males. The common initial presenting symptoms were abdominal pain (58.8%) and bowel obstruction (30.2%). The most common primary site was the duodenum (60.5%) and the majority (65.1%) were diagnosed with stage III/IV disease. Patients with a high neutrophil-lymphocyte ratio (NLR) (≥0.85) were more likely to be in the metastatic stage at diagnosis (P=0.01). The 3-year overall survival (OS) rates based on stage were 100% (I), 85% (II), 53% (III) and 33.9% (IV) (P=0.001). In addition to the stage, the Eastern Cooperative Oncology Group Performance Status (P<0.001), NLR (P<0.001), hypoalbuminemia (P=0.02) and chemotherapy in a metastatic setting (P=0.02) were prognostic factors for OS. In conclusion, NLR is a potential prognostic biomarker for a metastatic stage at diagnosis. Advanced stage, lower performance status score, low albumin level and high NLR are associated with short OS.
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Affiliation(s)
- Bader Alshamsan
- Section of Medical Oncology, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia
- Department of Medicine, College of Medicine, Qassim University, Buraidah 51432, Saudi Arabia
| | - Mohamed Aseafan
- Section of Medical Oncology, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia
- Section of Medical Oncology, Department of Internal Medicine, Security Forces Hospital Program, Riyadh 11481, Saudi Arabia
| | - Ahmed Badran
- Section of Medical Oncology, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia
- Clinical Oncology and Nuclear Medicine Department, Faculty of Medicine, Ain Shams University, Cairo 11517, Egypt
| | - Amgad Shaheen
- Section of Medical Oncology, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia
- Medical Oncology Department, National Cancer Institute, Cairo University, Cairo 12613, Egypt
| | - Mahmoud A. Elshenawy
- Section of Medical Oncology, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia
- Clinical Oncology Department, Faculty of Medicine, Menoufia University, Shebin El Kom 32511, Egypt
| | - Shouki Bazarbashi
- Section of Medical Oncology, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia
| | - Ali H. Aljubran
- Section of Medical Oncology, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia
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Surgical Options for Peritoneal Surface Metastases from Digestive Malignancies-A Comprehensive Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020255. [PMID: 36837456 PMCID: PMC9960111 DOI: 10.3390/medicina59020255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/25/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023]
Abstract
The peritoneum is a common site for the dissemination of digestive malignancies, particularly gastric, colorectal, appendix, or pancreatic cancer. Other tumors such as cholangiocarcinomas, digestive neuroendocrine tumors, or gastrointestinal stromal tumors (GIST) may also associate with peritoneal surface metastases (PSM). Peritoneal dissemination is proven to worsen the prognosis of these patients. Cytoreductive surgery (CRS), along with systemic chemotherapy, have been shown to constitute a survival benefit in selected patients with PSM. Furthermore, the association of CRS with hyperthermic intraperitoneal chemotherapy (HIPEC) seems to significantly improve the prognosis of patients with certain types of digestive malignancies associated with PSM. However, the benefit of CRS with HIPEC is still controversial, especially due to the significant morbidity associated with this procedure. According to the results of the PRODIGE 7 trial, CRS for PSM from colorectal cancer (CRC) achieved overall survival (OS) rates higher than 40 months, but the addition of oxaliplatin-based HIPEC failed to improve the long-term outcomes. Furthermore, the PROPHYLOCHIP and COLOPEC trials failed to demonstrate the effectiveness of oxaliplatin-based HIPEC for preventing peritoneal metastases development in high-risk patients operated for CRC. In this review, we discuss the limitations of these studies and the reasons why these results are not sufficient to refute this technique, until future well-designed trials evaluate the impact of different HIPEC regimens. In contrast, in pseudomyxoma peritonei, CRS plus HIPEC represents the gold standard therapy, which is able to achieve 10-year OS rates ranging between 70 and 80%. For patients with PSM from gastric carcinoma, CRS plus HIPEC achieved median OS rates higher than 40 months after complete cytoreduction in patients with a peritoneal cancer index (PCI) ≤6. However, the data have not yet been validated in randomized clinical trials. In this review, we discuss the controversies regarding the most efficient drugs that should be used for HIPEC and the duration of the procedure. We also discuss the current evidence and controversies related to the benefit of CRS (and HIPEC) in patients with PSM from other digestive malignancies. Although it is a palliative treatment, pressurized intraperitoneal aerosolized chemotherapy (PIPAC) significantly increases OS in patients with unresectable PSM from gastric cancer and represents a promising approach for patients with PSM from other digestive cancers.
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Xiao C, Cheng Q, Cao C, Xiao X, Zhang Y. Ileal adenocarcinoma in a young pregnant woman: A rare case report. Front Oncol 2023; 13:1066153. [PMID: 36761939 PMCID: PMC9905710 DOI: 10.3389/fonc.2023.1066153] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/06/2023] [Indexed: 01/27/2023] Open
Abstract
Primary intestinal malignancies account for only 1%-3% of all malignant gastrointestinal tumors. Adenocarcinomas are uncommonly located in the ileum. Ileal adenocarcinoma (IA) is rare and difficult to diagnose because of its location. IA is common in older men and rare in young pregnant women. A 23-year-old pregnant woman was hospitalized several times for repeated vomiting and abdominal pain. Her symptoms were relieved after symptomatic treatment. She exhibited no typical manifestations of intestinal obstruction, such as abdominal distension, difficulty passing gas and defecation. Unfortunately, she was misdiagnosed with acute gastroenteritis. On the second day after delivery, the patient stopped passing gas and computed tomography (CT) revealed an intestinal obstruction. She was treated as paralytic ileus. However, in view of failed conservative management, she was decided for an exploratory laparotomy. A malignant ileal tumor 5cm from the ileocecal valve was found incidentally and was surgically excised accompanied with End-to-side anastomosis of ileal and transverse colon. The operation lasted 195 minutes. Pathological examination revealed an IA. Pregnant woman who experience symptoms of intestinal obstruction should be alert to the possibility of malignancy in the small intestine. IA is an insidious tumor in pregnant women. An "IA triad" can be defined as refractory vomiting, vague abdominal pain, and weight loss (or inadequate weight gain in pregnant women). Pregnant women with an IA triad should undergo investigation with endoscopy or, if necessary, magnetic resonance imaging (MRI).
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Affiliation(s)
- Chao Xiao
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China,Department of Obstetrics and Gynecology, The First People's Hospital of Zigong, Zigong, China
| | - Qijun Cheng
- Department of Obstetrics and Gynecology, The First People's Hospital of Zigong, Zigong, China
| | - Chengjian Cao
- Clinical Research Laboratory & Department of Clinical Examination, The First People's Hospital of Zigong, Zigong, China
| | - Xue Xiao
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China,*Correspondence: Xue Xiao, ; Yutao Zhang,
| | - Yutao Zhang
- Department of Pathology, The First People’s Hospital of Zigong, Zigong, China,*Correspondence: Xue Xiao, ; Yutao Zhang,
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Hu ML, Chiu YC, Tai WC, Huang HY, Yen HH, Chen YY, Chen CW, Su MY, Lin WP, Chiu CT, Chou JW, Feng CL, Huang SF, Shih YS, Chen SF, Ting CF, Chiang IP, Yii CY, Huang HC, Chen CT, Chang CW, Wang HY, Chang CW, Tsai CC, Lin SC, Shih SC, Tai CM, Tu CH, Lee TC, Perng DS, Shun CT, Wang HP, Lin CC, Chang WH, Chan YJ, Chen YJ, Chang YF, Tseng CH, Chen YS, Mo LR. Malignant Neoplasms of the Small Intestines. ATLAS OF SMALL INTESTINAL DISORDERS 2023:19-45. [DOI: 10.1007/978-981-99-6682-0_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
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Kawasaki A, Tsuji K, Uedo N, Kanesaka T, Miyamoto H, Gushima R, Minoda Y, Ihara E, Amano R, Yao K, Naito Y, Aoyagi H, Iwasaki T, Uchita K, Arima H, Doyama H. Non-atrophic gastric mucosa is an independently associated factor for superficial non-ampullary duodenal epithelial tumors: a multicenter, matched, case-control study. Clin Endosc 2023; 56:75-82. [PMID: 36600655 PMCID: PMC9902693 DOI: 10.5946/ce.2022.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 04/27/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND/AIMS The etiology of superficial non-ampullary duodenal epithelial tumors (SNADETs) remains unclear. Recent studies have reported conflicting associations between duodenal tumor development and Helicobacter pylori infection or endoscopic gastric mucosal atrophy. As such, the present study aimed to clarify the relationship between SNADETs and H. pylori infection and/or endoscopic gastric mucosal atrophy. METHODS This retrospective case-control study reviewed data from 177 consecutive patients with SNADETs who underwent endoscopic or surgical resection at seven institutions in Japan over a three-year period. The prevalence of endoscopic gastric mucosal atrophy and the status of H. pylori infection were compared in 531 sex- and age-matched controls selected from screening endoscopies at two of the seven participating institutions. RESULTS For H. pylori infection, 85 of 177 (48.0%) patients exhibited SNADETs and 112 of 531 (21.1%) control patients were non-infected (p<0.001). Non-atrophic mucosa (C0 to C1) was observed in 96 of 177 (54.2%) patients with SNADETs and 112 of 531 (21.1%) control patients (p<0.001). Conditional logistic regression analysis revealed that non-atrophic gastric mucosa was an independent risk factor for SNADETs (odds ratio, 5.10; 95% confidence interval, 2.44-8.40; p<0.001). CONCLUSION Non-atrophic gastric mucosa, regardless of H. pylori infection status, was a factor independently associated with SNADETs.
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Affiliation(s)
- Azusa Kawasaki
- Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Ishikawa, Japan
| | - Kunihiro Tsuji
- Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Ishikawa, Japan
| | - Noriya Uedo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Takashi Kanesaka
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Hideaki Miyamoto
- Department of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Ryosuke Gushima
- Department of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yosuke Minoda
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Eikichi Ihara
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ryosuke Amano
- Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Kenshi Yao
- Department of Endoscopy, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Yoshihide Naito
- Department of Gastroenterology, Fukui Prefectural Hospital, Fukui, Japan
| | - Hiroyuki Aoyagi
- Department of Gastroenterology, Fukui Prefectural Hospital, Fukui, Japan
| | - Takehiro Iwasaki
- Department of Gastroenterology, Kochi Red Cross Hospital, Kochi, Japan
| | - Kunihisa Uchita
- Department of Gastroenterology, Kochi Red Cross Hospital, Kochi, Japan
| | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Hisashi Doyama
- Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Ishikawa, Japan,Correspondence: Hisashi Doyama Department of Gastroenterology, Ishikawa Prefectural Central Hospital, 2-1 Kuratsukihigashi, Kanazawa, Ishikawa 920-8530, Japan E-mail:
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Lee JS, Park SH, Choi SJ. Radiologic Review of Small Bowel Malignancies and Their Mimicking Lesions. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:110-126. [PMID: 36818705 PMCID: PMC9935952 DOI: 10.3348/jksr.2021.0168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/22/2021] [Accepted: 04/19/2022] [Indexed: 11/18/2022]
Abstract
Because of their small size, small bowel malignancies are often easily missed when radiologists read CT images, which can lead to errors in the normal small bowel due to their similar enhancement to the small bowel or non-specific enhancement. In addition, small bowel malignancies are sometimes mistaken for masses of other origins, such as the uterus, rectum, or omentum. In this article, we describe various small-bowel malignancies, their mimicking lesions and the typical and atypical features on CT imaging along with their clinical manifestations.
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Affiliation(s)
- Jong Soo Lee
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - So Hyun Park
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Seung Joon Choi
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
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Chen V, Jones M, Cohen L, Yang W, Bedi J, Mohan HM, Apte SS, Larach JT, Flood M, Heriot A, Kong J, Warrier S. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in small bowel adenocarcinoma with peritoneal metastasis: a systematic review. Pleura Peritoneum 2022; 7:159-167. [PMID: 36560970 PMCID: PMC9742456 DOI: 10.1515/pp-2022-0121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 10/22/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives Small bowel adenocarcinoma (SBA) with peritoneal metastasis (PM) is rare and despite treatment with systemic chemotherapy, the prognosis is poor. However, there is emerging evidence that cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) may offer a survival benefit over systemic therapy alone. This systematic review will assess the effectiveness of CRS-HIPEC for SBA-PM. Content Three databases were searched from inception to 11/10/21. Clinical outcomes were extracted and analysed. Summary A total of 164 cases of SBA-PM undergoing CRS-HIPEC were identified in 12 studies. The majority of patients had neoadjuvant chemotherapy (87/164, 53%) and complete cytoreduction (143/164, 87%) prior to HIPEC. The median overall survival was 9-32 months and 5-year survival ranged from 25 to 40%. Clavien-Dindo grade III/IV morbidity ranged between 19.1 and 50%, while overall mortality was low with only 3 treatment-related deaths. Outlook CRS-HIPEC has the potential to improve the overall survival in a highly selected group of SBA-PM patients, with 5-year survival rates comparable to those reported in colorectal peritoneal metastases. However, the expected survival benefits need to be balanced against the intrinsic risk of morbidity and mortality associated with the procedure. Further multicentre studies are required to assess the safety and feasibility of CRS-HIPEC in SBA-PM to guide best practice management for this rare disease.
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Affiliation(s)
- Vicky Chen
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Morgan Jones
- Department of Colorectal Surgery, Alfred Health, Prahran, VIC, Australia
| | - Lauren Cohen
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Wilson Yang
- Department of Colorectal Surgery, Alfred Health, Prahran, VIC, Australia
| | - Jasman Bedi
- Department of Colorectal Surgery, Alfred Health, Prahran, VIC, Australia
| | - Helen M. Mohan
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Sameer S. Apte
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - José Tomas Larach
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Michael Flood
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Alexander Heriot
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Joseph Kong
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia,Department of Colorectal Surgery, Alfred Health, Prahran, VIC, Australia
| | - Satish Warrier
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia,Department of Colorectal Surgery, Alfred Health, Prahran, VIC, Australia
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Arpa G, Fassan M, Guerini C, Quaquarini E, Grillo F, Angerilli V, Guzzardo V, Lonardi S, Bergamo F, Lenti MV, Pedrazzoli P, Paulli M, Di Sabatino A, Vanoli A. Claudin-18 expression in small bowel adenocarcinoma: a clinico-pathologic study. Virchows Arch 2022; 481:853-863. [PMID: 35925388 PMCID: PMC9734203 DOI: 10.1007/s00428-022-03393-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/15/2022] [Accepted: 07/27/2022] [Indexed: 01/22/2023]
Abstract
Non-ampullary small bowel adenocarcinoma is a rare neoplasm with an ominous prognosis, whose incidence is higher in some chronic immuno-inflammatory conditions, such as coeliac and Crohn's disease. Recently, claudin 18.2, a transmembrane protein normally expressed in gastric mucosa, has been recognized as a novel pan-cancer therapeutic target, and several clinical trials with claudin-18-directed drugs have shown promising results on various gastrointestinal malignancies. This is the first study focusing on claudin-18 expression in small bowel adenocarcinomas. The immunohistochemical expression of claudin-18 (clone 43-14A) was assessed in 81 small bowel adenocarcinomas of diverse aetiologies and correlated with several clinico-pathologic features and patient survival. We found that 28% of adenocarcinomas were immunoreactive for claudin-18, with cutoff values of ≥1% at any intensity, while 6% of cancers showed immunoexpression of ≥75% with 2+/3+ score. Moreover, claudin-18 (≥1%) was positively associated with cytokeratin 7 (CK7) and MUC5AC expression, showing CK7+/MUC5AC+ carcinomas the highest rate of positive cases, whereas a negative correlation was found between claudin-18 and CDX2 expression. In addition, some cancer-adjacent dysplastic growths and foci of gastric-type metaplasia in Crohn's disease-associated cases showed claudin-18 immunoreactivity. Survival analysis showed a non-significant trend towards a worse cancer-specific survival for claudin-18-positive cases. A fraction of small bowel adenocarcinomas, mainly sporadic or Crohn's disease-associated, and often exhibiting a non-intestinal immunoprofile, expressed claudin-18, suggesting that claudin-18-directed targeted therapy is worth investigating in such cancers.
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Affiliation(s)
- Giovanni Arpa
- Department of Molecular Medicine, Unit of Anatomic Pathology, University of Pavia, Via Carlo Forlanini 16-27100, Pavia, Italy
- Anatomic Pathology Unit, Fondazione IRCCS San Matteo Hospital, Pavia, Italy
| | - Matteo Fassan
- Department of Medicine, DIMED, University of Padua, Padua, Italy
- Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
| | - Camilla Guerini
- Department of Molecular Medicine, Unit of Anatomic Pathology, University of Pavia, Via Carlo Forlanini 16-27100, Pavia, Italy
- Anatomic Pathology Unit, Fondazione IRCCS San Matteo Hospital, Pavia, Italy
| | - Erica Quaquarini
- Medical Oncology Unit, ICS Maugeri-IRCCS SpA SB, 27100, Pavia, Italy
| | - Federica Grillo
- Pathology Unit, Department of Surgical and Diagnostic Sciences (DISC), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | | | - Sara Lonardi
- Department of Oncology, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
| | - Francesca Bergamo
- Department of Oncology, Veneto Institute of Oncology, IOV-IRCCS, Padua, Italy
| | - Marco Vincenzo Lenti
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Paolo Pedrazzoli
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
- Oncology Unit, IRCCS San Matteo Hospital, Pavia, Italy
| | - Marco Paulli
- Department of Molecular Medicine, Unit of Anatomic Pathology, University of Pavia, Via Carlo Forlanini 16-27100, Pavia, Italy
- Anatomic Pathology Unit, Fondazione IRCCS San Matteo Hospital, Pavia, Italy
| | - Antonio Di Sabatino
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Alessandro Vanoli
- Department of Molecular Medicine, Unit of Anatomic Pathology, University of Pavia, Via Carlo Forlanini 16-27100, Pavia, Italy.
- Anatomic Pathology Unit, Fondazione IRCCS San Matteo Hospital, Pavia, Italy.
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48
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Alherz F, Al Omoush TM, Alenezi NH, Albalawi TF, Alsaif O. Primary Adenocarcinoma of the Jejunum: Case Report of Rare Small Bowel Neoplasm. Cureus 2022; 14:e33032. [PMID: 36589706 PMCID: PMC9797756 DOI: 10.7759/cureus.33032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2022] [Indexed: 12/29/2022] Open
Abstract
Small bowel adenocarcinoma (SBA) is rare cancer that accounts for less than 2% of all gastrointestinal tract cancers. Usually, the clinical presentation is unspecific, and a patient might complain of nausea, vomiting, abdominal pain, small bowel obstruction, and small bowel bleeding. Because of these unspecific symptoms, the patient might be diagnosed late, from six to ten months, which affects the prognosis. This study contains a case report of a 38-year female with SBA in the jejunum, with unspecific symptoms. She had a history of recurrent admissions due to acute pancreatitis, acute kidney injury, and hyponatremia caused by dehydration. The patient was diagnosed six months after the first symptoms of nausea and vomiting started. The patient underwent exploratory laparotomy for a jejunal stricture mass, and a lymph node was resected. The course after surgery was smooth, and the patient was discharged home on the fourth-day post-surgery. In conclusion, the symptoms of SBA are unspecific and cannot be diagnosed without complete medical histories and lab examinations, making diagnosing SBA challenging.
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Affiliation(s)
- Fadhel Alherz
- General Surgery, Dr. Sulaiman Al-Habib Medical Group, Khobar, SAU
| | | | - Nasser H Alenezi
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dhahran, SAU
| | - Turki F Albalawi
- College of Medicine, King Fahad University Hospital, Dammam, SAU
| | - Osama Alsaif
- General Surgery, King Fahad Specialist Hospital, Dammam, SAU
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49
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Muacevic A, Adler JR, Khattak UM, Tariq H, Ashfaq M, Babur M. Small Bowel Adenocarcinoma: A Rare Case of Iron Deficiency Anemia. Cureus 2022; 14:e32724. [PMID: 36686113 PMCID: PMC9850317 DOI: 10.7759/cureus.32724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
Neoplasms of the small bowel are relatively rare, with less than 5% occurrence among other GI cases. Primary adenocarcinoma, an aggressive sub-type of small bowel cancers, usually presents with vague blood loss and abdominal pain symptoms, causing a delayed diagnosis at an advanced stage of the disease and a poor prognosis. The preferable treatment of choice is surgical resection with chemotherapy, which has shown to have survival benefits. Here we present a case of a 66-year-old male patient with persistent iron deficiency anemia requiring multiple blood transfusions and an unexplained weight loss. A series of diagnostic tests, including upper and lower GI endoscopy, Tc-99 RBC scintigraphy, barium follow-through, CT scans, bone marrow biopsy, esophagogastroduodenoscopy and colonoscopy were inconclusive. He was later diagnosed with a small bowel adenocarcinoma on exploratory laparotomy and surgically treated. Adjuvant chemotherapy was also started. Our case report highlights the course of SBA presenting in an unusual way which was challenging to diagnose with the standard investigations to help physicians/surgeons suspect it at an early stage in the future. This may save patients and help avoid delayed diagnosis or misdiagnosis, especially in patients with an unusual presentation like our patient who presented only with iron deficiency anemia.
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50
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Clinicopathological characteristics and prognostic factors of elderly small intestine adenocarcinoma using propensity score matching analysis: a study based on SEER database. Int J Colorectal Dis 2022; 37:2397-2407. [PMID: 36301375 DOI: 10.1007/s00384-022-04266-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/06/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Small intestine adenocarcinoma (SIA) is a scant disease that has no adequate clinical trials, so its prognostic factors are still unclear, especially in elderly patients. In this article, we aimed to explore the clinicopathology presentation, treatments, outcomes, and predictors of small intestine adenocarcinoma patients aged 65 years or older. METHODS We retrieved clinicopathology data of small intestine adenocarcinoma patients diagnosed between 2004 and 2015 from the Surveillance Epidemiology and End Results (SEER) database. We clarified patients into two groups: the surgery and the non-surgery group and conducted propensity score matching (PSM) to compare survival outcoming. We identified the prognostic indicators for cancer-specific survival (CSS) and overall survival (OS) by the Cox proportional hazards model. RESULTS In total, 1018 eligible cases were enrolled, with a median survival of 16 months; the 3-year OS and CSS rates were 36% and 41.7%, and the 5-year OS and CSS rates were 26.5% and 33.3%. Multivariate analyses revealed that age, grade, tumor stage, surgery, and chemotherapy were independent prognostic factors for OS, while grade, tumor stage, surgery, radiation, and chemotherapy were independent factors for CSS. After PSM, only surgery and tumor stage (AJCC 6th) were independent prognostic factors for OS and CSS. CONCLUSION Surgery could bring benefit to survival for elderly SIA patients, and the early stage of the disease was another significant prognostic factor.
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