Published online Jul 27, 2026. doi: 10.4240/wjgs.117966
Revised: March 12, 2026
Accepted: April 17, 2026
Published online: July 27, 2026
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Duodenal papillary adenocarcinoma is exceptionally rare in patients with acquired immunodeficiency syndrome (AIDS), and while this would normally be treated by radical resection, such treatment has historically been considered high-risk in AIDS patients due to their immune deficiencies.
This report presents the case of a 63-year-old female with AIDS who underwent pancreaticoduodenectomy for duodenal papillary adenocarcinoma (pT2N1M0, stage IIIA) and achieved 5-year survival. Through standardized antiretroviral therapy, her CD4+ levels were maintained above 200 cells/μL. Perioperative infection prophylaxis included piperacillin-tazobactam and ornidazole. Postoperative adjuvant chemotherapy was initiated based on her absolute neutrophil count being ≥ 1.50 × 109/L but was reduced due to the occurrence of recurrent grade 3 diarrhea; ultimately, the patient could tolerate only 70% of the standard XELOX regimen over four cycles. The surgery was completed without complications. During over 5 years of follow-up, surveillance imaging showed no recurrence or metastasis, the tumor markers remained normal, and her performance status was fully recovered.
This case demonstrates that with immune optimization (CD4+ > 200 cells/μL), tailored infection prophylaxis, and neutrophil-guided chemotherapy, radical surgery can be feasible and can enable long-term survival in AIDS patients with duodenal papillary adenocarcinoma, suggesting that the CD4+ level is a potential threshold for assessing patient eligibility for surgery in comparable cases.
Core Tip: This case demonstrates that pancreaticoduodenectomy can achieve 5-year disease-free survival in patients with duodenal papillary adenocarcinoma complicated by acquired immunodeficiency syndrome, and represents the first case with comprehensive long-term prognostic outcomes documented for this specific patient population. Key factors for treatment success include effective multidisciplinary team collaborative management, tailored chemotherapy regimens guided by the patient’s absolute neutrophil count, and proactive perioperative infection prophylaxis. This case suggests that surgical eligibility should not simply be based on a CD4+ T-cell count ≥ 200 cells/μL as the absolute criterion; instead, it should be determined through comprehensive assessment incorporating the CD4+ count, viral load control, nutritional status, and tumor-specific factors.