Long-term survival after pancreaticoduodenectomy for duodenal papillary adenocarcinoma in a patient with acquired immunodeficiency syndrome: A case report and review of literature

Figure 1 Imaging features of a duodenal papillary tumor. A and B: Axial contrast-enhanced computed tomography shows an enhancing nodular lesion (1.80 cm × 1.80 cm) in the duodenal papilla region; C and D: Note the dilated biliary and pancreatic ducts (common hepatic duct: 1.50 cm) and the double duct sign; E and F: Gastroscopy reveals a tumor (1.50 cm × 1.50 cm) in the descending duodenum obscuring the nipple opening. The discrepancy between endoscopic (1.50 cm × 1.50 cm) and pathological (1.00 cm × 1.00 cm × 0.50 cm) tumor dimensions may be attributed to tissue shrinkage during formalin fixation, partial tissue loss from preoperative biopsy, and intraoperative manipulation.

Figure 2 Pathological findings of duodenal papillary adenocarcinoma. A: A gray-red solid mass (1.00 cm × 1.00 cm × 0.50 cm) at the duodenal papilla with a gray-white cut surface and moderate consistency, poorly demarcated from surrounding tissues. Attached organs include the stomach (8.00 cm × 6.50 cm × 4.00 cm), duodenum (length 27.00 cm), gallbladder (11.00 cm × 4.00 cm × 3.50 cm; rough mucosa, smooth serosa), and pancreas (7.50 cm × 6.00 cm × 2.00 cm; lobulated cut surface). No tumor invasion is observed in any organ; B: Papillary adenocarcinoma infiltrating the muscularis propria. No cancer infiltration is seen in the serosa or periserosal tissues.

Figure 3 Proposed multidisciplinary management pathway for people with human immunodeficiency virus undergoing abdominal oncologic surgery (e. g., pancreaticoduodenectomy). CT: Computed tomography; CEA: Carcinoembryonic antigen; CA19-9: Carbohydrate antigen 19-9; MRI: Magnetic resonance imaging; MRCP: Magnetic resonance cholangiopancreatography; PET-CT: Positron emission tomography-computed tomography; HIV: Human immunodeficiency virus; MDT: Multidisciplinary team; ART: Antiretroviral therapy; ECOG: Eastern Cooperative Oncology Group; BMI: Body mass index; DVT: Deep venous thrombosis.