Duodenal carcinoma at the ligament of Treitz. A molecular and clinical perspective

Abstract

BackgroundThere is very small occurrence of adenocarcinoma in the small bowel. We present a case of primary duodenal adenocarcinoma and discuss the findings of the case diagnostic modalities, current knowledge on the molecular biology behind small bowel neoplasms and treatment options.CaseThe patient had a history of iron deficiency anemia and occult bleeding with extensive workup consisting of upper endoscopy, colonoscopy, capsule endoscopy, upper gastrointestinal series with small bowel follow through and push enteroscopy. Due to persistent abdominal pain and iron deficiency anemia the patient underwent push enteroscopy which revealed adenocarcinoma of the duodenum. The patient underwent en-bloc duodenectomy which revealed T3N1M0 adenocarcinoma of the 4th portion of the duodenum.ConclusionsPrimary duodenal carcinoma, although rare should be considered in the differential diagnosis of occult gastrointestinal bleeding when evaluation of the lower and upper GI tract is unremarkable. We discuss the current evaluation and management of this small bowel neoplasm.

Whole‐exome sequencing of duodenal adenocarcinoma identifies recurrent Wnt/β‐catenin signaling pathway mutations

“…Small bowel cancer, which accounts for merely 1% to 2% of gastrointestinal malignant lesions, is an exceedingly rare malignancy considering that the small intestine comprises 75% of the length of the alimentary tract and 90% of its surface mucosal area . Duodenal adenocarcinoma, the most frequent type of duodenum malignancy, is considered to be akin to distal gastric cancer with regard to both histopathologic features and patterns of recurrence and survival .…”

“…Duodenal adenocarcinoma, the most frequent type of duodenum malignancy, is considered to be akin to distal gastric cancer with regard to both histopathologic features and patterns of recurrence and survival . However, a vague presentation and inaccessibility for routine flexible endoscopy dramatically impede early and precise diagnosis, causing a large percentage of patients to be diagnosed at late stages of disease (TNM stage III and IV) . Meanwhile, to the best of our knowledge, little is known regarding the pathogenesis, prediction of prognosis, or determination of treatment in patients with duodenal adenocarcinoma.…”

SOX9 Is Highly Expressed in Nonampullary Duodenal Adenoma and Adenocarcinoma in Humans

“…Nonampullary duodenal adenoma and adenocarcinoma are uncommon lesions 1-3. With the widespread use of endoscopy, the number of reports of endoscopic therapy for these lesions has recently increased 4-8.…”

A case of primary adenocarcinoma of the third portion of the duodenum resected by laparoscopic and endoscopic cooperating surgery

“…Primary duodenal adenocarcinoma is uncommon, and only 14–45% occurs in the third or the fourth portion of the duodenum [3,5] . Anemia is one of the most common presenting symptoms and is associated with gastrointestinal bleeding [6,7] .…”