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[PMID]:29480844
[Au] Autor:Wang X; Jin M; Ye Q; Wang M; Hu Y; Yang Y; Yang J; Cai J
[Ad] Endereço:Department of Oncology, First Affiliated Hospital of Yangtze University, Jingzhou.
[Ti] Título:Solitary duodenum metastasis from breast cancer with 8 years' latency: A case report.
[So] Source:Medicine (Baltimore);97(2):e9550, 2018 Jan.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Advanced breast cancer frequently metastasizes to the lungs, liver, and bones. Metastatic involvement of the duodenal bulb is extremely rare and difficult to detect by endoscopy. PATIENT CONCERNS: A 51-year-old menopausal woman presented with abdominal fullness and obstructive symptoms, and was diagnosed with adenocarcinoma in the duodenal bulb. The patient had undergone modified radical mastectomy of the left breast for infiltrating ductal carcinoma (IDC) 8 years previously. DIAGNOSIS: Metastatic infiltration of the duodenal bulb originating from IDC was proven histologically and immunohistochemically. INTERVENTIONS: She received chemotherapy with docetaxel and capecitabine followed by hormone maintenance therapy with letrozole after operation. OUTCOMES: After treatment, the patient recovered well. She is currently being followed up. LESSONS: Patients with known breast cancer history with the IDC histological type and presenting with nonspecific abdominal symptoms or signs, such as abdominal fullness, nausea, and vomiting, should undergo endoscopy with histopathological examination in order to detect possible gastrointestinal metastasis of the primary breast tumor. This report intends to alert people to heed this type of breast cancer metastasis and not treat it as a primary gastrointestinal tumor.
[Mh] Termos MeSH primário: Neoplasias da Mama/patologia
Carcinoma Ductal de Mama/patologia
Neoplasias Duodenais/secundário
[Mh] Termos MeSH secundário: Diagnóstico Diferencial
Neoplasias Duodenais/tratamento farmacológico
Neoplasias Duodenais/patologia
Neoplasias Duodenais/cirurgia
Feminino
Seres Humanos
Meia-Idade
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180227
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009550


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[PMID]:29309111
[Au] Autor:Ignjatovic M; Bezmarevic M; Cerovic S
[Ti] Título:Solitary extramedullary plasmacytoma of the duodenum and pancreas: A case report and review of the literature.
[So] Source:Vojnosanit Pregl;73(4):402-7, 2016 Apr.
[Is] ISSN:0042-8450
[Cp] País de publicação:Serbia
[La] Idioma:eng
[Ab] Resumo:Introduction: The extramedullary plasmacytomas (EMPs) are rare tumors of plasma cell disorders which are rarely found in the duodenum. We presented a case of solitary EMPs involving the duodenum and pancreas successfully treated by surgical resection after failure of chemotherapy. Case Report: A 55-year-old female with previously diagnosed solitary EMP of the duodenum was admitted to our institution after failure of three cycles of vincristine, adriablastine, dexamethasone (VAD) chemotherapy regimen with an upper gastrointestinal obstruction. On admission computed tomography of the abdomen showed tumor in the region of the second part of duodenum and uncinate process of the pancreas with a complete duodenal obstruction. Intraoperatively a tumor formation was in the region of the second duodenal part, originated from the wall of duodenum with the total diameter of 7 x 5 cm, covering the entire circumference of duodenal wall leaded to a narrowing of duodenal lumen to the thigh gap with an upper gastrointestinal obstruction. Infiltration in the head of the pancreas and uncinate process were also found. The Whipple's procedure was performed but postoperative course was complicated by rapidly refilling chylous ascites which was resolved 4 days after the surgery. Conclusion: Each patient with gastrointestinal EMPs should be considered separately and in timely manner, thus adequate treatment could provide local disease control.
[Mh] Termos MeSH primário: Neoplasias Duodenais/patologia
Neoplasias Pancreáticas/patologia
Plasmocitoma/patologia
[Mh] Termos MeSH secundário: Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico
Neoplasias Duodenais/tratamento farmacológico
Neoplasias Duodenais/cirurgia
Feminino
Seres Humanos
Obstrução Intestinal/etiologia
Meia-Idade
Invasividade Neoplásica
Neoplasias Pancreáticas/tratamento farmacológico
Neoplasias Pancreáticas/cirurgia
Plasmocitoma/tratamento farmacológico
Plasmocitoma/cirurgia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180213
[Lr] Data última revisão:
180213
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180109
[St] Status:MEDLINE
[do] DOI:10.2298/VSP141031142I


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[PMID]:28461144
[Au] Autor:Bourgouin S; Ewald J; Mancini J; Moutardier V; Delpero JR; Le Treut YP
[Ad] Endereço:Aix-Marseille University, APHM La Conception, Department of Surgery and Liver Transplantation, Marseille, France; Sainte Anne Military Teaching Hospital, Department of Oncologic and Digestive Surgery, Toulon, France. Electronic address: stephane_bourgouin@hotmail.fr.
[Ti] Título:Disease-free survival following resection in non-ductal periampullary cancers: A retrospective multicenter analysis.
[So] Source:Int J Surg;42:103-109, 2017 Jun.
[Is] ISSN:1743-9159
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Predictors of recurrence following pancreaticoduodenectomy are well described for ductal periampullary cancers but lack reliability for non-ductal tumors. The purpose of this study is to analyze the disease-free survival (DFS) and to define the predictors of recurrence following resection for ampullary (AC), bile duct (BDC) and duodenal cancers (DC). MATERIALS AND METHODS: Clinico-pathological data of patients operated on between 2001 and 2011 were retrospectively reviewed. The effect of lymphatic invasion was specified using the lymph node ratio (LNR) and the number of positive nodes (NPN), with thresholds calculated with the likelihood ratio. Kaplan-Meier disease-free survival (DFS) curves were compared for all covariates by a log-rank test. Multivariate logistic regression analyses were performed to identify predictors of recurrence. RESULTS: 135 patients were identified. Mean follow-up was 49 ± 35 months. Median DFS was not reached for AC and was 36 and 18 months for DC and BDC, respectively. Five-year DFS was 52%, 43% and 32% for AC, DC and BDC, respectively. Predictors of recurrence were T4 tumors, neural invasion and preoperative biliary drainage for DC, ≥3 positive nodes and ≥4% loss of BMI for AC, and T3-T4 tumors for BDC. CONCLUSION: Loss of BMI ≥4% is a strong predictor of recurrence in AC, and the recurrence risk increases with the total number of lymph nodes invaded (0; 1-3; ≥4). Only T stage influences recurrence for BDC. Considering DC, the adverse effect of preoperative biliary drainage should be validated in randomized series.
[Mh] Termos MeSH primário: Ampola Hepatopancreática
Neoplasias do Ducto Colédoco/cirurgia
Neoplasias Duodenais/cirurgia
Pancreaticoduodenectomia
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Ampola Hepatopancreática/cirurgia
Neoplasias do Ducto Colédoco/mortalidade
Neoplasias do Ducto Colédoco/patologia
Intervalo Livre de Doença
Neoplasias Duodenais/mortalidade
Neoplasias Duodenais/patologia
Feminino
Seres Humanos
Masculino
Meia-Idade
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180131
[Lr] Data última revisão:
180131
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE


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[PMID]:29262285
[Au] Autor:Kourkoumpetis T; Jarbrink-Sehgal ME
[Ad] Endereço:Baylor College of Medicine, Houston, TX kourkoum@bcm.edu.
[Ti] Título:Melanoma Metastatic to the Duodenum.
[So] Source:N Engl J Med;377(25):e34, 2017 Dec 21.
[Is] ISSN:1533-4406
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Neoplasias Duodenais/secundário
Melanoma/secundário
Neoplasias Cutâneas/patologia
[Mh] Termos MeSH secundário: Idoso de 80 Anos ou mais
Neoplasias Duodenais/patologia
Duodeno/patologia
Seres Humanos
Masculino
Melanoma/patologia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180108
[Lr] Data última revisão:
180108
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171221
[St] Status:MEDLINE
[do] DOI:10.1056/NEJMicm1702470


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[PMID]:29277816
[Au] Autor:Sreedhar A; Nair R; Scialla W
[Ad] Endereço:Department of Internal Medicine, Lehigh Valley Health Network, Allentown, PA, U.S.A. arshasreedhar@gmail.com.
[Ti] Título:Paraneoplastic Auto-immune Hemolytic Anemia: An Unusual Sequela of Enteric Duplication Cyst.
[So] Source:Anticancer Res;38(1):509-512, 2018 01.
[Is] ISSN:1791-7530
[Cp] País de publicação:Greece
[La] Idioma:eng
[Ab] Resumo:Enteric duplication (ED) cysts are rare congenital anomalies of the alimentary canal that present in childhood. Although benign in most case, ED cysts have the potential to cause complications including a rare association with secondary carcinomas. Autoimmune hemolytic anemia presenting as a paraneoplastic syndrome secondary to solid tumors is an unusual phenomenon. Here we report a patient case with ED cyst described in association with intestinal adenocarcinoma and warm-auto immune hemolytic anemia, with resolution of the hemolysis upon its surgical resection.
[Mh] Termos MeSH primário: Adenocarcinoma/diagnóstico
Adenocarcinoma/cirurgia
Anemia Hemolítica Autoimune/tratamento farmacológico
Neoplasias Duodenais/diagnóstico
Neoplasias Duodenais/cirurgia
[Mh] Termos MeSH secundário: Adenocarcinoma/patologia
Anemia Hemolítica Autoimune/diagnóstico
Anemia Hemolítica Autoimune/patologia
Anti-Inflamatórios/uso terapêutico
Cistos/diagnóstico
Cistos/cirurgia
Progressão da Doença
Neoplasias Duodenais/patologia
Duodeno/patologia
Glucocorticoides/uso terapêutico
Seres Humanos
Masculino
Meia-Idade
Prednisona/uso terapêutico
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Inflammatory Agents); 0 (Glucocorticoids); VB0R961HZT (Prednisone)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180104
[Lr] Data última revisão:
180104
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171227
[St] Status:MEDLINE


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[PMID]:28448856
[Au] Autor:D'Ambrosio L; Palesandro E; Boccone P; Tolomeo F; Miano S; Galizia D; Manca A; Chiara G; Bertotto I; Russo F; Campanella D; Venesio T; Sangiolo D; Pignochino Y; Siatis D; De Simone M; Ferrero A; Pisacane A; Dei Tos AP; Aliberti S; Aglietta M; Grignani G
[Ad] Endereço:Sarcoma Unit, Division of Medical Oncology Candiolo Cancer Institute - FPO, IRCCS, Strada Provinciale 142, Km 3.95, 10060 Candiolo, TO, Italy; University of Torino, Department of Oncology, Regione Gonzole, 10, 10043 Orbassano, TO, Italy.
[Ti] Título:Impact of a risk-based follow-up in patients affected by gastrointestinal stromal tumour.
[So] Source:Eur J Cancer;78:122-132, 2017 06.
[Is] ISSN:1879-0852
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Follow-up aims to precociously identify recurrences, metastases or treatment-related adverse events so as to undertake the appropriate therapy. Guidelines admit lack of knowledge on optimal surveillance schedule, but suggest follow-up based on experts' opinion and risk stratification. To identify the impact, if any, of regular follow-up, we interrogated our prospectively collected database whether early detection of recurrences affected both clinical management and, likely, the outcome. PATIENTS AND METHODS: We required information to be available on primary surgery and ≥3°years of follow-up for non-recurring patients. We analysed recurrence characteristics (asymptomatic versus symptomatic, low- versus high tumour burden) and computed tomography (CT) scan counts to detect one recurrence. Kaplan-Meier method estimated recurrence-free survival (RFS), post-recurrence progression-free survival (PR-PFS), and disease-specific overall survival (OS). Comparisons used Hazard ratios (HR) with 95% confidence intervals (CIs). Multivariate analyses employed the Cox proportional hazards model. All tests were two-sided. RESULTS: Between 01/2001 and 12/2012 we found 233 study-eligible patients. Estimated 5- and 10-year RFS were 61.8% and 50.4%, respectively. After a 68-month median follow-up, we observed 94 (40.3%) recurrences [73/94 (77.7%) asymptomatic versus 21/94 (22.3%) symptomatic and 45/94 (47.9%) low- versus 49/94 (52.1%) high tumour burden]. Multivariate analysis revealed that symptomatic and high tumour burden recurrences were highly predictive of both worse PR-PFS (HR:3.19, P < 0.001; HR:2.80, P = 0.003, respectively) and OS (HR:3.65, P < 0.001; HR:2.38, P = 0.026, respectively). Finally, 29 second (primary) cancers were detected during follow-up. CONCLUSIONS: Regular follow-up detects recurrences at an earlier stage and may be associated with a better PR-PFS and OS for these patients. In the absence of randomised trials, these evidences support follow-up effort and cost.
[Mh] Termos MeSH primário: Neoplasias Gastrointestinais/cirurgia
Tumores do Estroma Gastrointestinal/cirurgia
[Mh] Termos MeSH secundário: Adulto
Assistência ao Convalescente
Idoso
Idoso de 80 Anos ou mais
Neoplasias do Colo/mortalidade
Neoplasias do Colo/cirurgia
Neoplasias Duodenais/mortalidade
Neoplasias Duodenais/cirurgia
Feminino
Neoplasias Gastrointestinais/mortalidade
Tumores do Estroma Gastrointestinal/mortalidade
Seres Humanos
Estimativa de Kaplan-Meier
Masculino
Meia-Idade
Recidiva Local de Neoplasia/mortalidade
Recidiva Local de Neoplasia/cirurgia
Estudos Prospectivos
Neoplasias Retais/mortalidade
Neoplasias Retais/cirurgia
Fatores de Risco
Neoplasias Gástricas/mortalidade
Neoplasias Gástricas/cirurgia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1708
[Cu] Atualização por classe:171230
[Lr] Data última revisão:
171230
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170428
[St] Status:MEDLINE


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[PMID]:29215473
[Au] Autor:Kallenberg FGJ; Latchford A; Lips NC; Aalfs CM; Bastiaansen BAJ; Clark SK; Dekker E
[Ad] Endereço:Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
[Ti] Título:Duodenal Adenomas in Patients With Multiple Colorectal Adenomas Without Germline APC or MUTYH Mutations.
[So] Source:Dis Colon Rectum;61(1):58-66, 2018 Jan.
[Is] ISSN:1530-0358
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Patients with genetic adenomatous polyposis syndromes have an increased risk for duodenal cancer, and clear surveillance recommendations exist for this group. However, limited data are available on the duodenal phenotype of patients with multiple colorectal adenomas (10-99) without a germline APC or MUTYH mutation. OBJECTIVE: We aimed to assess the frequency, extent, and progression of duodenal adenomas in patients with multiple colorectal adenomas without a germline APC or MUTYH mutation. DESIGN: This was an historical cohort study. SETTINGS: This study was undertaken at 2 polyposis registries: the Academic Medical Center in the Netherlands, and St. Mark's Hospital in the United Kingdom. PATIENTS: We collected data on all patients with 10 to 99 colorectal adenomas and absent APC and MUTYH mutations, who underwent ≥1 esophagogastroduodenoscopy. MAIN OUTCOME MEASURES: The frequency, extent, and progression of duodenal adenomas were measured. Demographic and endoscopic data were collected, described, and compared between patients with and without duodenal adenomas. RESULTS: Eighty-three patients were identified, of which 8 (9.6%) had duodenal adenomas, detected at a median of 58 years (range, 45-75 y). Duodenal adenomas were detected in 6 of 8 patients at first esophagogastroduodenoscopy. At diagnosis, all 8 patients had Spigelman stage I or II disease. Two of 5 patients with duodenal adenomas who underwent follow-up esophagogastroduodenoscopies increased to stage III disease. The other 3 remained stable. No one developed duodenal cancer. No differences in demographic and endoscopic data were found between patients with and without duodenal adenomas. LIMITATIONS: This study was limited by its retrospective design, selection bias, and small sample size. CONCLUSIONS: Duodenal adenomas are found in a minority of patients with multiple colorectal adenomas without a germline APC or MUTYH mutation, at an average age of 58 years, and, at diagnosis, disease severity is mild. These results are a first step in unraveling the duodenal phenotype of these patients, which is needed to provide appropriate upper GI screening and surveillance recommendations. See Video Abstract at http://links.lww.com/DCR/A357.
[Mh] Termos MeSH primário: Polipose Adenomatosa do Colo/genética
DNA Glicosilases/genética
Neoplasias Duodenais/genética
Genes APC/fisiologia
[Mh] Termos MeSH secundário: Adenoma/epidemiologia
Adenoma/genética
Polipose Adenomatosa do Colo/epidemiologia
Idoso
Neoplasias Duodenais/epidemiologia
Feminino
Mutação em Linhagem Germinativa
Seres Humanos
Masculino
Meia-Idade
Países Baixos/epidemiologia
Sistema de Registros
Estudos Retrospectivos
Reino Unido/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Nm] Nome de substância:
EC 3.2.2.- (DNA Glycosylases); EC 3.2.2.- (mutY adenine glycosylase)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171215
[Lr] Data última revisão:
171215
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171208
[St] Status:MEDLINE
[do] DOI:10.1097/DCR.0000000000000868


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[PMID]:29049170
[Au] Autor:Guo X; Yu Y; Wang M; Qin R
[Ad] Endereço:Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
[Ti] Título:Case report of a congenital duodenal transverse septum causing partial obstruction.
[So] Source:Medicine (Baltimore);96(42):e7093, 2017 Oct.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Duodenal obstructions caused by congenital anatomic abnormalities are rare in adults. Several patients in whom the duodenal obstruction was caused by a congenital duodenal diaphragm have been described. The duodenal obstruction in the patient presented herein was caused by a transverse septum, which has not been previously reported. A transverse septum is usually observed in the vagina; those involving the digestive tract have been rarely observed. CASE PRESENTATION: We herein report a case involving a 69-year-old woman with a congenital duodenal transverse septum causing partial obstruction. She was admitted to our hospital with a 3-month history of epigastric pain and vomiting. Upper gastrointestinal endoscopy, iodinated water-soluble contrast imaging, and abdominal computed tomography revealed dilation of the stomach and a neoplasm in the descending part of the duodenum. The patient was suspected to have a tumor in the descending part of the duodenum. Exploratory laparotomy showed a banded duodenal transverse septum at the junction of the second part of the duodenum. The duodenal transverse septum was approximately 2 mm thick and 1 cm wide and divided the duodenal lumen into 2 parts. The duodenal papillae were completely normal and located under the duodenal transverse septum. Histopathological analysis of the transverse septum showed that it was similar to the organizational structure of the duodenal wall. CONCLUSION: The possibility of congenital disease should be considered in older patients with intestinal obstruction, even when imaging studies reveal a duodenal neoplasm.
[Mh] Termos MeSH primário: Obstrução Duodenal/congênito
Duodeno/anormalidades
[Mh] Termos MeSH secundário: Dor Abdominal/etiologia
Idoso
Diagnóstico Diferencial
Neoplasias Duodenais/diagnóstico
Obstrução Duodenal/complicações
Obstrução Duodenal/diagnóstico
Feminino
Seres Humanos
Vômito/etiologia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171122
[Lr] Data última revisão:
171122
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171020
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000007093


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[PMID]:28991077
[Au] Autor:Sourrouille I; Lefèvre JH; Shields C; Colas C; Bellanger J; Desaint B; Paye F; Tiret E; Parc Y
[Ad] Endereço:1 Department of Digestive Surgery, Hôpital Saint-Antoine, Paris, France 2 Mater Misericordiae University Hospital, Dublin, Ireland 3 Laboratory of Angiogenetics and Oncogenetics, Hôpital Pitié-Salpétrière, Paris, France 4 Centre de Prise en Charge Multidisciplinaire des Personnes Predisposes Héréditairement au Cancer Colorectal, Hôpital Saint-Antoine, Paris, France 5 Department of Digestive Endoscopy, Hôpital Saint-Antoine, Université Pierre et Marie Curie, Paris, France.
[Ti] Título:Surveillance of Duodenal Polyposis in Familial Adenomatous Polyposis: Should the Spigelman Score Be Modified?
[So] Source:Dis Colon Rectum;60(11):1137-1146, 2017 Nov.
[Is] ISSN:1530-0358
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Duodenal polyposis is a manifestation of adenomatous polyposis that predisposes to duodenal or ampullary adenocarcinoma. Duodenal polyposis is monitored by upper GI endoscopies and may require iterative resections and prophylactic radical surgical treatment when malignancy is threatening. OBJECTIVE: The purpose of this study was to evaluate severity scoring for surveillance and treatment in a large series of duodenal polyposis. DESIGN: From 1982 to 2014, every patient surveyed by upper GI endoscopies for duodenal polyposis was included. SETTINGS: The study was conducted at a single tertiary care center. PATIENTS: We performed 1912 upper GI endoscopies in 437 patients (median = 3; interquartile range, 2-6 endoscopies). MAIN OUTCOME MEASURES: Conservative treatment was performed in 103 patients (159 endoscopic and 17 surgical resections), whereas radical surgical treatment (Whipple procedure or duodenectomy) was required in 52 (median age, 47.5 y; range, 43.0-57.3 y) because of high-grade dysplasia or unresectable lesions. RESULTS: Genes involved were APC (n = 274; 62.7%) and MUTYH (n = 21; 4.8%). First upper GI endoscopies (median age, 32 y; range, 21-44 y) revealed duodenal polyposis in 190 (43.5%). Rates of low-grade dysplasia, high-grade dysplasia, and duodenal or ampulary adenocarcinoma at 5 years were 65% (range, 61.7%-66.9%), 12.1% (range, 10.3%-13.9%), and 2.4% (range, 1.5%-3.3%), whereas 10-year rates were 75.8% (range, 73.1%-78.5%), 20.8% (range, 18.2%-23.4%), and 5.4% (range, 3.8%-7.0%). The rate of ampullary abnormalities rose during surveillance from 18.3% at the first upper GI endoscopies to 47.4% at the fourth. Predictive factors for high-grade dysplasia were age at first upper GI endoscopy, type and age of colorectal surgery, Spigelman score, presence of an ampullary abnormality, and number of endoscopic treatments. In multivariate analysis, only age at first upper GI endoscopy and presence of an ampullary abnormality were independent predictive factors. Histologic analysis after radical surgical treatment showed high-grade dysplasia in 30 patients and duodenal or ampulary adenocarcinoma in 11 (4 patients had lymph node involvement). LIMITATIONS: The study was limited by its retrospective analysis of a prospective database. CONCLUSIONS: More than 20% of patients developed high-grade dysplasia with duodenal polyposis after 10 years. Iterative endoscopic resections allowed extended control, but surgery remained necessary in 12% of the patients and happened too late in many cases; 20% of those operated had developed duodenal or ampulary adenocarcinoma, whereas 8% exhibited malignancy with lymph node involvement. The trigger for prophylactic surgery required a more accurate predictive score leading to closer endoscopic surveillance. Modifying the Spigelman score by accounting for ampullary abnormalities should be considered as a means to increase compliance with closer endoscopic follow-up in high-risk patients. See Video Abstract at http://links.lww.com/DCR/A430.
[Mh] Termos MeSH primário: Polipose Adenomatosa do Colo/diagnóstico
Assistência ao Convalescente/métodos
Neoplasias Duodenais/diagnóstico
Duodeno/diagnóstico por imagem
Endoscopia Gastrointestinal
[Mh] Termos MeSH secundário: Polipose Adenomatosa do Colo/patologia
Neoplasias Duodenais/patologia
Duodeno/patologia
Seres Humanos
Estadiamento de Neoplasias
[Pt] Tipo de publicação:EDITORIAL
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171106
[Lr] Data última revisão:
171106
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171010
[St] Status:MEDLINE
[do] DOI:10.1097/DCR.0000000000000903


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[PMID]:28991073
[Au] Autor:Tierney J; Vitale GC
[Ad] Endereço:Louisville, Kentucky.
[Ti] Título:Spigelman Scoring System Underestimates the Risk of Ampullary and Duodenal Carcinoma in Patients With Familial Adenomatous Polyposis With Duodenal Polyposis.
[So] Source:Dis Colon Rectum;60(11):1119-1120, 2017 11.
[Is] ISSN:1530-0358
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Polipose Adenomatosa do Colo
Neoplasias Duodenais
[Mh] Termos MeSH secundário: Seres Humanos
Pólipos Intestinais
Risco
[Pt] Tipo de publicação:JOURNAL ARTICLE; COMMENT
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171107
[Lr] Data última revisão:
171107
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171010
[St] Status:MEDLINE
[do] DOI:10.1097/DCR.0000000000000908



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