Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
권호 표지

Endoscopic Resection of an Adenocarcinoma Arising from a Sporadic Tubulovillous Adenoma of the Duodenum

십이지장 대롱융모샘종에서 기인한 샘암종에 대한 내시경 절제술

  • Seok, Hwa-Young (Department of Internal Medicine, East-West Neo Medical Center, Kyunghee University College of Medicine) ;
  • Cha, Jae-Myung (Department of Internal Medicine, East-West Neo Medical Center, Kyunghee University College of Medicine) ;
  • Lee, Joung-Il (Department of Internal Medicine, East-West Neo Medical Center, Kyunghee University College of Medicine) ;
  • Joo, Kwang-Ro (Department of Internal Medicine, East-West Neo Medical Center, Kyunghee University College of Medicine) ;
  • Shin, Hyun-Phil (Department of Internal Medicine, East-West Neo Medical Center, Kyunghee University College of Medicine) ;
  • Jung, Sung-Won (Department of Internal Medicine, East-West Neo Medical Center, Kyunghee University College of Medicine) ;
  • Jang, Na-Eun (Department of Internal Medicine, East-West Neo Medical Center, Kyunghee University College of Medicine)
  • 석화영 (경희대학교 의과대학 동서신의학병원 내과학교실) ;
  • 차재명 (경희대학교 의과대학 동서신의학병원 내과학교실) ;
  • 이정일 (경희대학교 의과대학 동서신의학병원 내과학교실) ;
  • 주광로 (경희대학교 의과대학 동서신의학병원 내과학교실) ;
  • 신현필 (경희대학교 의과대학 동서신의학병원 내과학교실) ;
  • 정성원 (경희대학교 의과대학 동서신의학병원 내과학교실) ;
  • 장나은 (경희대학교 의과대학 동서신의학병원 내과학교실)
  • Received : 2010.03.12
  • Accepted : 2010.05.30
  • Published : 2010.08.30
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Abstract

Duodenal tumors may pose diagnostic difficulties in asymptomatic young patients because the duodenum may be overlooked during routine upper gastrointestinal endoscopy and because duodenal tumors are rare and present non-specific signs and symptoms. Although adenomas are the most common duodenal tumors, adenocarcinoma arising from sporadic tubulovillous adenoma without familial adenomatous polyposis is an uncommon condition in young patients. In patients with sporadic duodenal adenomas, the prevalence of colorectal adenomas is higher than prevalence for the general population. Herein, we report the case of a 27-year male with adenocarcinoma arising from a sporadic tubulovillous adenoma of the duodenum. The tumor was completely resected by endoscopic resection. Synchronous colon adenoma was also detected and treated by endoscopic mucosal resection.

십이지장 종양은 드물고 특별한 증상이나 징후가 없으며, 일상적인 상부위장관 내시경 검사에서 십이지장을 간과할 수 있기 때문에 증상이 없는 젊은 연령의 십이지장 종양은 진단이 어려울 수 있다. 십이지장 종양들 중 샘종이 가장 흔하지만, 가족샘종폴립증을 동반하지 않고 젊은 연령에서 십이지장의 산발적 대롱융모샘종으로부터 샘암종이 발생하는 것은 드문 현상이다. 한편, 산발적 십이지장 샘종 환자에서 대장 샘종의 유병률은 일반인에 비해 높다고 알려져 있다. 저자들은 27세 남자에서 십이지장의 산발적 대롱융모샘종으로부터 기인한 샘암종을 내시경 절제술로 완전 절제하였고, 이 환자에서 대장의 동시성 샘종을 발견하고 내시경 점막절제술로 치료하였기에 이를 보고한다.

Keywords

References

  1. Perzin KH, Bridge MF. Adenomas of the small intestine: a clinicopathologic review of 51 cases and a study of their relationship to carcinoma. Cancer 1981;48:799-819. https://doi.org/10.1002/1097-0142(19810801)48:3<799::AID-CNCR2820480324>3.0.CO;2-Q
  2. Kerremans RP, Lerut J, Penninckx FM. Primary malignant duodenal tumors. Ann Surg 1979;190:179-182. https://doi.org/10.1097/00000658-197908000-00010
  3. Spira IA, Ghazi A, Wolff WI. Primary adenocarcinoma of the duodenum. Cancer 1977;39:1721-1726. https://doi.org/10.1002/1097-0142(197704)39:4<1721::AID-CNCR2820390450>3.0.CO;2-M
  4. Bal A, Joshi K, Vaiphei K, Wig JD. Primary duodenal neoplasms: a retrospective clinico-pathological analysis. World J Gastroenterol 2007;13:1108-1111. https://doi.org/10.3748/wjg.v13.i7.1108
  5. Ryder NM, Ko CY, Hines OJ, Gloor B, Reber HA. Primary duodenal adenocarcinoma: a 40-year experience. Arch Surg 2000;135:1070-1074. https://doi.org/10.1001/archsurg.135.9.1070
  6. Witteman BJ, Janssens AR, Griffioen G, Lamers CB. Villous tumours of the duodenum. An analysis of the literature with emphasis on malignant transformation. Neth J Med 1993;42: 5-11.
  7. Sellner F. Investigations on the significance of the adenomacarcinoma sequence in the small bowel. Cancer 1990;66:702-715. https://doi.org/10.1002/1097-0142(19900815)66:4<702::AID-CNCR2820660419>3.0.CO;2-Z
  8. Moss WM, McCart PM, Juler G, Miller DR. Primary adenocarcinoma of the duodenum. Arch Surg 1974;108:805-807. https://doi.org/10.1001/archsurg.1974.01350300047013
  9. Solem CA, Harmsen WS, Zinsmeister AR, Loftus EV Jr. Small intestinal adenocarcinoma in Crohn's disease: a case-control study. Inflamm Bowel Dis 2004;10:32-35. https://doi.org/10.1097/00054725-200401000-00005
  10. Heniford BT, Iannitti DA, Evans P, Gagner M, Henderson JM. Primary nonampullary/periampullary adenocarcinoma of the duodenum. Am Surg 1998;64:1165-1169.
  11. Tocchi A, Mazzoni G, Puma F, et al. Adenocarcinoma of the third and fourth portions of the duodenum: results of surgical treatment. Arch Surg 2003;138:80-85. https://doi.org/10.1001/archsurg.138.1.80
  12. Nakayoshi T, Tajiri H, Matsuda K, Kaise M, Ikegami M, Sasaki H. Magnifying endoscopy combined with narrow band imaging system for early gastric cancer: correlation of vascular pattern with histopathology (including video). Endoscopy 2004; 36:1080-1084. https://doi.org/10.1055/s-2004-825961
  13. Machida H, Sano Y, Hamamoto Y, et al. Narrow-band imaging in the diagnosis for colorectal mucosal lesions: a pilot study. Endoscopy 2004;36:1094-1098. https://doi.org/10.1055/s-2004-826040
  14. Murray MA, Zimmerman MJ, Ee HC. Sporadic duodenal adenoma is associated with colorectal neoplasia. Gut 2004;53: 261-265. https://doi.org/10.1136/gut.2003.025320
  15. Dariusz A, Jochen R. Increased prevalence of colorectal adenoma in patients with sporadic duodenal adenoma. Eur J Gastroenterol Hepatol 2009;21:816-818. https://doi.org/10.1097/MEG.0b013e328306c7cc
  16. Oka S, Tanaka S, Nagata S, et al. Clinicopathologic features and endoscopic resection of early primary nonampullary duodenal carcinoma. J Clin Gastroenterol 2003;37:381-386. https://doi.org/10.1097/00004836-200311000-00006
  17. Hirasawa T, Iishi H, Tatsuta M, Ishigura S. Clinicopathologic features and endoscopic resection of duodenal adenocarcinomas and adenomas with the submucosal saline injection technique. Gastrointest Endosc 1997;46:507-513. https://doi.org/10.1016/S0016-5107(97)70005-1
  18. Nagatani K, Takekoshi T, Baba Y, et al. Indications for endoscopic treatment of early duodenal cancer: based on cases reported in the literature. Endosc Digest 1993;7:969-976.
  19. Tada T, Arai J, Ohta A, et al. Successful endoscopic resection of an early carcinoma of the duodenum. Diagn Ther Endosc 1999;5:239-244. https://doi.org/10.1155/DTE.5.239