Duodenal Signet Ring Cell Carcinoma in a Celiac Patient

Successful endoscopic mucosal resection for non-ampullary duodenal signet-ring cell carcinoma

We present a case of non-ampullary duodenal signet-ring cell carcinoma treated by endoscopic mucosal resection. The patient is a 61-year-old male with a history of coronary artery bypass grafting, hypertension, dyslipidemia, and diabetes mellitus complicated by end-stage renal disease requiring peritoneal dialysis who presented for routine endoscopic screening. A 9 mm protruding mass was found in the second part of the duodenum, proximal to the ampulla of Vater. Biopsy of the mass revealed proliferation of signet-ring cells with vacuolated foamy cytoplasm and displaced ovoid nuclei, consistent with signet-ring cell carcinoma. We performed endoscopic mucosal resection and achieved margin-free resection without complications. No recurrence was seen during the 24 months of follow-up. Duodenal signet-ring cell carcinoma is a rare entity most commonly occurring in the ampulla of Vater. This is the first report of successful endoscopic mucosal resection for early non-ampullary duodenal signet-ring cell carcinoma.

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

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Laparoscopic and endoscopic cooperating surgery (LECS) enabled en bloc resection with adequate surgical margins and secure intra-abdominal suturing for duodenal neoplasms.

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Thorough mobilization of the mesocolon and pancreas head is essential for this procedure because it facilitates correct resection and suturing.

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LECS is a feasible treatment option for duodenal neoplasms.

Introduction

We report a case of primary adenocarcinoma in the third portion of the duodenum (D3) curatively resected by laparoscopic and endoscopic cooperating surgery (LECS).

Presentation of case

A 65-year-old woman had a routine visit to our hospital for a follow-up of rectal cancer resected curatively 2 years ago. A routine screening gastroduodenal endoscopy revealed an elevated lesion of 20 mm in diameter in the D3. The preoperative diagnosis was adenoma with high-grade dysplasia; however, suspicion about potential adenocarcinoma was undeniable. Curative resection was performed by LECS. Pathological examination revealed intramucosal adenocarcinoma arising from normal duodenal mucosa. The tumor was stage I (T1/N0/M0) in terms of the tumor, nodes, metastasis (TNM) classification. LECS for duodenal tumor has seldom been reported previously, and this is the first report of LECS for primary adenocarcinoma in the D3. The transverse mesocolon was removed from the head of pancreas to expose the duodenum, and the accessory right colic vein was cut; this was followed by the Kocher maneuver for mobilization of the lesion site.

Discussion

LECS enabled en bloc resection with adequate surgical margins and secure intra-abdominal suturing. Thorough mobilization of the mesocolon and pancreas head is essential for this procedure because it facilitates correct resection and suturing.

Conclusion

LECS is a feasible treatment option for duodenal neoplasms, including intramucosal adenocarcinoma, even though it exists in the D3.

Signet Ring Cell Lymphoma of the Small Bowel: A case report

Gastrointestinal lymphoma of the bowel is uncommon compared to adenocarcinoma. Signet ring cell lymphoma (SRCL) is a rare variant of non-Hodgkin's lymphoma that is characterized by clear cytoplasm with displaced nuclei to the periphery giving a signet ring appearance. Small bowel involvement has not been previously reported. We report the rare case of a 78-year-old female who presented with short history of fever, loss of appetite, nausea, vomiting, mild weight loss with abdominal discomfort and was later diagnosed to have SRCL of the ileum.