Papillary adenocarcinoma arising in a tubular duplication of the jejunum

Adenocarcinoma of Jejunal Duplication Cyst-Case Report and Review of Literature

Alimentary tract duplication cyst refers to congenital malformations that involve the mesenteric side of bowel and share a common wall or blood supply with the bowel. Duplication cyst occurs in any segment of the gastrointestinal tract from mouth to anus, but is more commonly seen in the mesentery of the ileo-colic region. Duplication cyst presents more frequently in children with abdominal pain or swelling. In adults, the diagnosis of duplication cyst is incidental and can present with complications like bleed, fistula formation, inflammatory mass, and rarely malignant transformation. English-language literature review has shown only three cases of malignancies reported so far associated with jejunal duplication cyst. A case of incidentally detected metastatic adenocarcinoma in a jejunal duplication cyst is being reported here, along with literature review of malignancies associated with small bowel duplication cyst.

Adenocarcinoma originating from a completely isolated duplication cyst of the mesentery in an adult

Alimentary tract duplications are uncommon congenital abnormalities that usually have an anatomical connection with some part of the gastrointestinal tract and have a common blood supply with the adjacent segment of intestine. A completely isolated duplication cyst (CIDC) is a very rare type of gastrointestinal duplication that does not communicate with the normal bowel segment and possesses its own exclusive blood supply. Only 5 CIDC cases in adults have been reported in the English medical literature. Additionally, only 1 case of mucinous cystadenoma from an infected CIDC of the ileum has been reported. This report describes a 52-year-old male patient with a peritoneal CIDC, which upon curative excision was found to have given rise to an adenocarcinoma. The latter was lined internally with malignant glandular cells and contained a smooth muscular outer layer as determined by microscopic examination of the tissue. We believe that this is the first reported case of an adenocarcinoma originating from a CIDC in an adult.

Gastroesophageal Heterotopia and HER2/neu Overexpression in an Adenocarcinoma Arising From a Small Bowel Duplication

Small bowel duplications are congenital structures commonly lined by heterotopic gastric or pancreatic mucosa. Though benign in children, small bowel duplications have the potential for malignant degeneration in adulthood. Here, we present the first reported case of metastatic adenocarcinoma arising from a small bowel duplication lined by gastroesophageal mucosa. The cancer demonstrated overexpression of the HER2/neu oncoprotein and amplification of the HER2/neu gene. This represents the only report of HER2 overexpression in this type of lesion. The patient is being treated with traditional chemotherapeutic agents in addition to monoclonal antibody therapy directed at the HER2 protein, and has demonstrated a clinical benefit from treatment. This case demonstrates that the anatomic location of a mass may be distinct from its biological origin, and this difference may have important practical implications for diagnostic testing and treatment.

Clinical and pathological analysis of malignancies arising from alimentary tract duplications

BACKGROUND

Malignant change is a rare complication of alimentary tract duplications.

METHODS

Articles concerning malignancies arising from alimentary tract duplications published from 1955 to 2012 on PubMed were extensively reviewed. These cases were reclassified and analyzed according to sites of clinical manifestations, diagnostic examinations, methods of management, pathological findings, clinical staging and prognosis.

RESULTS

There were 64 citations in the literature that provided adequate descriptions of 67 cases of malignancies arising from alimentary tract duplications near the oesophagus (n = 6), stomach (n = 10), small intestine (n = 19), appendix (n = 1) and large intestine (n = 31). Among the cases described above, 57 underwent surgical treatment. In 43 patients with known prognosis, 7 died of tumour progression. In another 5 cases, the tumours recurred and metastasized recurred and metastasised after surgery at an average of 11.4 months.

CONCLUSIONS

For relieving symptoms and preventing malignant change, all duplications should be considered for surgery. Unfortunately, prognosis is generally poor once malignancy has occurred in the duplications.

Outcome of alimentary tract duplications operated on by minimally invasive surgery: a retrospective multicenter study by the GECI (Groupe d'Etude en Coeliochirurgie Infantile)

BACKGROUND

Alimentary tract duplications (ATD) are a rare cause of intestinal obstruction in childhood. There are many case reports but few series about laparoscopy or thoracoscopy for ATD. The aim of our study was to report the outcome of minimally invasive surgery (MIS) for ATD.

METHODS

This was a retrospective multicenter study from the GECI (Groupe d'Etude en Coeliochirurgie Infantile). We reviewed the charts of 114 patients operated on by MIS for ATD from 1994 to 2009.

RESULTS

Sixty-two patients (54 %) had a prenatal diagnosis. Forty-nine patients (43 %) were symptomatic before surgery: 33 of those patients (63 %) with postnatal diagnosis compared to 16 (25 %) with prenatal diagnosis (P < 0.01). In this last group, the median age at onset of symptoms was 16 days (range = 0-972). One hundred and two patients had laparoscopy (esophageal to rectal duplications) and 12 patients had thoracoscopy for esophageal duplications. The mean operative time was 90 min (range = 82-98). There were 32 (28 %) resection anastomoses, 55 (48 %) enucleations, and 27 (24 %) unroofings. The conversion rate was 32 %, and in a multivariate analysis, it was significantly higher, up to 41 % for patients weighing <10 kg (P < 0.01). Ten patients (8 %) had unintentional perioperative opening of the digestive tract during the dissection. Eight patients had nine postoperative complications, including six small bowel obstructions. The median length of hospital stay was 4 days (range = 1-21) without conversion and 6 days (range = 1-27) with conversion (P = 0.01). The median follow-up was 3 months (range = 1-120). Eighteen of the 27 patients who underwent partial surgery had an ultrasound examination during follow-up. Five (18 %) of them had macroscopic residue.

CONCLUSION

This study showed that MIS for ATD is feasible with a low rate of complications. Patients with prenatal diagnosis should have prompt surgery to prevent symptoms, despite a high rate of conversion in small infants.

Adenocarcinoma arising in a cystic duplication of the small bowel: case report and review of literature

Enteric duplications are rare, but can occur anywhere along the digestive tract. Most of the patients become symptomatic in early childhood and only a few cases of adult patients have been reported in literature. Here we report a unique case of an adenocarcinoma arising in a coincidentally found cystic duplication of the small bowel.