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Presentamos el caso de una paciente celíaca de 19 años que es diagnosticada de adenocarcinoma de duodeno estenosante tras la realización de las pruebas complementarias de imagen que presentamos donde se objetiva un megaestómago que se extiende hasta pelvis, así como un comentario en cuanto a su diagnóstico y tratamiento, ya que supone una entidad muy poco frecuente a dicha edad y con un tratamiento quirúrgico definitivo aún en controversia., We present a case of a 19-year-old celiac patient who was diagnosed with stenosing adenocarcinoma of the duodenum after the complementary studies that we present. In these images, a mega-stomach that extends to the pelvis is observed. For this reason we make a comment about its diagnosis and treatment, because it is a very rare entity at this age and has a definitive surgical treatment still in controversy.

application/pdf, Introduction: Duodenal adenocarcinoma is a rare malignancy; recently, it has been found to be accompanied by operative indications., Methods: Nine consecutive rare cases were diagnosed with duodenal carcinoma （DC）, in which clinicopathological characteristics were retrospectively examined. Age was ranged over middle-aged males and females. No clinical onset with severe symptoms was observed, and the specific treatment for accompanied diseases or habits was not found., Outcomes: One case of two T1 stage DCs that underwent pancreas-sparing duodenectomy. Stage II DC was diagnosed in three cases, and stage III DC was diagnosed in four cases. Pancreaticoduodenectomy （PD） mainly occurred in seven patients, and duodenectomy was limited in two patients. All operations were safely performed, and the postoperative course showed no severe morbidity. Histological findings showed R0 resection in eight cases and R1 at the retroperitoneal dissecting part in one case. Five patients with advanced-stage DC underwent adjuvant chemotherapy; however, four patients showed tumor recurrence within 12months. With additional strong chemotherapy, eight patients survived up to 84months, and one died of liver metastasis at 43months after surgery. Three representative cases of mucosal invasion with widespread pancreas-sparing duodenectomy and advanced-stage DC cases undergoing duodenectomy or PD are shown., Conclusion: In the field of upper digestive tract surgery, duodenal adenocarcinoma and various applications of surgery or adjuvant chemotherapy for long-term survival are important.

Inflammatory and neoplastic diseases of the esophagus and duodenum cause a significant burden to healthcare and economies worldwide. Their etiology is multifactorial, but precursor lesions and risk factors are identifiable. Gastroesophageal reflux disease (GERD) is exceedingly common in western countries and causes the most medical health care expenses of all gastrointestinal diseases. GERD is the main risk factor for esophageal adenocarcinoma (EAC)––it can complicate into Barrett’s esophagus (BE) and further into esophageal adenocarcinoma. EAC has a poor overall prognosis still today, despite evolving management. High-quality prognostic biomarkers for EAC and progression of BE into cancer are lacking. Unlike esophageal diseases, nonampullary duodenal adenomas and adenocarcinoma (DAC) are rare neoplasias, although their incidence is slowly rising. In these rare diseases, the molecular pathological profiling is still incomplete, and the range of applicable prognostic biomarkers is very limited. Carbonic anhydrases (CA) are highly active, pH-controlling enzymes of the body. They participate in various physiological processes, but their primary function is to preserve optimal intra- and extracellular pH conditions in normal tissues. In cancer, CAII, CAIX, and CAXII seem to contribute to the development of malignant pH arrangement. The malignant pH gradient––slightly alkaline intracellular pH and extracellular acidosis––is in many ways critical to cancer progression, by benefiting cancer cell abilities to grow, migrate, invade, and metastasize. This study’s aim was to investigate the immunohistochemical expression patterns and potential roles of CAII, CAIX, and CAXII in the predisposing, premalignant and malignant conditions of distal esophagus and nonampullary duodenum. CA expression was evaluated in normal esophagus, GERD, Barrett’s esophagus, esophageal adenocarcinoma, normal duodenum, nonampullary duodenal adenomas and duodenal adenocarcinoma. The patient c, Tiivistelmä Ruokatorven ja pohjukaissuolen tulehdukselliset sairaudet ja kasvaimet aiheuttavat merkittäviä kustannuksia ja kuormittavat terveydenhuoltoa kaikkialla maailmassa. Näiden sairauksien etiologia on monitekijäinen, mutta hoidettavia esiasteita ja riskitekijöitä on tunnistettu ja niiden tutkiminen on potilaan hoidon ja ennusteen kannalta tärkeää. Ruokatorven refluksitauti on yleistynyt pitkään maailmanlaajuisesti. Sen hoito aiheuttaa nykyään suurimmat lääkehoidolliset kustannukset kaikista ruuansulatuskanavan sairauksista. Refluksitauti on myös ruokatorven adenokarsinooman merkittävin riskitekijä — Barrettin ruokatorvi on refluksitaudin komplikaatio ja ruokatorven adenokarsinooman esiaste. Ruokatorven adenokarsinooman ennuste on edelleen huono. Biomerkkiaineita ruokatorvisyövän ennusteen ja Barrettin ruokatorven muuntumisriskin selventämiseksi on etsitty pitkään, mutta käyttökelpoisia merkkiaineita ei ole juurikaan kliinisessä käytössä. Ei-ampullaarisen pohjukaissuolen adenoomat ja adenokarsinooma ovat sen sijaan hyvin harvinaisia kasvaimia. Tämän vuoksi niiden molekyylipatologisten ennustetekijöiden ja biomerkkiaineiden määritystyö on vielä epätäydellistä verrattuna yleisempiin syöpätyyppeihin. Hiilihappoanhydraasit (CA) ovat korkean aktiviteetin entsyymejä, jotka kontrolloivat pH:n muutoksia elimistössä. Ne osallistuvat lukuisiin kehon fysiologisiin prosesseihin, mutta niiden pääasiallinen tehtävä on säilyttää optimaaliset pH-olosuhteet soluissa ja niiden ulkopuolella. Syöpäsoluissa CAII, IX ja XII kuitenkin näyttävät olevan osallisina nk. pahanlaatuisen pH-gradientin syntymisessä. Tässä suhteessa niiden liiallinen tai liian vähäinen toiminta vaikuttaa olevan hyödyllistä syöpäsoluille. Tämän tutkimuksen tavoitteena oli selvittää CAII, IX ja XII:n immunohistokemiallinen ilmentyminen ja potentiaalinen merkitys ruokatorven ja pohjukaissuolen syövissä sekä niille altistavissa muutoksissa. Hiilihappoanhydraasien ilmentyminen määritettiin normaalissa ruokatorves

Background The malignant transformation of an ectopic pancreas in the duodenum is extremely rare. Herein, we report a case of an adenocarcinoma that arose from an ectopic pancreas. We also reviewed 14 cases of malignant transformations arising from an ectopic pancreas in the duodenum that were previously published. Case presentation An 81-year-old man with a 1-month history of vomiting was admitted to our institution. Esophagogastroduodenoscopy (EGD) and computed tomography (CT) scans revealed an obstruction at the first part of the duodenum. A distal gastrectomy was performed for diagnostic and therapeutic purposes. The histopathological examination of the resected specimen showed adenocarcinoma that arose from an ectopic pancreas (Heinrich type 1). The patient is alive without relapse at 18 months of follow-up. Conclusions Adenocarcinoma that arises from an ectopic pancreas should be considered when an obstruction is identified in the duodenum.

Background The malignant transformation of an ectopic pancreas in the duodenum is extremely rare. Herein, we report a case of an adenocarcinoma that arose from an ectopic pancreas. We also reviewed 14 cases of malignant transformations arising from an ectopic pancreas in the duodenum that were previously published. Case presentation An 81-year-old man with a 1-month history of vomiting was admitted to our institution. Esophagogastroduodenoscopy (EGD) and computed tomography (CT) scans revealed an obstruction at the first part of the duodenum. A distal gastrectomy was performed for diagnostic and therapeutic purposes. The histopathological examination of the resected specimen showed adenocarcinoma that arose from an ectopic pancreas (Heinrich type 1). The patient is alive without relapse at 18 months of follow-up. Conclusions Adenocarcinoma that arises from an ectopic pancreas should be considered when an obstruction is identified in the duodenum.

Periampullary adenocarcinoma, including pancreatic cancer, has a poor prognosis that has not improved in the last decades. Therefore, in order to find more effective treatment regimens, it is necessary to gain more insight into the biology and clinical behaviour of these tumours. This thesis entails a thorough histopathological characterization of retrospectively collected tumours from a consecutive cohort of patients with resected periampullary adenocarcinoma, followed by tissue microarray-based immunohistochemical studies of eight candidate protein biomarkers. Tumours were classified as being of pancreatobiliary type (PB-type) or intestinal type (I-type), using histological criteria, and all biomarker analyses were performed in strata according to morphological type. In Paper I, histopathological studies showed that a standardized and meticulous protocol for assessment of the surgical specimens, as well as blind revisions of slides, had impact on the decision on tumour origin, the number of involved lymph nodes and involved margins. The biomarker studies in Paper II revealed that expression of the global gene regulator special AT-rich sequencebinding protein 1 (SATB1) was an independent factor of poor prognosis in PB-type tumours. SATB1 expression, however, also indicated a better response to adjuvant chemotherapy, in particular in I-type tumours. A closely related protein, SATB2, was found to be expressed in a few tumours only, making it difficult to draw any firm conclusions on its prognostic value. In Paper III, biomarker studies on proteins related togemcitabine metabolism revealed that a high ratio between cytoplasmic and nuclear expression of human protein R (HuR) indicated resistance to chemotherapy in PB-type tumours. In I-type tumours, high expression of human equilibrative nucleoside transporter 1 (hENT1) was a favourable prognostic factor and high expression of deoxycytidine kinase (dCK) indicated sensitivity to chemotherapy. In Paper IV, biomarker stud