Lucandri Giorgio, Fiori Giulia, Lucchese Sara, Pende Vito, Farina Massimo, Giordano Marco, Santoro Emanuele
1st Department of Surgery, San Giovanni-Addolorata Hospital, Rome, Italy.
Department of Pathology, San Giovanni-Addolorata Hospital, Rome, Italy.
J Surg Case Rep. 2022 Sep 6;2022(9):rjac391. doi: 10.1093/jscr/rjac391. eCollection 2022 Sep.
Duodenal neuroendocrine tumors (NETs) account for <3% of all gastrointestinal NET. Most lesions are small-sized and are located in the first or second duodenal part. Tumoral grading, evaluated by Ki67 index, strongly influences patient's outcome. Endoscopic resection is recommended for lesions measuring <2 cm, while pancreaticoduodenectomy should be the treatment of choice for large duodenal NET; Whipple procedure should be preferred in case of duodenal origin and contiguity with gastric antrum. Involvement of surrounding structures, as well as the presence of resectable liver metastases, does not contraindicate surgical resection. Herein we report a case of a 68-year-old male, presenting with an extensive mass of the descending pre-ampullary duodenal part, with involvement of the right colon and the presence of a pericholecystic single liver metastasis. In spite of such advanced disease, surgery on the patient was successful, with an uneventful postoperative outcome.
十二指肠神经内分泌肿瘤(NETs)占所有胃肠道NET的比例不到3%。大多数病变体积较小,位于十二指肠第一部或第二部。通过Ki67指数评估的肿瘤分级对患者的预后有很大影响。对于直径小于2 cm的病变,建议进行内镜切除,而对于较大的十二指肠NET,胰十二指肠切除术应作为首选治疗方法;如果肿瘤起源于十二指肠且与胃窦相邻,则应首选Whipple手术。周围结构受累以及存在可切除的肝转移并不构成手术切除的禁忌证。在此,我们报告一例68岁男性患者,其十二指肠壶腹前降部有广泛肿块,累及右结肠,并存在胆囊周围单发性肝转移。尽管疾病已处于晚期,但该患者的手术仍获成功,术后恢复顺利。