Clinicopathological evaluation of duodenal well-differentiated endocrine tumors

Abstract

Aim: To assess the clinicopathological characteristics of duodenal well-differentiated endocrine tumors.

Methods: We examined clinicopathological characteristics in 11 consecutive patients with duodenal well-differentiated endocrine tumors treated by endoscopic therapy or surgery in our hospital from 1992 through 2007. Patients with well-differentiated endocrine tumors of the papilla of Vater or with gastrinoma were excluded.

Results: Three patients received endoscopic treatment, and 8 underwent surgery. In patients who received endoscopic treatment, the tumor diameter was less than 1.0 cm, with no histopathological evidence of lymphovascular invasion or invasion of the muscularis. There were no complications such as late bleeding or perforation after treatment. Among 8 patients with tumors less than 1.0 cm in diameter, 3 underwent partial resection, and 2 underwent radical surgery. Three patients had lymphovascular invasion, 1 had invasion of the muscularis, and 1 had proximal lymph node metastasis. Among 3 patients with tumors 1.0 cm or more in diameter, 1 underwent partial resection, and 2 underwent radical surgery. One patient had lymphovascular invasion, with no lymph node metastasis. After treatment, all patients are alive and have remained free of metastasis and recurrence.

Conclusion: Duodenal well-differentiated endocrine tumors less than 1.0 cm in diameter have a risk of lymphovascular invasion, invasion of the muscularis, and lymph node metastasis, irrespective of procedural problems.

Figure 1

Upper gastrointestinal endoscopy showed a submucosal-tumor-like, protruding lesion 0.7 cm in diameter, arising in the anterior wall of the duodenal bulb. The top of the tumor was yellowish white, with dilated blood vessels.

Figure 2

Upper gastrointestinal endoscopy showed a homogenous, oval hypoechoic mass, mainly located in the third layer.

Figure 3

Histopathological examination. A: Macroscopic view of resected specimens obtained by endoscopic mucosal resection (hematoxylin and eosin staining). The longest diameter was 0.7 cm; B: Histopathological examination of specimens (hematoxylin and eosin staining, × 10) showed that cubic, atypical cells forming follicular or glandular patterns, with rounded nuclei and eosinophilic syncytia; C: Histopathological examination of specimens (chromogranin A staining, × 10) showed that tumors stained positively for chromogranin A.