AI Article Synopsis
- Periampullary tumors, though rare, pose significant surgical challenges due to their location near the major papilla in the duodenum; neuroendocrine tumors (NETs) comprise a small percentage of these tumors.
- A 40-year-old male patient was diagnosed with a well-differentiated neuroendocrine tumor after surgical removal of a lymph node, leading to the discovery of a periampullary mass during surgery.
- The study concludes that transduodenal local resection of certain periampullary tumors can be as effective as more invasive procedures while minimizing complications.
Article Abstract
Introduction And Importance: Periampullary tumors are characterized as tumors that emerge nearby to the major papilla in the duodenum. They are rare lesions with an incidence rate of 0.4-0.48 per 100,000. Neuroendocrine tumors (NETs) constitute only 3% of all duodenal tumors. Their proximity to the major and minor papillae along with the gastric outlet raises a surgical challenge.
Case Presentation: Our patient is a 40-year-old, male, medically free. He presented with history of a testicular mass. A CT scan of the abdomen and pelvis was done and showed a large retroperitoneal lymph node. A biopsy of the epididymal mass showed no evidence of malignancy. Excision of the left para-aortic mass revealed a metastatic lymph node of a well-differentiated neuroendocrine tumor. Further evaluation by gallium-68 PET-CT scan showed a periampullary neuroendocrine tumor. The decision to operate was concluded in a multidisciplinary team meeting, and intraoperatively the duodenum showed a well-defined mass between the first and second part of the duodenum which was excised via a -duodenal submucosal approach. A frozen section confirmed a negative margin. The final histopathology report showed a grade 2 metastatic well-differentiated neuroendocrine tumor. The latest follow-up was 3 years post-op via fluorine-18 fluorodeoxyglucose PET-CT and it showed no FDG avid disease at the duodenum or pancreases with no FDG avid lymphadenopathy or distant metastasis.
Conclusion: Periampullary tumors that fall under certain parameters could be resected via transduodenal local resection. This procedure yields equivalent results to more invasive surgeries, such as a Whipple's procedure, with less morbidity.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8767234 | PMC |
| http://dx.doi.org/10.1016/j.amsu.2021.103126 | DOI Listing |
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