Papillary carcinoma of the duodenum combined with right renal carcinoma: a case report
© Zhang et al.; licensee BioMed Central Ltd. 2013
Received: 30 August 2012
Accepted: 14 January 2013
Published: 1 February 2013
We report a case of papillary carcinoma of the duodenum combined with right renal carcinoma. A 58-year-old man underwent a physical examination that revealed intrahepatic and extrahepatic bile duct dilatation on B ultrasound. Intrahepatic bile duct dilatation could be seen on magnetic resonance imaging (MRI), but the head of the pancreas and distal bile duct showed no tumor signals, which led to a diagnosis of periampullary carcinoma and right renal carcinoma. Considering the trauma of pancreaticoduodenectomy combined with renal resection operation is greater, we carried out the laparoscopic right renal radical resection first, and then a pylorus-preserving pancreaticoduodenectomy was performed. However, postoperative intra-abdominal infections and bleeding occurred; our patient improved after vascular interventional microcoil embolization for the treatment of hemostasis. The second operation for celiac necrotic tissue elimination, jejunal fistulization and peritoneal lavage and drainage was performed 14 days latter. Our patient improved gradually and was discharged on the 58th postoperative day. There has been no tumor recurrence after a follow-up of 26 months.
Duodenal papilla carcinoma is classified as a periampullary carcinoma. Its early diagnosis is difficult because of the lesion site. It easily leads to bile duct obstruction because the cancer is in the ampulla; therefore the main clinical feature is progressive deepening painless jaundice[1–3]. There have been no previous reports of cases of duodenal papilla carcinoma combined with right renal carcinoma. Here, we describe such a case. Our patient was found to have intrahepatic and extrahepatic bile duct dilatation on B ultrasound without other symptoms initially, and was then hospitalized for further examination and treatment.
Duodenal papilla carcinoma is a rare finding, and comprises of less than 1% of all digestive malignant tumors. However, it is the second most common periampullary malignancy. The first clinical symptoms are always jaundice[4–6]. However, in this particular case, our patient had no clinical symptoms and intrahepatic and extrahepatic bile duct dilatation was only revealed on physical examination. The diagnosis of periampullary carcinoma and right renal carcinoma was made when our patient was hospitalized for further examination and treatment. He had diabetes and hypertension, kept under regular medical control for the past 20 years. This is therefore a very rare case. Radical resection is the only curative operation method for duodenal papilla carcinoma[7–9]. The trauma and risk are greater if resection of the two tumors is performed at the same time, so we carried out the laparoscopic right renal radical resection first. Our patient recovered well. However, he presented with symptoms of cholangitis in the following month. The pylorus-preserving pancreaticoduodenectomy was performed after we cured the cholangitis, then postoperative intra-abdominal infections and bleeding occurred. This may have been caused by the preoperative cholangitis or our patient’s diabetes. We then took appropriate treatment measures. Our patient improved gradually and was discharged on the 58th postoperative day. There has been no tumor recurrence after a follow-up of 2 years and 2 months.
Our patient gave his written informed consent for this case report to be published.
- Howe JR, Klimstra DS, Moccia RD, Conlon KC, Brennan MF: Factors predictive of survival in ampullary carcinoma. Ann Surg. 1998, 228: 87-94. 10.1097/00000658-199807000-00013.PubMed CentralView ArticlePubMedGoogle Scholar
- Beger HG, Treitschke F, Gansauge F, Harada N, Hiki N, Mattfeldt T: Tumor of the ampulla of Vater: experience with local or radical resection in 171 consecutively treated patients. Arch Surg. 1999, 134: 526-532. 10.1001/archsurg.134.5.526.View ArticlePubMedGoogle Scholar
- Yamashita Y, Ito K, Fujita N, Noda Y, Kobayashi G, Obana T, Horaguchi J, Kato Y, Koshita S, Kanno Y, Ogawa T, Kurose A, Sawai T: A case of early carcinoma of the papilla of Vater confined to the mucosa and continuative epithelium of glands in Oddi’s sphincter (m-God) treated by endoscopic papillectomy. Intern Med. 2010, 49: 2447-2450. 10.2169/internalmedicine.49.4128.View ArticlePubMedGoogle Scholar
- Talamini MA, Moesinger RC, Pitt HA, Sohn TA, Hruban RH, Lillemoe KD, Yeo CJ, Cameron JL: Adenocarcinoma of the ampulla of Vater. A 28-year experience. Ann Surg. 1997, 225: 590-599. 10.1097/00000658-199705000-00015.PubMed CentralView ArticlePubMedGoogle Scholar
- Crist DW, Sitzmann JV, Cameron JL: Improved hospital morbidity, mortality, and survival after the Whipple procedure. Ann Surg. 1987, 206: 358-365. 10.1097/00000658-198709000-00014.PubMed CentralView ArticlePubMedGoogle Scholar
- Duffy JP, Hines OJ, Liu JH, Ko CY, Cortina G, Isacoff WH, Nguyen H, Leonardi M, Tompkins RK, Reber HA: Improved survival for adenocarcinoma of the ampulla of Vater: fifty-five consecutive resections. Arch Surg. 2003, 138: 941-948. 10.1001/archsurg.138.9.941.View ArticlePubMedGoogle Scholar
- Sperti C, Pasquali C, Piccoli A, Sernagiotto C, Pedrazzoli S: Radical resection for ampullary carcinoma: long-term results. Br J Surg. 1994, 81: 668-671. 10.1002/bjs.1800810512.View ArticlePubMedGoogle Scholar
- Rattner DW, Fernandez-del Castillo C, Brugge WR, Warshaw AL: Defining the criteria for local resection of ampullary neoplasms. Arch Surg. 1996, 131: 366-371. 10.1001/archsurg.1996.01430160024003.View ArticlePubMedGoogle Scholar
- Nikfarjam M, Muralidharan V, McLean C, Christophi C: Local resection of ampullary adenocarcinomas of the duodenum. ANZ J Surg. 2001, 71: 529-533. 10.1046/j.1440-1622.2001.02185.x.View ArticlePubMedGoogle Scholar
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.