ReviewClinical and pathological analysis of malignancies arising from alimentary tract duplications
Introduction
Malignant change is a rare complication of alimentary tract duplications. Few cases have been reported, while most case reports with partial literature reviews mainly reported involving a single site. However, to our knowledge, at least 67 of such cases have been reported in the English literature from April 1955 to July 2012. This meta analysis reclassified these 67 cases according to sites (oesophagus, stomach, small intestines, appendix, large intestines) and put emphasis on analysing management, clinical staging and prognosis of malignancies in duplications.
As far as we know, this is the largest series of malignancies within alimentary tract duplications ever to be reported, and for the first time the where relationship between clinical staging and prognosis of this series of special tumours is analyzed.
Section snippets
Methods
PubMed search in July 2012 for articles published since April 1955 with the key words “alimentary tract duplication malignant tumour” yielded 658 articles in English. Cases not describing alimentary tract duplications combined with tumours were excluded. The remaining publications were all reviewed, and other articles fulfilling the inclusion criteria were admitted using quoted references and secondary sources after careful review.
Sixty-four articles describing 67 cases of malignancies arising
Results
From April 1955 to July 2012, there were 64 case reports in the English literature that provided adequate descriptions of 67 cases of malignancies arising from alimentary tract duplications near the oesophagus (n = 6), stomach (n = 10), small intestine (n = 19)[duodenal (n = 3), jejunum (n = 3), ileum (n = 12), not described (n = 1)], appendix (n = 1), and large intestine (n = 31) [cecum (n = 5), colon (n = 13), and rectum (n = 13)](Table 1).
A higher incidence of the tumour arising from large
Discussion
Alimentary tract duplication is an unusual congenital anomaly that can involve any part of the gastrointestinal tract from mouth to anus. An incidence of 1:4500 in pediatric patients has been reported [65], accounting for two-thirds of alimentary tract duplications. The remaining cases become symptomatic and are diagnosed in adults [66]. Previous research reported that 50% of alimentary tract duplication cysts occur in the small bowel, with the majority (70%) in the ileum. Duplications of the
Conclusions
Although enteric duplications occur most often in the small bowel, the highest incidence of malignancies arising from alimentary tract duplications occurs in the colorectum. Female predominance of 3:1 is found in the colorectum site.
Malignant transformation should be suspected if any abnormal solid component is found within the duplication or serum CEA or CA19–9 level is elevated. When the tumour size is greater than 4 cm, it is considered to be more invasive and to more likely metastasis. In
Authorship statement
Guarantor of the integrity of the study: Haifen Ma
Study concepts: Haifen Ma
Study design: Haifen Ma
Definition of intellectual content: Haifen Ma
Literature research: Weihua Xiao, Junqiang Li, Yiqiao Li
Clinical studies: Haifen Ma
Experimental studies: Haifen Ma
Data acquisition: Haifen Ma
Data analysis: Haifen Ma
Statistical analysis: Haifen Ma
Manuscript preparation: Haifen Ma
Manuscript editing: Haifen Ma
Manuscript review: Haifen Ma
Conflict of interest statement
This paper has no conflicts of interest.
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Duodenal duplication cyst presenting as bilious vomiting in a neonate
2020, Journal of Pediatric Surgery Case ReportsCitation Excerpt :All patients identified were female and the age of presentation varied between 34 and 41 years old. The majority of the malignant lesions consisted of adenocarcinoma, with the potential of invasion and metastasis increasing in tumors beyond 4 cm [23]. Therefore, long term follow up is required in cases in which partial resection or internal drainage of cyst is performed.
Long duodeno-jejunal tubular duplication presenting as gastric outlet bowel obstruction in a child
2017, Journal of Pediatric Surgery Case ReportsCitation Excerpt :Marsupialization of the cyst with the proximal jejunum has also been described in cases of the duplication presenting as pancreatitis. Medical management was employed initially and after patient stabilization was achieved, the procedures were then carried out [8,9]. The open surgical approach was the preferred modality for our patient.
A case of ileocecal duplication cyst protruding into the intestinal lumen enucleated via an anti-mesenteric approach
2016, Journal of Pediatric Surgery Case ReportsCitation Excerpt :Duplication cysts of the alimentary tract can occur at any point in the intestinal tract, but most commonly occur in the small intestine [3]. It is widely accepted that these lesions should be removed completely when diagnosed, because they can contain ectopic tissue such as gastric mucosa, and are associated with malignancy, especially in adults with lesions of the colon [7,8]. The standard surgical procedure for duplication cysts is total resection with the adjacent native intestine.
Risk-reduction surgery in pediatric surgical oncology: A perspective
2016, Journal of Pediatric SurgeryCitation Excerpt :Malignancy has been reported in association with duplicated esophageal, gastric, small intestine, appendiceal, and colonic lesions [239–249]. Carcinoma in the intestinal tract developing with coexistent duplication has been reviewed by Ma and colleagues [250]. These scholars conducted a meta-analysis of 64 case reports in the English literature from 1955 to 2012 and identified esophageal (n = 6), gastric (n = 10), small intestine (n = 19; duodenal, 3; jejunum, 3; ileum, 12; not described, 1), appendix (n = 1), and large intestine (n = 31; cecum, 5; colon, 13; rectum, 13) cases.
Surgical management of an intussuscepted duodenal duplication cyst in a pediatric patient with heterotaxy
2015, Journal of Pediatric Surgery Case ReportsCitation Excerpt :Although a rare occurrence, duodenal duplication cysts may contain malignancy [2]. Ma et al. [18] retrospectively looked at 67 cases of malignancies arising from alimentary tract duplication cysts and identified 3 arising from the duodenum. Overall, adenocarcinoma was the most frequently identified malignancy identified and tumors greater than 4 cm were considered more invasive with greater malignant potential.