Intramucosal duodenal adenocarcinoma concomitant with Saint’s triad


Duodenal tubulovillous adenomas are rare and have malignant potential. Their successful management depends on the preoperative diagnosis and adequate excision. Endoscopic mucosal resection or submucosal dissection can control superficial tumors. Adenocarcinoma of the duodenum may originate in tubular or tubulovillous adenoma, and possible diagnostic challenges occur concerning the endoscopic biopsy findings. We report a 62-year-old female with chronic epigastric burning and a bolus sensation. Upper gastrointestinal endoscopy showed a non-ampullary duodenal tumor, and the biopsy study diagnosed a tubulovillous adenoma. Further mucosectomy revealed an intramucosal adenocarcinoma in a tubulovillous adenoma with a tumor-free pedicle. Besides the intestinal neoplasms, the patient had the diagnosis of classical Saint’s triad; and the manifestations were hiatus hernia, gallbladder disorder, and colonic diverticula. The objective is to report two scarcely described conditions and comment on controversial points of view about the concomitance of Saint’s triad and malignancy. Case reports can reduce late diagnosis, enhancing the suspicion index on rare diseases.



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Anand U, Pandey MK, Priyadarshi RN, et al. Large tubullo-villous adenoma of duodenum presenting as gastric outlet obstruction. J Clin Diagn Res 2015;9:PD03-4. DOI:

Biello AR, Lin-Hurtubise KM, Condon FJ, Allen EJ. Duodenal adenocarcinoma at the ligament of Treitz: management and outcome. Hawaii J Health Soc Welf 2019;78:316-9.

Hwang KL, Kim GH, Lee BE, et al. Long-term outcomes of endoscopic resection for non-ampullary duodenal epithelial tumors: A single-center experience. Turk J Gastroenterol 2020;31:49-57. DOI:

Jiménez-Fuertes M, Ruíz-Tóvar J, Díaz-García G, Durán-Poveda M. [Moderately differentiated adenocarcinoma of the third duodenal portion]. Cir Cir 2017;85:76-9. DOI:

Khanal S, Joshi U, Bhattarai A, et al. Primary duodenal adenocarcinoma: uncommon tumor, uncommon presentation. A case report and review of the literature. Int Med Case Rep J 2020;13:165-9. DOI:

Lemyé AC, Guy-Viterbo V, van Vyve E. Adenocarcinoma of the duodenum arising in a tubulo-villous adenoma. Acta Chir Belg 2009;109:95-7. DOI:

Lubner MG, Menias CO, Johnson RJ, et al. Villous gastrointestinal tumors: multimodality imaging with histopathologic correlation. Radiographics 2018;38:1370-84. DOI:

Malik MN, Shah Z, Rafae A, et al. Small intestinal tumors: a rare case of tubulovillous adenoma in duodenum. Cureus 2019;11:e4671. DOI:

Morotti A, Gned D, Di Martino L, et al. Small bowel cancer diagnosis: role of nuclear magnetic resonance. Ital J Med 2016;10:134-6.

Velandia C, Morales RD, Coello C, et al. Neoadjuvant chemotherapy in locally advanced duodenal adenocarcinoma. E Cancer Med Sci 2018;12:816. DOI:

Araújo-Martins M, Pimentel-Nunes P, Libânio D, et al. How is endoscopic submucosal dissection for gastrointestinal lesions being implemented? Results from an international survey. GE Port J Gastroenterol 2020;27:1-17. DOI:

Dos Santos VM, Dos Santos LAM. Comments on Saint's triad. Surg Case Rep 2015;1:115. DOI:

Santos VM, Carneiro MV, Soares VVP, et al. An elderly man with gastric cancer, Saint's triad and Heyde’s syndrome. Rev Gastroenterol Peru 2018;38:289-92.

Santos VM, Yano VM, Alves da Cunha GLQ, et al. Yellow nail syndrome, Phrygian cap gallbladder and Saint’s triad? Case report. Méd Uis 2015;28:387-91. DOI:

Terada T. Histopathologic features and frequency of gallbladder lesions in consecutive 540 cholecystectomies. Int J Clin Exp Pathol 2013;6:91-6.

Case Reports
Adenocarcinoma/diagnosis, tubulovillous adenoma, duodenal neoplasm/pathology, endoscopy/digestive system, Saint’s triad.
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How to Cite
Dantas Gomes Gonçalves, M., Grigolli, V., Carvalho Kalmar, T. C., Modesto dos Santos, V., Sonjia Villela, L., & Arruda Modesto dos Santos, L. (2021). Intramucosal duodenal adenocarcinoma concomitant with Saint’s triad. Italian Journal of Medicine, 15(2).