TRUNG TAM Y KHOA MED

PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
SIEU AM
NOI SOI
XET
NGHIEM

CME

RARE MALIGNANT TUMORS

OF STOMACH AND
DUODENUM

NOI SOI
MEDIC
PHAM CHI TOAN, MD. &
MEDIC ENDOSCOPIC STAFF

MEDIC 254 Hoa Hao Q. 10 TP. Ho Ch Minh

T: 8357284 8355 136 fax: 8488352543 email: medic@hcm. vnn. vn

EXIT

TRUNG TAM Y KHOA MED

PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
SIEU AM
NOI SOI
XET
NGHIEM

CME

NOI SOI
MEDIC
STOMACH

LYMPHOMA
LEIOMYOSARCOMA
CARCINOID TUMOR
METASTASES

MEDIC 254 Hoa Hao Q. 10 TP. Ho Ch Minh

T: 8357284 8355 136 fax: 8488352543 email: medic@hcm. vnn. vn

EXIT

TRUNG TAM Y KHOA ME

GASTRIC LYMPHOMA
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
SIEU AM
NOI SOI
XET
NGHIEM

CME

2-3 % of all stomach malignant tumors

non-Hodgkin lymphoma
Classification : histology, immunology,
genetics
Malt-lymphoma

NOI SOI
MEDIC
MEDIC 254 Hoa Hao Q. 10 TP. Ho

EXIT

TRUNG TAM Y KHOA ME

PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
SIEU AM
NOI SOI
XET
NGHIEM

CME

Colonic lymphoma Right colectomy

4yrs Epigastric pain Gastric
lymphoma

NOI SOI
MEDIC
MEDIC 254 Hoa Hao Q. 10 TP. Ho

EXIT

TRUNG TAM Y KHOA ME

Local thickening poor echogenic
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
SIEU AM
NOI SOI
XET
NGHIEM

CME

NOI SOI
MEDIC
MEDIC 254 Hoa Hao Q. 10 TP. Ho

EXIT

TRUNG TAM Y KHOA ME

Pathology
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
SIEU AM
NOI SOI
XET
NGHIEM

CME

NOI SOI
MEDIC
MEDIC 254 Hoa Hao Q. 10 TP. Ho

EXIT

TRUNG TAM Y KHOA ME

LEIOMYOSARCOMA
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
SIEU AM
NOI SOI
XET
NGHIEM

CME

Rare
No clear distinction with leiomyoma
Endoscopy : polypoid lesion, central
umbilicated ulcer
Biopsy

NOI SOI
MEDIC
MEDIC 254 Hoa Hao Q. 10 TP. Ho

EXIT

TRUNG TAM Y KHOA ME

Polypoid lesion central umbilicated
ulcer
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
SIEU AM
NOI SOI
XET
NGHIEM

CME

NOI SOI
MEDIC
MEDIC 254 Hoa Hao Q. 10 TP. Ho

EXIT

TRUNG TAM Y KHOA ME

Pathology
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
SIEU AM
NOI SOI
XET
NGHIEM

CME

NOI SOI
MEDIC
MEDIC 254 Hoa Hao Q. 10 TP. Ho

EXIT

TRUNG TAM Y KHOA ME

CARCINOID TUMOR
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
SIEU AM
NOI SOI
XET
NGHIEM

CME

2-3% in stomach
Hematemesis, melena, rarely carcinoid
syndrome
Endoscopy:polypoid or ulcerated lesion
25% metastase

NOI SOI
MEDIC
MEDIC 254 Hoa Hao Q. 10 TP. Ho

EXIT

TRUNG TAM Y KHOA ME

Hematemesis Polypoid lesion Biopsy:
carcinoid tumor
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
SIEU AM
NOI SOI
XET
NGHIEM

CME

NOI SOI
MEDIC
MEDIC 254 Hoa Hao Q. 10 TP. Ho

EXIT

TRUNG TAM Y KHOA ME

Epigastric pain Big ulcer Bleeding
Biopsy: carcinoid tumor
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
SIEU AM
NOI SOI
XET
NGHIEM

CME

NOI SOI
MEDIC
MEDIC 254 Hoa Hao Q. 10 TP. Ho

EXIT

TRUNG TAM Y KHOA ME

METASTASES
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
SIEU AM
NOI SOI
XET
NGHIEM

CME

Melanoma
Breast cancer
Lung cancer

NOI SOI
MEDIC
MEDIC 254 Hoa Hao Q. 10 TP. Ho

EXIT

TRUNG TAM Y KHOA ME

Skin melanoma 2yrs ago
Hematemesis ---> gastroscopy: black
spots, bleeding ulcer
PHONG
KHAM
Biopsy : gastric metastase from
X QUANG
CT SCAN
melanoma
MRI
DSA
SIEU AM
NOI SOI
XET
NGHIEM

CME

NOI SOI
MEDIC
MEDIC 254 Hoa Hao Q. 10 TP. Ho

EXIT

TRUNG TAM Y KHOA ME

PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
SIEU AM
NOI SOI
XET
NGHIEM

CME

Tonsillar cancer. Gastric bleeding

ulcers
Biopsy:gastric metastase

NOI SOI
MEDIC
MEDIC 254 Hoa Hao Q. 10 TP. Ho

EXIT

TRUNG TAM Y KHOA ME

DUODENUM
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
SIEU AM
NOI SOI
XET
NGHIEM

CME

Adenocarcinoma
( 73 %)
Leiomyosarcoma
( 14 %)
Carcinoid tumor
( 11 %)
Lymphoma
( 02%)

NOI SOI
MEDIC
MEDIC 254 Hoa Hao Q. 10 TP. Ho

EXIT

TRUNG TAM Y KHOA ME

DUODENAL CANCER
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
SIEU AM
NOI SOI
XET
NGHIEM

CME

Rare : 0. 35% of all gastrointestinal

carcinomas
MEDIC : 8 cases per 35. 000 ( 1999)
2/3 at the ampulla of vater
Diagnosis : endoscopy + biopsy
Lesion : polypoid, ulcerated
US + CT : staging

NOI SOI
MEDIC
MEDIC 254 Hoa Hao Q. 10 TP. Ho

EXIT

TRUNG TAM Y KHOA ME

Gastrectomy 2/3 due to gastric
cancer Efferent loop:bleeding tumor
Biopsy: adenocarcinoma
PHONG
KHAM
Seeding mechanism?
X QUANG
CT SCAN
MRI
DSA
SIEU AM
NOI SOI
XET
NGHIEM

CME

NOI SOI
MEDIC
MEDIC 254 Hoa Hao Q. 10 TP. Ho

EXIT

TRUNG TAM Y KHOA ME

Gastrectomy 2/3 due to gastric
cancer Efferent loop:bleeding tumor
Biopsy : adenocarcinoma Seeding
PHONG
KHAM
mechanism ?
X QUANG
CT SCAN
MRI
DSA
SIEU AM
NOI SOI
XET
NGHIEM

CME

NOI SOI
MEDIC
MEDIC 254 Hoa Hao Q. 10 TP. Ho

EXIT

TRUNG TAM Y KHOA ME

Side-viewing duodenoscope:
Jaundice. US:dilated extra
intrahepatic biliaryducts Endoscopy :
PHONG
KHAM
Vater tumor Biopsy: adenocarcinoma
X QUANG
CT SCAN
MRI
DSA
SIEU AM
NOI SOI
XET
NGHIEM

CME

NOI SOI
MEDIC
MEDIC 254 Hoa Hao Q. 10 TP. Ho

EXIT

TRUNG TAM Y KHOA ME

No symptoms US:dilated extra&intra
hepatic biliary ducts Endoscopy:
Vater tumor Biopsy: adenocarcinoma
PHONG

KHAM
X QUANG
CT SCAN
MRI
DSA

SIEU AM
NOI SOI
XET
NGHIEM

CME

NOI SOI
MEDIC
MEDIC 254 Hoa Hao Q. 10 TP. Ho

EXIT

TRUNG TAM Y KHOA ME

PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
SIEU AM
NOI SOI
XET
NGHIEM

CME

Anemia, weight loss US: unknown

dilated extra
&intrahepatic biliary ducts Endos:
Vater tumor
Biopsy: adenocarcinoma

NOI SOI
MEDIC
MEDIC 254 Hoa Hao Q. 10 TP. Ho

EXIT

TRUNG TAM Y KHOA ME

PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
SIEU AM
NOI SOI
XET
NGHIEM

CME

No clinical symptoms US: unknown

dilated extra & intrahepatic biliary
ducts Endoscopy: Vater tumor
Biopsy: adenocarcinoma

NOI SOI
MEDIC
MEDIC 254 Hoa Hao Q. 10 TP. Ho

EXIT

TRUNG TAM Y KHOA ME

CONCLUSION
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
SIEU AM
NOI SOI
XET
NGHIEM

CME

Rare
No symptoms at early stage
Endoscopy & biopsy
Side-viewing duodenoscope
papilla
Endosonography

NOI SOI
MEDIC
MEDIC 254 Hoa Hao Q. 10 TP. Ho

for

vater

EXIT

TRUNG TAM Y KHOA ME

References
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
SIEU AM
NOI SOI
XET
NGHIEM

CME

1. Michael v. Sivak: Gastroenterologic Endoscopy.

W. B Saunders Company. 1987 ; 22: 475-489.
23:512-520
2.
William
S.
H,
Fenton.
S:
Bockus
Gastroenterology. W. B Saunders Company. 1995;
51:848-854;52: 859-872; 53:875-880

NOI SOI
MEDIC
MEDIC 254 Hoa Hao Q. 10 TP. Ho

EXIT