TRUNG TAM Y KHOA MED

PHONG
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X QUANG
CT SCAN
MRI
DSA
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NOI SOI
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NGHIEM

CME

NOI SOI
MEDIC
DUODENAL TUMORS

NGUYEN SN TAY

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

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

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TRUNG TAM Y KHOA ME

A. INCIDENCE:
PHONG
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NGHIEM

CME

10%20% of small bowel tumors. ( #0, 6% all

gastrointestinal benign and malignant neoplasms)
Equal in both men and women.
Approximately 2500 cases of small bowel tumors
occur annually in the US

NOI SOI
MEDIC

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TRUNG TAM Y KHOA ME

1. Benign Neoplasms:
PHONG
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CT SCAN
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DSA
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NOI SOI
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NGHIEM

CME

1. Adenoma:

NOI SOI
MEDIC

The most common duodenal tumor

They appear as both sessile and pedunculated
polyps. The surface is the same collor of the
surrounding mucosa.
Histological classify :
+Tubular
+Tubulovillous : if more than 2025% but less than
7580% of the polyp consists of vilous elements
+Vilous: high degree of malignant potential

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TRUNG TAM Y KHOA ME

1. Benign Neoplasms:
PHONG
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MRI
DSA
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NOI SOI
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NGHIEM

CME

2. Leiomyoma

NOI SOI
MEDIC

The most frequently occurring benign tumor in the

small intestine. Most common in the jejunum. 1020%
in the duodenum.
Round or ovoid sessile polyp, rarely pedunculate, with
a smoothly tapering border. The central hemorrhagic
ulcer should arouse a suspicion of leiomyoma.
Most leiomyomas arise from the muscularis propria.
Leiomyomas
are
composed
of
bundles
of
spindleshaped smooth muscle cells with elongated
nuclei and abundant cytoplasm arranged in a
herringbone
pattern.
Differentiation
from
leiomyosarcomas is difficult. Absence of cellular
pleomorphism, rare mitotic activity, and no invasion of
surrounding tissue are indications of benign status.
EXIT

TRUNG TAM Y KHOA ME

1. Benign Neoplasms:
PHONG
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NOI SOI
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NGHIEM

CME

3. Lipoma

NOI SOI
MEDIC

They appear in the colon( 6570%), the ileum,

the duodenum, and the jejunum.
stroma.
They arise from the submucosal adipose tissue
or serosal fat and thus are typically
extramucosal in location.
Histologically, they are composed of mature
adipose tissue supported by a fibrous

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TRUNG TAM Y KHOA ME

1. Benign Neoplasms:
PHONG
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CT SCAN
MRI
DSA
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NOI SOI
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NGHIEM

CME

4. Brunner S Gland Adenoma

NOI SOI
MEDIC

They make up 3050% of benign lesions of the

duodenum.
they are usually smaller than 1cm and often
multiple and polypoid.
Microscopically, they are composed of enlarged
aggregates of glandular tissue often in the form
of a polypoid mass. Intersection of the glandular
structure by bands of smooth muscle, cystic
dilatation of the glandular structure, and a
fibrous capsule are characteristic

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TRUNG TAM Y KHOA ME

1. Benign Neoplasms:
PHONG
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MRI
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NGHIEM

CME

5. Neurogenic Tumors

NOI SOI
MEDIC

They constitute 3, 26, 4% of small bowel

tumors.
They may be solitary or multifocal and may
arise from nerve sheaths (neurilemomas),
sympathetic ganglia (ganglioneuromas), and
neural connective tissue (neurofibromas).
They may be associated with cafe au lait spots
and
cutaneous
neurofibromas
(von
Recklinghausen s disease).

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TRUNG TAM Y KHOA ME

1. Benign Neoplasms:
PHONG
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NOI SOI
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NGHIEM

CME

6. Angiomas

NOI SOI
MEDIC

They can be subdivided into hemangiomas or

true vascular tumors (5% of all small bowel
tumors) and telangiectasias or focal angio
dysplasia.
Histologically, hemangioma are bloodfilled
sinuses with endothelial lining.
Telangiectasia may be hereditary or acquired.

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TRUNG TAM Y KHOA ME

1. Benign Neoplasms:
PHONG
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NOI SOI
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NGHIEM

CME

6. Angiomas

NOI SOI
MEDIC

Three subgroups have been described:

+Type I: Commonly found in the right segment
of the colon of elderly people
+Type II: Congenital ( autosomal recessive)and
presents as gross varices in the small intestine
of people younger than 20 years of age.
+Type III: OslerWeberRendu syndrome, is
familial, occurs in an autosomal dominant
pattern, and involves the entire gut.

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TRUNG TAM Y KHOA ME

1. Benign Neoplasms:
PHONG
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NOI SOI
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7. Polyposis Syndrome

NOI SOI
MEDIC
More than 100 polyps in number.
Mode of transmission:
Hereditary:

Autosomal dominant:
Familial (multiple) polyposis
Gardner syndrome
PeutJeghers syndrome
Autosomal recessive:
Turcot syndrome

Non hereditary:
Cronkhitecanada syndrome
Juvenile polyposis

CME

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TRUNG TAM Y KHOA ME

II. Malignant Neoplasm
PHONG
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NGHIEM

CME

1. Adenocarcinoma:

NOI SOI
MEDIC

0, 35% of all gastrointestinal carcinomas.

The lesion are usually polypoid but can infiltrate
the duodenal wall to produce annular constriction.
2/3 of duodenal adenocarcinoma are in the region
of the ampulla of vater.
Regional lymph nodes and the liver are the most
common metastatic sites.

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TRUNG TAM Y KHOA ME

II. Malignant Neoplasm
PHONG
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CME

2. Carcinoids:

NOI SOI
MEDIC

The second most common small bowel

malignancy. Most frequently in the ileum. When
arising in the duodenum, they tend to be less
aggressive in terms of inducing desmoplasia
and metastasis.
Typically,
carcinoids
appear
as
small
submucosal nodules, but they can become
polypoid.
Microscopically, they are composed of uniform,
small, round cells that assume a variety of
histologic patterns

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TRUNG TAM Y KHOA ME

II. Malignant Neoplasm
PHONG
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NOI SOI
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NGHIEM

CME

3. Sarcoma

NOI SOI
MEDIC

The third most common malignancy of the small

bowel, of which the leiomyosarcoma is the most
frequent ( most common in the jejunum, 10% in the
duodenum).
These tumors tend to grow slowly and may becom
quite bulky. They often outgrow their bloodsupply
and thus are subject to ulceration and necrosis.
Metastasis is usually directly to the peritoneum, less
often by hematogenous spread to the liver, and least
often by lymphogenous extension to regional nodes.
Sarcomas can arise from smooth muscle, connective
tissue, fatty tissue, vascular components, or neural
elements.
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TRUNG TAM Y KHOA ME

II. Malignant Neoplasm
PHONG
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DSA
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NOI SOI
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NGHIEM

CME

4. Lymphoma:

NOI SOI
MEDIC

Although rare in the gastrointestinal tract of

adults, lymphoma is the most common digestive
tract tumor in children.
Lymphomas may involve the bowel as primary
growths or as expressions of a generalized
lymphomatous process. Lymphomas can appear
as fungating ulcerated masses or as diffuse
thickening of the gut wall.
All forms of nonHodgkin s lymphomas have
been reported. Most are of the Bcell type

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TRUNG TAM Y KHOA ME

III. Metastases and contigious
spreadings
PHONG
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DSA
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NGHIEM

CME

The most common sources are breast

carcinoma, lung carcinoma, and melanoma.
Cancers involving the duodenum by contiguous
spread are
from pancreas, stomach, biliary tree, right
kidney and the hepatic flexure of the colon.

NOI SOI
MEDIC

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TRUNG TAM Y KHOA ME

C. CLINICAL FEATURES
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
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NOI SOI
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NGHIEM

CME

nonspecific late diagnosis

NOI SOI
MEDIC

1. Bleeding:

Bleeding may be occult to massive and

commonly results from ulceration and necrosis
of the tumors.
Leiomyomas,
leiomyosarcomas,
and
hemangiomas bleed more frequently than do
other small bowel tumors.

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TRUNG TAM Y KHOA ME

C. CLINICAL FEATURES
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
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NOI SOI
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NGHIEM

2. Bowel obstruction

NOI SOI
MEDIC

Tumors obstructing the duodenal lumen produce

symptoms of abdominal pain and often anorexia,
nausea, and vomiting.
Bowel
obstrustion
can
be
caused
by
intussusception, with the tumors acting as the lead
point, by annular constriction of the bowel, by
volvulus, or by compression from an adjacent
tumor mass.

3. Obstructive jaundice

The frequent sign of ampullary and periampullary

tumors

CME

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TRUNG TAM Y KHOA ME

4. PHYSICAL EXAMINATION
PHONG
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NGHIEM

CME

Unrevealing

NOI SOI
MEDIC

A palpable mass often indicates a malignant

growth, such as a lymphoma or a leiomyosarcoma,
although benign leiomyomas may occasionally
present as a mass.
Abdominal distention resulting from bowel
obstruction is a late finding, as are hepatomegaly
and extensive lymphadenopathy.
Melanin spots on the lips and buccal mucosa
suggest the PeutzJeghers syndrome.
Angiomas visible under the nails and beneath the
tongue suggest the OslerWeberRendu syndrome

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TRUNG TAM Y KHOA ME

D. DIAGNOSIS
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
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NOI SOI
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NGHIEM

1. Bariumcontrast radiography:.

NOI SOI
MEDIC

CME

Barium can be administered by mouth or through a tube

passed through the stomach and into the duodenum
(enteroclysis).
Localized filling defects in the opacified intestinal lumen
have been produced by either intraluminal or
extraluminal lesions.
Villous tumors: Dappled radiolucency of frondlike
projections set in a matrix of barium (soap bubble).
Smoothwalled polypoid defects suggest : Adenoma,
Brunner s gland adenoma, lipoma, leiomyoma
(particularly if a central ulcer fleck is present), or
carcinoid.
Luminal stenosis may indicate infiltration of the duodenal
wall by tumor.
At least 15%30% false negative results.
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TRUNG TAM Y KHOA ME

D. DIAGNOSIS
PHONG
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CT SCAN
MRI
DSA
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NGHIEM

CME

2. Endoscopy

NOI SOI
MEDIC
improve the diagnosis of duodenal tumors.

In most instances routine upper gastrointestinal

endoscopy probably does not include bowel
beyond the second portion of the duodenum.
Oral insertion of a smallcaliber colonoscope allows
evaluation of the small bowel, at least to the
proximal jejunum.
Endoscopy
provides
for
photographic
documentation and biopsy.
Endosonography permit precise delineation of
intramural and extraluminal tumors, as well as of
adjacent structures.

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TRUNG TAM Y KHOA ME

D. DIAGNOSIS
PHONG
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NGHIEM

CME

3.
Ultrasonography,
tomography, and magnetic
scaning

computed
resonance

NOI SOI
MEDIC

aids
in
detection
of
hepatic
metastasis,
adenopathy, bowel wall thickening, extraluminal
masses, and biliary onstruction.
Angiography may help define highly vascular
tumors or sites of bleeding
Exploratory laparotomy, on occasion, may be the
only method capable of establishing a diagnosis.
This is more commonly the case in the presence of
tumors distal to the duodenum.

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E. TREATMENT
PHONG
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MRI
DSA
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NGHIEM

CME

The treatment of benign and malignant tumors

of the duodenum is surgical removal.

NOI SOI
MEDIC

1. Benign Polypoid Tumors:

Can often be accomplished by endoscopic snare

and cautery. When involvement of the
duodenum
is
extensive
or
when
the
configuration of the lesion precludes endoscopic
removal, duodenotomy or duodenectomy may
be necessary.

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TRUNG TAM Y KHOA ME

E. TREATMENT
PHONG
KHAM
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CT SCAN
MRI
DSA
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NOI SOI
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NGHIEM

CME

2. Malignat tumors

NOI SOI
MEDIC

Require an operative approach.

For
ampullary
carcinoma,
a
pancreatoduodenectomy
(Whipples operation) is the usual procedure.
Malignant lesion of the duodenal bulb and of the
third and fourth portions of the duodenum can
often
be
ttacked
successfully
without
pancreatectomy.
Except when used for the treatment of
lymphomas, radiation and chemotherapy have not
been notably successful

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TRUNG TAM Y KHOA ME

F. PROGNOSIS
PHONG
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NGHIEM

CME

1. Benign tumors:

NOI SOI
MEDIC

The outlook for patients is excelent.

Adenomas, especially familial polyposis, require
careful follow up.

2. Malignant tumors:

Survival depends in large part on early diagnosis.

Unfortunately 3050%of small bowel malignancy
have metastasized by the time of discovery.
Endoscopic examination offers the hope of earlier
detection, particularly in the duodenum. Newer
supplemental techniques such as needle biopsy
and endoscopic ultrasonography may further
improve diagnostic accuracy
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TRUNG TAM Y KHOA ME

DUODENAL TUMORS
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
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NOI SOI
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NGHIEM

CME

10%-20% of small bowel tumors

Approximately 2500 cases of
tumors occur annually in the us
Equal in both men and women

NOI SOI
MEDIC
small

bowel

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TRUNG TAM Y KHOA ME

CLASSIFICATION
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
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NOI SOI
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NGHIEM

CME

Benign neoplasms
Adenoma
Leiomyoma
lipoma
Brunners
gland
adenoma
Neurofibroma
Angioma
polyposis syndrome

Malignant
neoplasms
Adenocarcinoma
Leiomyosarcoma
Lymphoma
Metastases
contiguous
spreading

NOI SOI
MEDIC

and

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TRUNG TAM Y KHOA ME

CLINICAL FEATURES
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
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NOI SOI
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NGHIEM

CME

Bleeding:Occult to massive
Bowel obstruction
Obstructive jaundice
Physical examination: unrevealing

NOI SOI
MEDIC
EXIT

TRUNG TAM Y KHOA ME

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

CME

1) Barium-contrast radiography:
By mouth or enteroclysis
Localized filling defects or luminal stenosis
At least 15%-30% false negative results

NOI SOI
MEDIC
EXIT

TRUNG TAM Y KHOA ME

POLYPOSE
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
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NOI SOI
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NGHIEM

CME

NOI SOI
MEDIC

Multiple localized
filling defects at
Duodenum

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TRUNG TAM Y KHOA ME

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

CME

Include second portion of the duodenum

Oral
insertion
of
a
small
caliber
colonoscope
Photographic documentation and biopsy
Endosonography

NOI SOI
MEDIC

EXIT

TRUNG TAM Y KHOA ME

Adenoma
PHONG
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CT SCAN
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DSA
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NOI SOI
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NGHIEM

CME

NOI SOI
MEDIC

Sessile
or
pedunculated
Surface : same color
surrounding mucosa

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TRUNG TAM Y KHOA ME

CASE 1: ADENOMA
PHONG
KHAM
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CT SCAN
MRI
DSA
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NOI SOI
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NGHIEM

CME

NOI SOI
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EXIT

TRUNG TAM Y KHOA ME

CASE 2: ADENOMA
PHONG
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X QUANG
CT SCAN
MRI
DSA
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NOI SOI
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NGHIEM

CME

NOI SOI
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EXIT

TRUNG TAM Y KHOA ME

CASE 3: ADENOMA
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
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NOI SOI
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NGHIEM

CME

NOI SOI
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EXIT

TRUNG TAM Y KHOA ME

CASE 4: ADENOMA
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
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NOI SOI
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NGHIEM

CME

NOI SOI
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EXIT

TRUNG TAM Y KHOA ME

CASE 5: ADENOMA
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
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NOI SOI
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NGHIEM

CME

NOI SOI
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EXIT

TRUNG TAM Y KHOA ME

CASE 6: ADENOMA
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
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NOI SOI
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NGHIEM

CME

NOI SOI
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EXIT

TRUNG TAM Y KHOA ME

CASE 7: ADENOMA
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
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NOI SOI
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NGHIEM

CME

NOI SOI
MEDIC
EXIT

TRUNG TAM Y KHOA ME

CASE 8: ADENOMA
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
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NOI SOI
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NGHIEM

CME

NOI SOI
MEDIC
EXIT

TRUNG TAM Y KHOA ME

Leiomyoma CASE 9: LEIOMYOMA
PHONG
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X QUANG
CT SCAN
MRI
DSA
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NOI SOI
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NGHIEM

CME

NOI SOI
MEDIC

Round or ovoid sessile

polyp
Smoothly
tapering
border
Central
hemorrhagic
ulcer

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TRUNG TAM Y KHOA ME

CASE 10: LEIOMYOMA
PHONG
KHAM
X QUANG
CT SCAN
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DSA
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NOI SOI
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NGHIEM

CME

NOI SOI
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EXIT

TRUNG TAM Y KHOA ME

CASE 10: LEIOMYOMA
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
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NOI SOI
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NGHIEM

CME

NOI SOI
MEDIC
EXIT

TRUNG TAM Y KHOA ME

CASE 10: LEIOMYOMA
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
SIEU AM
NOI SOI
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NGHIEM

CME

NOI SOI
MEDIC
EXIT

TRUNG TAM Y KHOA ME

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

CME

NOI SOI
MEDIC
Pillow sign

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TRUNG TAM Y KHOA ME

Brunners gland adenoma
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
SIEU AM
NOI SOI
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NGHIEM

CME

NOI SOI
MEDIC
Often
multiple
polypoid

and

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TRUNG TAM Y KHOA ME

Telangiectasia
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
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NOI SOI
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NGHIEM

CME

NOI SOI
MEDIC
Raised
arteriolar bleb
Thin tendrils
outward

central

radiate

EXIT

TRUNG TAM Y KHOA ME

Polyposis syndrome
CASE 11: POLYPOSE AT DUODENUM
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
SIEU AM
NOI SOI
XET
NGHIEM

CME

NOI SOI
MEDIC

EXIT

TRUNG TAM Y KHOA ME

CASE 11: POLYPOSE AT THE STOMACH
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
SIEU AM
NOI SOI
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NGHIEM

CME

NOI SOI
MEDIC
EXIT

TRUNG TAM Y KHOA ME

CASE 11: POLYPOSE AT DUODENUM
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
SIEU AM
NOI SOI
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NGHIEM

CME

NOI SOI
MEDIC
EXIT

TRUNG TAM Y KHOA ME

CASE 11: POLYPOSE AT DUODENUM
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
SIEU AM
NOI SOI
XET
NGHIEM

CME

NOI SOI
MEDIC
EXIT

TRUNG TAM Y KHOA ME

CASE 11: POLYPOSE AT DUODENUM
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
SIEU AM
NOI SOI
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NGHIEM

CME

NOI SOI
MEDIC
EXIT

TRUNG TAM Y KHOA ME

CASE 11: POLYPOSE AT THE COLON
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
SIEU AM
NOI SOI
XET
NGHIEM

CME

NOI SOI
MEDIC
EXIT

TRUNG TAM Y KHOA ME

CASE 11: POLYPOSE AT THE COLON
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
SIEU AM
NOI SOI
XET
NGHIEM

CME

NOI SOI
MEDIC
EXIT

TRUNG TAM Y KHOA ME

CASE 11: POLYPOSE AT THE COLON
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
SIEU AM
NOI SOI
XET
NGHIEM

CME

NOI SOI
MEDIC
EXIT

TRUNG TAM Y KHOA ME

CASE 11: POLYPOSE AT THE COLON
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
SIEU AM
NOI SOI
XET
NGHIEM

CME

NOI SOI
MEDIC
EXIT

TRUNG TAM Y KHOA ME

CASE 11: POLYPOSE AT THE COLON
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
SIEU AM
NOI SOI
XET
NGHIEM

CME

NOI SOI
MEDIC
EXIT

TRUNG TAM Y KHOA ME

CASE 11: POLYPOSE AT THE COLON
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
SIEU AM
NOI SOI
XET
NGHIEM

CME

NOI SOI
MEDIC
EXIT

TRUNG TAM Y KHOA ME

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

CME

NOI SOI
MEDIC

Polypoid or infiltrate
2/3 in the region of the
ampulla of vater

EXIT

TRUNG TAM Y KHOA ME

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

CME

NOI SOI
MEDIC
EXIT

TRUNG TAM Y KHOA ME

CASE12: AMPULLARY
ADENOCARCINOMA
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
SIEU AM
NOI SOI
XET
NGHIEM

CME

NOI SOI
MEDIC
EXIT

TRUNG TAM Y KHOA ME

CASE 12: AMPULLARY
ADENOCARCINOMA
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
SIEU AM
NOI SOI
XET
NGHIEM

CME

NOI SOI
MEDIC
EXIT

TRUNG TAM Y KHOA ME

CASE 12: AMPULLARY
ADENOCARCINOMA
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
SIEU AM
NOI SOI
XET
NGHIEM

CME

NOI SOI
MEDIC
EXIT

TRUNG TAM Y KHOA ME

CASE 12: HISTOLOGICAL
APPEARANCE
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
SIEU AM
NOI SOI
XET
NGHIEM

CME

NOI SOI
MEDIC
EXIT

TRUNG TAM Y KHOA ME

CASE 13:PERIAMPULLARY
ADENOCARCINOMA
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
SIEU AM
NOI SOI
XET
NGHIEM

CME

NOI SOI
MEDIC
EXIT

TRUNG TAM Y KHOA ME

CASE 13:PERIAMPULLARY
ADENOCARCINOMA
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
SIEU AM
NOI SOI
XET
NGHIEM

CME

NOI SOI
MEDIC
EXIT

TRUNG TAM Y KHOA ME

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

CME

NOI SOI
MEDIC

Umbilicated
polypoid mass

EXIT

TRUNG TAM Y KHOA ME

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

CME

NOI SOI
MEDIC

Fleshy
mass
lesions

EXIT

TRUNG TAM Y KHOA ME

Metastases and contiguous spreading
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
SIEU AM
NOI SOI
XET
NGHIEM

CME

NOI SOI
MEDIC

Duodenal
invasion
by
carcinoma of
the pancreas

EXIT

TRUNG TAM Y KHOA ME

CASE 14: DUODENAL INVASION BY
CARCINOMA OF THE PANCREAS
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
SIEU AM
NOI SOI
XET
NGHIEM

CME

NOI SOI
MEDIC
EXIT

TRUNG TAM Y KHOA ME

CASE 14: DUODENAL INVASION BY
CARCINOMA OF THE PANCREAS
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
SIEU AM
NOI SOI
XET
NGHIEM

CME

NOI SOI
MEDIC
EXIT

TRUNG TAM Y KHOA ME

CASE 14: DUODENAL INVASION BY
CARCINOMA OF THE PANCREAS
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
SIEU AM
NOI SOI
XET
NGHIEM

CME

NOI SOI
MEDIC
EXIT

TRUNG TAM Y KHOA ME

CASE 14: HISTOLOGICAL
APPEARANCE
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
SIEU AM
NOI SOI
XET
NGHIEM

CME

NOI SOI
MEDIC
EXIT

TRUNG TAM Y KHOA ME

CASE 14: HISTOLOGICAL
APPEARANCE
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
SIEU AM
NOI SOI
XET
NGHIEM

CME

NOI SOI
MEDIC
EXIT

TRUNG TAM Y KHOA ME

CASE 15: DUODENAL INVASION BY
CARCINOMA OF THE PANCREAS
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
SIEU AM
NOI SOI
XET
NGHIEM

CME

NOI SOI
MEDIC
EXIT

TRUNG TAM Y KHOA ME

CASE 15: DUODENAL INVASION BY
CARCINOMA OF THE PANCREAS
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
SIEU AM
NOI SOI
XET
NGHIEM

CME

NOI SOI
MEDIC
EXIT

TRUNG TAM Y KHOA ME

CASE 15: DUODENAL INVASION BY
CARCINOMA OF THE PANCREAS
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
SIEU AM
NOI SOI
XET
NGHIEM

CME

NOI SOI
MEDIC
EXIT

TRUNG TAM Y KHOA ME

CASE 15: DUODENAL INVASION BY
CARCINOMA OF THE PANCREAS
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
SIEU AM
NOI SOI
XET
NGHIEM

CME

NOI SOI
MEDIC
EXIT

TRUNG TAM Y KHOA ME

CASE 15: HISTOLOGICAL
APPEARANCE
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
SIEU AM
NOI SOI
XET
NGHIEM

CME

NOI SOI
MEDIC
EXIT

TRUNG TAM Y KHOA ME

CASE 15: HISTOLOGICAL
APPEARANCE
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
SIEU AM
NOI SOI
XET
NGHIEM

CME

NOI SOI
MEDIC
EXIT

TRUNG TAM Y KHOA ME

Gastric adenocarcinoma metastatic
to the duodenum
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
SIEU AM
NOI SOI
XET
NGHIEM

CME

NOI SOI
MEDIC
EXIT

TRUNG TAM Y KHOA ME

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

CME

CASE 16: GASTRIC

ADENOCARCINOMA
METASTATIC TO THE DUODENUM

NOI SOI
MEDIC

EXIT

TRUNG TAM Y KHOA ME

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

CME

CASE 16: GASTRIC

ADENOCARCINOMA METASTATIC TO
THE DUODENUM

NOI SOI
MEDIC

EXIT

TRUNG TAM Y KHOA ME

CASE 16: GASTRIC
ADENOCARCINOMA
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
SIEU AM
NOI SOI
XET
NGHIEM

CME

NOI SOI
MEDIC
EXIT

TRUNG TAM Y KHOA ME

CASE 16: HISTOLOGICAL
APPEARANCE
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
SIEU AM
NOI SOI
XET
NGHIEM

CME

NOI SOI
MEDIC
EXIT

TRUNG TAM Y KHOA ME

CASE 16: HISTOLOGICAL
APPEARANCE
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
SIEU AM
NOI SOI
XET
NGHIEM

CME

NOI SOI
MEDIC
EXIT

TRUNG TAM Y KHOA ME

Hypernephroma metastatic to the
duodenum
PHONG
KHAM
X QUANG
CT SCAN
MRI
DSA
SIEU AM
NOI SOI
XET
NGHIEM

CME

NOI SOI
MEDIC
EXIT

TRUNG TAM Y KHOA ME

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

CME

Ultrasonography, computed tomography and

magnetic resonance scanning
Angiography
Exploratory lapa rotomy

NOI SOI
MEDIC

EXIT

TRUNG TAM Y KHOA ME

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

CME

Benign tumors:Endoscopic snare and cautesy,

duodenotomy, duodenectomy
Malignant tumors:Whipples operation

NOI SOI
MEDIC

EXIT

TRUNG TAM Y KHOA ME

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

CME

Benign tumors:Excelent
Malignant tumors:
depend in large part on early diagnosis
30%-50% metastasized by the time of
discovery
Endoscopic offers the hope of earlier
detection

NOI SOI
MEDIC

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 ; 23: 512-520.
2- William S.H, Fenton.S: Bockus Gastroenterology.
W.B Saunders Company.1995 ; 53:875-880.
3- C.Mel Wilcox: Atlas of Clinical Gastrointestinal
Endoscopy. W.B Saunders Company. 1995

NOI SOI
MEDIC

EXIT