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  • • Upper GI endoscopic or contrast radiographic evidence of duodenal tumor

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Epidemiology

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Adenomas

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  • • Sessile or pedunculated

    • May be associated with familial adenomatous polyposis

    Tubular: Low malignant potential

    Villous

    • -High malignant risk

      -30% of those > 3 cm with malignant focus

      -Often periampullary

    Brunner gland

    • -Hyperplasia of exocrine glands

      -Often asymptomatic

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Gastrointestinal Stromal Tumors (GIST)

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  • • Difficult to distinguish benign from malignant on histologic studies

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Neuroendocrine (Carcinoid) Tumors

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  • • Often endocrinologically active

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Hamartomas

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  • • Associated with Peutz-Jeghers syndrome

    • Rare malignant potential

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Lipomas

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  • • No malignant potential

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Symptoms and Signs

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  • • Gastric outlet obstruction

    • Biliary obstruction and jaundice

    • Upper GI bleeding

    • Carcinoid syndrome (flushing, diarrhea) if hepatic metastases are present

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Laboratory Findings

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  • • Neuroendocrine tumors: Elevated serum serotonin, somatostatin or gastrin; urine 5-hydroxyindoleacetic acid (5-HIAA)

    • Anemia

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Imaging Findings

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  • • Duodenal tumor evident on upper GI endoscopy or contrast radiography

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  • • Duodenal mass

    • Often asymptomatic

    • CT scan may help differentiate tumor type

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Rule Out

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  • • Malignant duodenal tumors or focus of malignancy in a benign tumor

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  • • Symptoms and signs of duodenal mass

    • Upper GI endoscopy or contrast radiography

    • Endoscopic biopsy or polpectomy

    • CT scan to distinguish tumor type and rule out metastases

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When to Admit

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  • • Severe gastric obstruction prohibiting eneteral intake

    • GI bleeding

    • Biliary obstruction

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  • • Endoscopic removal if possible

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Surgery

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Indications

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  • • Failure of endoscopic removal

    • If malignant, pancreaticoduodenectomy usually indicated

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Medications

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  • • GIST: Imatinib mesylate.

    • Carcinoid syndrome: Octreotide.

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Treatment Monitoring

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  • • Repeated interval upper GI endoscopy or contrast radiography

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Complications

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  • • Bleeding

    • Gastric outlet obstruction

    • Biliary obstruction

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Prognosis

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  • • If benign, most tumors cured by removal

    • If malignant, 60% overall 5-year survival

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References

Egberts JH. et al. Small bowel cancer: single-centre results over a period of 12 years. Hepato-Gastroenterology, 2007;54(73):129-34.  [PubMed: 17419246]
Oka K. et al. Aggressive carcinoid tumors arising in the duodenum, ileum, and rectum with liver metastasis: a report of three cases. Hepato-Gastroenterology, 2008;55(86-87):1660-3.

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