Duodenal Tumors, Benign

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

Epidemiology

Adenomas

• • 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

Gastrointestinal Stromal Tumors (GIST)

• • Difficult to distinguish benign from malignant on histologic studies

Neuroendocrine (Carcinoid) Tumors

• • Often endocrinologically active

Hamartomas

• • Associated with Peutz-Jeghers syndrome

  • Rare malignant potential

Lipomas

• • No malignant potential

Symptoms and Signs

• • Gastric outlet obstruction

  • Biliary obstruction and jaundice

  • Upper GI bleeding

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

Laboratory Findings

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

  • Anemia

Imaging Findings

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

• • Duodenal mass

  • Often asymptomatic

  • CT scan may help differentiate tumor type

Rule Out

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

• • 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

When to Admit

• • Severe gastric obstruction prohibiting eneteral intake

  • GI bleeding

  • Biliary obstruction

• • Endoscopic removal if possible

Surgery

Indications

• • Failure of endoscopic removal

  • If malignant, pancreaticoduodenectomy usually indicated

Medications

• • GIST: Imatinib mesylate.

  • Carcinoid syndrome: Octreotide.

Treatment Monitoring

• • Repeated interval upper GI endoscopy or contrast radiography

Complications

• • Bleeding

  • Gastric outlet obstruction

  • Biliary obstruction

Prognosis

• • If benign, most tumors cured by removal

  • If malignant, 60% overall 5-year survival

References