Tumour

Site

— duodenum (particularly periampullary) 70%: see Chapter 3.

— mucous membrane/muscularis/extramural.

— serosal/mesenteric/nodal/single/multifocal.

— mesenteric/anti-mesenteric border.

— Meckel's diverticulum.

Size

— length x width x depth (cm) or maximum dimension (cm). Appearance

— polypoid/sessile/ulcerated/diffusely infiltrative/fleshy/pigmented/yellow/ stricture/intussusception ± secondary ischaemic necrosis of the tumour tip/intussusceptum or receiving segment (intussuscipiens).

Duodenal carcinomas tend to be papillary or polypoid, distal carcinoma ulcerated and annular with constriction of the bowel wall (napkin ring-like). Presentation can be non-specific, e.g. anaemia or weight loss, with poorly defined central abdominal pain or signs of subacute obstruction. There may be a detectable mass either on abdominal examination or CT scan. Carcinoid tumour is nodular, yellow, uni-/multifocal causing bowel obstruction due to fibrosis or acting as the apex of an intussusception. Malignant lymphoma can be subtle in the edge of a perforated jejunitis or a fungating, fleshy mural or mesenteric mass. There may be a preceding history of coeliac disease. Metastases are often serosal seedlings, nodules or plaques. GISTs are mural lesions which can be dumb bell-shaped with luminal and extramural components. They can also be separate from the bowel and mesenteric in location.

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