Duodenal Carcinoma

Michael P. Federle, MD, FACR

Key Facts

Imaging

Irregular intraluminal mass or “apple core” lesion at or distal to ampulla of Vater
Irregular thickening of duodenal wall
Concentric narrowing of duodenal lumen
Polypoid intraluminal mass
Local lymphadenopathy and local infiltration
Biliary ± pancreatic duct dilatation
- With periampullary tumors
Liver ± peritoneal metastases

Top Differential Diagnoses

Clinical Issues

Other signs/symptoms
- Nausea and vomiting, weight loss, anemia, upper GI bleed
- Periampullary tumors may present with jaundice
Rare: Represents < 1% of all gastrointestinal neoplasms

Diagnostic Checklist

Most duodenal carcinomas cause focal stenoses or obstruction; large mass with cavitation is often lymphoma or GIST

(Left) Axial CECT in a 60-year-old man with weight loss and early satiety shows obvious liver metastases

. (Right) Axial CECT in the same patient also shows paraduodenal lymph node metastases

(Left) Axial CECT in the same patient shows the relatively subtle mass that narrows the 3rd portion of the duodenum

. There is also a subtle extension of tumor along the superior mesenteric vessels

. (Right) Film from an upper GI series in the same patient shows the duodenal carcinoma more clearly

. Note the “shoulder” or abrupt transition to tumor at its proximal extent. The lumen of the more proximal duodenum is dilated.

TERMINOLOGY

Abbreviations

Definitions

IMAGING

General Features

Best diagnostic clue
- Irregular intraluminal mass or “apple core” lesion at or distal to ampulla of Vater
Location
- 15% in 1st portion of duodenum
- 40% in 2nd portion of duodenum
- 45% in distal duodenum
Size
- Usually < 8 cm
Morphology
- Polypoid, ulcerated, or annular constricting mass
- Intraluminal mass with numerous frond-like projections for carcinomas arising in villous tumors

Fluoroscopic Findings

May have various appearances
- Ulcerated mass
- Polypoid mass
- Annular constricting “apple core” lesion
- “Soap bubble” reticulated pattern for villous tumors

CT Findings