Endoscopic signs of tumors of the duodenum

Benign tumors of the duodenum

Primary tumors of the duodenum are extremely rare - 0.009%.

Classification of benign tumors of the duodenum.

Zollinger-Ellison syndrome.

1. Tumors of epithelial origin:
   • adenomas,
   • hyperplasia-like polyps.
2. Non-epithelial tumors:
   • lipomas,
   • neurinoma,
   • fibroids,
   • leiomyomas and others.

Benign tumors can be single and multiple. There was no primary localization. The fluid is asymptomatic. Clinical manifestations in case of complications (bleeding, obstruction).

Epithelial benign tumors. These include polyps and polypoid tumor changes in the mucous membrane of the duodenum. They are spherical, mushroom-shaped or lobate in shape. Can be, like the polyps of the stomach, on a pedicle or on a wide base, easily mobile, soft or soft-elastic consistency, the coloring is more intense than the surrounding mucosa, often ulcerate, bleed easily.

True polyps, unlike polypoid and submucosal tumors, have a clearly delineated base, which later can be transformed into a leg. This is because the polyp is an epithelial tumor, while polypoid and submucosal tumors are formed by neoplastic tissues, covered with epithelium, and therefore can not have a well-delimited base. This diagnostic criterion, however, can not always be applied due to the great similarity of some submucosal tumors (for example, carcinoid) with polyps on a broad base.

For a biopsy, usually a piece of a tumor taken by biopsy forceps is sufficient. With an unclear histological picture, an endoscopic removal of the entire polyp is necessary.

Polyps up to 0.5 cm are observed at least once every 6 months, more than 0.5 cm shows polypectomy. Biopsy is mandatory, because in 7.4% go to cancer. Before polypectomy it is necessary to determine the relation to OBD. If the polyp is located next to the OBD - a hollow operation is indicated. Submucosal (non-epithelial) benign tumors. They are located in the submucosa layer, are covered by normal mucosa, the boundaries are clear, but the base is not distinctly delimited. The forms are round or oval, there is a positive symptom of the tent. Consistency is soft-elastic. If there is an ulcer on the surface of the tumor, a biopsy should be performed through ulceration or an extended biopsy.

Malignant tumors of the duodenum

Until 1976, there was not a single case of intravital diagnosis of duodenal cancer. It constitutes 0.3% of all malignant tumors of the gastrointestinal tract. Distinguish between primary and secondary cancers of the duodenum.

Primary cancer originates from the wall of the duodenum. It occurs very rarely - at 0.04%. It is localized mainly in the descending part, less often in the lower horizontal and extremely rarely in the upper horizontal branch of the duodenum. In the descending part, the supra, infra, and periampular location are distinguished. The latter is the most frequent and difficult to diagnose, because it is not always possible to differentiate from the fetal papilla carcinoma. Metastasis is noted late: first to regional lymph nodes, then - to the liver, pancreas, later - to other organs. Histologically, adenocarcinoma is defined in 80%.

Classification of primary cancer of the duodenum.

1. Polypous form (exophytic cancer).
2. Infiltrative-ulcerative form (endophytic cancer).
3. Sclerosis-stenosing form (endophytic cancer).

Exophytic cancer. It occurs more often. Tumor nodes are gray-red in color, often with erosion or ulceration on top. The tumor is clearly delineated from the surrounding mucosa, there is no infiltration. It can be rigid, but can be of a soft consistency, easily disintegrating, bleeding.

Infiltrative-ulcerative form. A flat ulcer defect of bright red color is defined as an irregular shape. The bottom is rough, the edges often have protruding papillae. With instrumental palpation - stiffness, light contact bleeding.

Skirrozno-stenosing form. There is a narrowing of the lumen of the duodenal ulcer. The mucous is dull, pale. The relief changes: the surface is uneven, knobby, folds do not straighten the air. With instrumental palpation - severe rigidity. Peristalsis is absent. Contact bleeding is insignificant.

Secondary cancer of the duodenum comes from neighboring organs (germination from the pancreas, fater papillae, bile ducts).

There are 3 stages of the process:

• I stage. The contraction of a tumor with the wall of the duodenum. The deformation of the lumen is not very pronounced (swelling, squeezing the wall). The mucous membrane is mobile, unchanged. No fistula. There is no tumor in intraluminal growth. Biopsy does not give anything.
• II stage. Tumor of the wall of the duodenum without involvement of the mucous membrane. Persistent deformation of the lumen. Mucous is fixed, there are changes in inflammatory nature, erosion. No fistula. There is no tumor in intraluminal growth. With a biopsy, changes in the inflammatory nature.
• III stage. Germination of all layers. The deformation of the lumen is stable. Mucous is fixed, there are proliferations of tumor tissue. There are fistulas. There is intraluminal growth of the tumor. When biopsy - cancer.

The diagnosis is reliable at grade III, high reliability at grade II, at grade I endoscopic diagnosis is ineffective.

Endoscopic signs of diseases of the hepatoduodenal zone

Edoscopic signs of chronic pancreatitis, diseases of the biliary system

1. Expressive duodenitis of the descending section with changes in the mucous type of "semolina" (lymphangiectasia).
2. Rough folding of the mucous postbulbarnogo department.
3. Pronounced focal duodenitis in the OBD region, papillitis.
4. The presence of duodenogastric reflux.
5. Deformation, narrowing of the lumen, changing the angles of the bends.

Indirect endoscopic signs of acute pancreatitis

Changes are caused by inflammation of the pancreas and its edema.

1. 1. Local inflammation along the back wall of the stomach and along the medial wall of the duodenum: hyperemia, edema, fibrin plaque, erosion, multiple hemorrhages, an increase in BDS in size, papillitis.
2. 2. An increase in the pancreas in size causes the posterior wall of the stomach and bulb of the duodenum to be pushed back, rectifying the upper duodenal bend, and flattening the lumen of the descending branch of the duodenum.

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10]