关键词: 十二指肠乳头肿瘤, X线计算机, 体层摄影术, 影像学诊断

Abstract:

Objective To explore the CT manifestations and clinical features of duodenal papillary tumors. Methods The CT and clinical data of 12 cases of duodenal papillary tumors confirmed by pathology were analyzed retrospectively. Results Among the 12 cases, 5 were with benign tumors, all of which were adenomas; and the other 7 were with malignant tumors, including 5 adenocarcinomas, 1 stromal tumor and 1 neuroendocrine tumor. All the 5 adenomas showed oval nodule with equal or slightly low density and clear boundary on unenhanced CT, and with homogeneous moderate enhancement on enhanced CT. Among the 5 adenocarcinomas, 1 case showed irregularly thickening of duodenal papilla and with obvious enhancement; 4 cases showed oval nodule (2 cases) or irregular mass (2 cases) and with equal and low density on unenhanced CT, and heterogeneous obvious enhancement on enhanced CT. Peripheral invasion occurred in 2 cases, cystic degeneration and necrosis were observed in 3 cases. One case of stromal tumor presented as irregular mass with heterogeneous equal and low density on unenhanced CT and heterogeneous enhancement on enhanced CT. One case of neuroendocrine tumor presented as oval nodule of equal density and with obvious uniform enhancement. Obstruction of the common bile duct and the main pancreatic duct occurred in all the 12 cases, and incomplete obstruction of duodenal occurred in 6 cases. Choledocholithiasis and acute pancreatitis occurred simultaneously in 2 adenocarcinomas. Single metastasis of retroperitoneal lymph node and ascites were observed in 1 case. The main symptoms of the 12 cases were jaundice and right upper abdominal pain, and all the 12 patients received surgical treatment. The 3 patients with adenomas underwent endoscopic resection, 4 patients with adenocarcinomas and 1 patient with stromal tumors underwent pancreatoduodenectomy and the remaining 4 cases underwent local resection. The 5 cases with adenocarcinomas were treated with systemic chemotherapy for 6 cycles. 12 cases were followed-up for 6 to 18 months, during which the patient with adenoma recurred and underwent reoperation, and no recurrence or metastasis happened for the rest cases. Conclusion Jaundice and right upper abdominal pain are the main clinical symptoms of duodenal papillary tumors, and obstruction of biliary and pancreatic ducts occurs in the early stage generally. CT diagnosis of this type of lesions is of great value . Early surgical resection may obtain a better prognosis.

Key words: duodenal papilla neoplasms, X-ray computed, tomography, imaging diagnosis