Duodenal Metastases and Lymphoma

Published on 19/07/2015 by admin

Filed under Radiology

Last modified 19/07/2015

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 Metastases: Bull’s-eye or “target” lesion; submucosal or polypoid mass

image Lymphoma: Bulky submucosal mass without obstruction
• Best imaging tool: Upper GI series, CECT
• Metastases: “Target” or bull’s-eye lesion with rounded submucosal mass

image Luminal obstruction and ulceration are common
• Lymphoma: Large smooth or lobulated submucosal mass 

image Aneurysmal dilation of lumen without obstruction
• Direct invasion: From primary cancer of pancreas, colon, kidney, gallbladder

image 

TOP DIFFERENTIAL DIAGNOSES

• Villous adenoma, duodenal carcinoma, secondary duodenal invasion, duodenal GIST
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PATHOLOGY

• Etiology

image Metastases: Melanoma, cancer of breast, lung, colon, pancreas, or kidney
image Lymphoma: Non-Hodgkin lymphoma of B-cell origin or mucosa-associated lymphoid tissue

CLINICAL ISSUES

• Most common signs/symptoms: Abdominal pain, nausea, vomiting, weight loss, palpable mass, upper GI bleeding

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DIAGNOSTIC CHECKLIST

• Consider duodenal carcinoma (usually obstructs lumen)
• Lymphoma: Bulky submucosal mass without obstruction
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(Left) Spot film from from an upper GI series shows an ulcerated mass image arising from the 2nd portion of the duodenum. There is a persistent pooling of barium within the lesion after the remainder of the duodenum has cleared.

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(Right) Axial CECT in the same patient reveals a high-attenuation mass image within the wall of the 2nd duodenum. A metastatic tumor was confirmed at surgery with the same histology as the primary colon cancer.
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(Left) Small bowel follow-through in a liver transplant recipient, who presented with upper gastrointestinal pain and bleeding, shows a large amorphous collection of barium image apparently arising from, and in continuity with, the distal duodenum. There is no evidence of bowel obstruction.

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(Right) Axial CECT in the same patient shows a large soft tissue density mass image arising from the distal duodenum. This is a good example of aneurysmal dilation of the bowel lumen caused by lymphoma.

TERMINOLOGY

Definitions

• Involvement of duodenum with malignant lymphoma or metastatic disease

IMAGING

General Features

• Best diagnostic clue

image Metastases: Bull’s-eye or “target” lesion; submucosal or polypoid mass
image Lymphoma: Bulky submucosal mass without obstruction of lumen
• Location

image Submucosal lesion in any portion of duodenum
• Size

image 1-5 cm
• Morphology

image Lymphoma: Smooth submucosal, often bulky mass

Fluoroscopic Findings

• Upper GI

image Metastases: “Target” or bull’s-eye lesion with rounded submucosal mass; luminal obstruction and ulceration are common

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