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Tumors of the Duodenum
Tumors of the duodenum are rare. The benign neoplasms that may be encountered are Brunner gland hyperplasia, polypoid adenomas, lipomas, leiomyomas, neurofibromas, hemangiomas, and aberrant pancreatic tissue. All benign tumors are rare and often only slightly elevated. A polyp may be on a pedicle and then appear mobile, shifting back and forth by peristaltic motion, and occasionally prolapsing into the pylorus ( Fig. 40.1 ).
Tumors of the Duodenum.
Carcinoma of the duodenum is also rare, but it is the most common site of primary small-bowel adenocarcinoma. The incidence of 0.35%, based on autopsy studies, is postulated to be a result of the rapid transit of material through the duodenum, lower bacterial load, neutralizing pH, and benzopyrene hydrolase, which is present in much higher concentrations and appears to detoxify benzopyrene, a carcinogen found in various foods. High-risk situations for adenocarcinoma are celiac sprue and familial adenomatous polyposis. Adenomas occur infrequently in patients with duodenal tumors, and the transition to malignancy does occur (see Chapter 70 ). Tumors of the ampulla are described in Chapter 141 .
Clinical Picture
In sporadic reports, obstruction symptoms have occurred when a large polyp on a pedicle prolapsed into the pylorus, acting as a ball valve. However, the usual presentation of duodenal tumors is bleeding, anemia, or jaundice. Unfortunately, by the time of diagnosis, the lesions have frequently spread: In one series, as many as 70% were beyond the local site at presentation.
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