Abstract
Purpose
The purpose of the study is to evaluate the CT appearance and pattern of metastatic disease of patients with surgically resected well-differentiated duodenal neuroendocrine tumors who underwent pre-operative dual-phase CT.
Methods
Clinical and pathologic records and CT images of 28 patients (average age 58.0 years) following Whipple procedure were retrospectively reviewed. The size, morphology (polypoid, intraluminal mass or wall thickening, intramural mass), location, CT attenuation in the arterial and venous phases, and the presence of lymph node or liver metastases were recorded.
Results
On CT, 19 patients (67.8%) had neuroendocrine tumors manifested as polypoid or intraluminal masses (38 lesions, multiple tumors in 3 patients), 4 patients (14.3%) had tumors manifested as wall thickening or intramural masses, and in 5 patients (17.9%), the primary tumor was not visualized. Lesions not seen at CT were less than 0.8 cm on pathologic diagnosis. The mean size of polypoid tumors on CT was 1.2 cm (range 0.3–3.8 cm); 24 tumors were 1.0 cm or smaller, and 14 tumors were larger than 1.0 cm. Most lesions were hypervascular in the arterial phase (19/23 patients) with an increase in tumor enhancement in the venous phase in 14 patients (60.9%), decrease in enhancement in 7 patients (30.4%), and no change in enhancement in 2 patients (8.7%). Thirteen patients (46.4%) had metastatic disease from carcinoid tumor, most commonly regional enhancing lymphadenopathy.
Conclusion
Duodenal carcinoid tumors commonly appear as an enhancing mass in either the arterial or venous phases. If a primary tumor is not seen in the duodenum, adjacent enhancing lymphadenopathy can be a clue to the presence of a duodenal carcinoid tumor.
Similar content being viewed by others
References
Chang S, Choi D, Lee SJ, et al. (2007) Neuroendocrine neoplasms of the gastrointestinal tract: classification, pathologic basis, and imaging features. Radiographics 27:1667–1679
Ellis L, Shale MJ, Coleman MP (2010) Carcinoid tumors of the gastrointestinal tract: trends in incidence in England since 1971. Am J Gastroenterol 105:2563–2569
Bosman FT, Carneiro F, Hruban RH, Theise ND (2010) WHO classification of tumours of the digestive system, 4th edn. Lyon, France: International Agency for Research on Cancer
Scarsbrook AF, Ganeshan A, Statham J, et al. (2007) Anatomic and functional imaging of metastatic carcinoid tumors. Radiographics 27:455–476
Levy AD, Sobin LH (2007) From the archives of AFIP Gastrointestinal carcinoids: imaging features with clinical pathologic comparison. RadioGraphics 27:237–257
Chetty R, Vajpeyi R (2009) Vasculopathic changes, a somatostatin-producing neuroendocrine carcinoma and a jejunal gastrointestinal stromal tumor in a patient with type 1 neurofibromatosis. Endocr Pathol 20:177–1817
Farmakis SG, Han M, White F, Khanna G (2014) Neurofibromatosis 1 vasculopathy manifesting as a peripheral aneurysm in an adolescent. Pediatr Radiol 44(10):1328–1331
Hoffman KM, Furukawa M, Jensen RT (2005) Duodenal neuroendocrine tumors: classification, functional syndromes, diagnosis, and medical treatment. Best Pract Res Clin Gastroenterol 19(5):675–697
Anlauf M, Perren A, Meyer CL, et al. (2005) Precursor lesions in patients with multiple endocrine neoplasia type 1—associated duodenal gastrinomas. Gastroenterology 128(5):1187–1198
Anlauf M, Enosawa T, Henopp T, et al. (2008) Primary lymph node gastrinoma or occult duodenal microgastrinoma with lymph node metastases in a MEN1 patient: the need for a systematic search for the primary tumor. Am J Surg Pathol 32(7):1101–1105
Abraham A, Singh J, Siddiqui G, et al. (2012) Endoscopic management of primary duodenal carcinoid tumor. Case Rep Gastroenterol 6:135–142
Sahani DV, Bonaffini PA, Fernández-Del Castillo C, Blake MA (2013) Gastroenteropancreatic neuroendocrine tumors: role of imaging in diagnosis and management. Radiology 266(1):38–61
Mullen JT, Wang H, Yao JC, et al. (2005) Carcinoid tumors of the duodenum. Surgery 128(6):971–978
Pfannenberg AC, Burkart C, Kröber SM, et al. (2005) Dual-phase multidetector thin-section CT in detecting duodenal gastrinoma. Abdom Imaging 30:543–547
Poultsides GA, Frederick WA (2006) Carcinoid of the ampulla of Vater: morphologic features and clinical implications. World J Gastroenterol 12(43):7058–7060
Krishna SG, Lamps LW, Rego RF (2010) Ampullary carcinoid: diagnostic challenges and update on management. Clin Gastroenterol Hepatol 8(1):e5–e6
Buck JL, Elsayed AM (1993) From the archives of the AFIP ampullary tumors: radiologic-pathologic correlation. Radiographics 13:193–212
Disclosures
We have no disclosures.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Tsai, S.D., Kawamoto, S., Wolfgang, C.L. et al. Duodenal neuroendocrine tumors: retrospective evaluation of CT imaging features and pattern of metastatic disease on dual-phase MDCT with pathologic correlation. Abdom Imaging 40, 1121–1130 (2015). https://doi.org/10.1007/s00261-014-0322-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00261-014-0322-7