The price diagnosis of duodenal papillary carcinoma
10.3760/cma.j.issn.1007-8118.2013.07.001
- VernacularTitle:十二指肠乳头癌的精确诊断
- Author:
Bianxi FENG
- Publication Type:Journal Article
- Keywords:
Duodenal neoplasms;
Diagnotic imaging;
Surgical procedures,operative
- From:
Chinese Journal of Hepatobiliary Surgery
2013;19(7):481-486
- CountryChina
- Language:Chinese
-
Abstract:
Precise diagnosis is the premise of precise surgery.Duodenal papillary carcinoma is one cause of obstructive jaundice,but the several preoperative diagnostic imaging investigations (including Ultrosonography,CT,MRI with MRCP,PTC,T-tube chalangiogrphy) can not make the correct diagnosis of the tumor in location and nature.In some cases,the error diagnoses resulted in error surgeries which led to reoperations.During a period of ten years from the beginning of 2003 to the end of 2012,29 cases with the entity made the correct diagnosis by surgeons in location and partly correct in nature.Based on the experience of these cases,comparing the data from clinic pictures,imaging findings and pathologic observations,seven common characters for the diagnostic imaging investigation were valuable to make precise diagnosis of duodenal papillary carcinoma.These common characteristics are listed as:(1) dilated gallbladder,marked intra-and extrahepatic biliary ductal dilatation in whole range,may combine dilation of pancreatic duct;(2) on cross-sectional imaging as a double-duct sign,which results from obstruction of both the distal common bile duct and the proximal pancreatic duct; (3) on cross-sectional imaging as a cyclo-dilatation at the level of renal hilum;(4) on cross-sectional imaging as a apple-stem sign,which results from dilated common bile duct and the normally proximal pancreatic duct; (5) on coronal plane imaging at the level of second lumbar vertebrae as a cutoff,or eccentricity,or irregular strcture ; (6) on cross-sectional imaging of CT imaging as a mass located at duodenum near the side of pancreas; (7) on MRCP examinations as a mass with hypointensity at the level of duodenal papilla.Any imaging examination alone,or combined examination show first characteristic with any one of the other six characteristics,the diagnosis of duodenal papillary carcinoma may be made,subsequently followed by a correct surgical decision.
