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Duodenal Carcinoids: Imaging Features with Clinical-Pathologic Comparison¹

¹ From the Departments of Radiologic Pathology (A.D.L., R.M.A.) and Hepatic and Gastrointestinal Pathology (L.H.S.), Armed Forces Institute of Pathology, 6825 16th St NW, Washington, DC 20306-6000; Department of Radiology and Nuclear Medicine (A.D.L., R.M.A.) and School of Medicine (L.D.T.), Uniformed Services University of the Health Sciences, Bethesda, Md; and Department of Radiology, University of Maryland School of Medicine, Baltimore (R.M.A.). Received November 2, 2004; revision requested January 4, 2005; revision received January 11; accepted February 2. Address correspondence to A.D.L. (e-mail: levya{at}afip.osd.mil).

View larger version (167K): [in a new window]   Figure 1a. Radiographs of polypoid duodenal carcinoids. (a) Spot radiograph from an upper gastrointestinal barium examination shows carcinoid of the duodenal bulb in a 55-year-old woman who presented with dyspepsia and epigastric pain. A well-defined, round, intraluminal polyp (arrow) is seen in the duodenal bulb. (b) Overhead prone radiograph from an upper gastrointestinal barium examination in a 54-year-old woman with NF-1 and a 6-month history of abdominal pain. A well-defined intraluminal polypoid mass (arrow) is seen in the periampullary portion of the second portion of the duodenum.

View larger version (169K): [in a new window]   Figure 1b. Radiographs of polypoid duodenal carcinoids. (a) Spot radiograph from an upper gastrointestinal barium examination shows carcinoid of the duodenal bulb in a 55-year-old woman who presented with dyspepsia and epigastric pain. A well-defined, round, intraluminal polyp (arrow) is seen in the duodenal bulb. (b) Overhead prone radiograph from an upper gastrointestinal barium examination in a 54-year-old woman with NF-1 and a 6-month history of abdominal pain. A well-defined intraluminal polypoid mass (arrow) is seen in the periampullary portion of the second portion of the duodenum.

View larger version (174K): [in a new window]   Figure 2a. Images of periampullary carcinoid in a 73-year-old man who complained of severe epigastric pain. (a) Spot radiograph from an upper gastrointestinal barium examination shows a well-defined mural mass (arrows) along the medial margin of the second portion of the duodenum. Barium fills an irregular, central ulcer crater. (b) Photograph of the mucosal surface of the duodenum from a specimen obtained during a Whipple operation shows that the mass contains an irregular, hemorrhagic ulcer crater.

View larger version (163K): [in a new window]   Figure 2b. Images of periampullary carcinoid in a 73-year-old man who complained of severe epigastric pain. (a) Spot radiograph from an upper gastrointestinal barium examination shows a well-defined mural mass (arrows) along the medial margin of the second portion of the duodenum. Barium fills an irregular, central ulcer crater. (b) Photograph of the mucosal surface of the duodenum from a specimen obtained during a Whipple operation shows that the mass contains an irregular, hemorrhagic ulcer crater.

View larger version (90K): [in a new window]   Figure 3a. Images of periampullary carcinoid in a 31-year-old woman who presented with jaundice. (a) Intravenous contrast-enhanced transverse arterial phase CT scan shows an enhancing mural mass (arrow) in the region of the papilla of Vater. (b) Photograph of the cut surface of a specimen obtained during a Whipple operation shows the carcinoid (arrow) in the duodenal wall adjacent to the ampulla of Vater. The paraduodenal and peripancreatic lymph nodes (arrowheads) shown in the surgical specimen were not evident at CT. P = pancreas.

View larger version (186K): [in a new window]   Figure 3b. Images of periampullary carcinoid in a 31-year-old woman who presented with jaundice. (a) Intravenous contrast-enhanced transverse arterial phase CT scan shows an enhancing mural mass (arrow) in the region of the papilla of Vater. (b) Photograph of the cut surface of a specimen obtained during a Whipple operation shows the carcinoid (arrow) in the duodenal wall adjacent to the ampulla of Vater. The paraduodenal and peripancreatic lymph nodes (arrowheads) shown in the surgical specimen were not evident at CT. P = pancreas.

View larger version (134K): [in a new window]   Figure 4a. Images of gastrin-secreting carcinoid tumors in a 47-year-old woman who presented with diarrhea due to Zollinger-Ellison syndrome. (a) Intravenous contrast-enhanced transverse portal-venous phase CT scan shows small, enhancing intraluminal polyps (arrowheads) in the second portion of the duodenum. (b) Endoscopic photograph shows two well-defined intraluminal polyps (arrows).

View larger version (111K): [in a new window]   Figure 4b. Images of gastrin-secreting carcinoid tumors in a 47-year-old woman who presented with diarrhea due to Zollinger-Ellison syndrome. (a) Intravenous contrast-enhanced transverse portal-venous phase CT scan shows small, enhancing intraluminal polyps (arrowheads) in the second portion of the duodenum. (b) Endoscopic photograph shows two well-defined intraluminal polyps (arrows).

View larger version (149K): [in a new window]   Figure 5a. Intravenous contrast-enhanced transverse CT scans of duodenal carcinoid in a 58-year-old woman who presented with abdominal pain. Her stools were positive for guaiac. (a) Portal venous phase scan shows an enhancing mass (*) arising from the medial duodenal wall and invading the pancreas. (b) On the equilibrium phase scan, the mass (*) shows a loss of contrast enhancement.

View larger version (146K): [in a new window]   Figure 5b. Intravenous contrast-enhanced transverse CT scans of duodenal carcinoid in a 58-year-old woman who presented with abdominal pain. Her stools were positive for guaiac. (a) Portal venous phase scan shows an enhancing mass (*) arising from the medial duodenal wall and invading the pancreas. (b) On the equilibrium phase scan, the mass (*) shows a loss of contrast enhancement.