Giant polypoid tumor expressing on the pyloric ring

Area of Science:

• Gastroenterology
• Surgical Oncology
• Diagnostic Imaging

Background:

• Giant polypoid tumors in the duodenum present diagnostic and therapeutic challenges.
• Accurate assessment of tumor invasion depth is crucial for selecting appropriate treatment strategies.

Purpose of the Study:

• To report a case of a giant polypoid tumor of the duodenum with challenging preoperative diagnosis.
• To discuss the difficulties in determining the invasion depth of such tumors.

Main Methods:

• Upper gastrointestinal endoscopy, computed tomography (CT), positron emission tomography (PET), and endoscopic ultrasound (EUS) were utilized for diagnosis.
• Surgical resection (distal gastrectomy) was performed for tumor removal.
• Histopathological examination was conducted for definitive diagnosis.

Main Results:

• A giant polypoid tumor was identified extending from the duodenal bulb to the pyloric ring.
• Preoperative imaging suggested potential muscularis propria invasion, leading to surgical resection over endoscopic removal.
• Histopathology revealed papillary adenocarcinoma confined to the mucosal layer without vascular invasion, differing from preoperative assessments.

Conclusions:

• Precise preoperative diagnosis of invasion depth in giant polypoid duodenal tumors remains difficult.
• Advanced imaging modalities may not always accurately predict the full extent of tumor invasion.
• This case underscores the importance of considering histopathological findings in refining diagnostic and treatment paradigms for duodenal neoplasms.