LEFT: 71 year-old woman with painless jaundice. Computerized tomography showed dilation of biliary and pancreatic ducts; the head of the pancreas had a prominent appearance. Endoscopy revealed nodular deformity in the periampullary duodenum; the ampulla itself (arrow) was grossly normal. Biopsies of the duodenal mucosa revealed invasive adenocarcinoma, which was most likely of pancreatic origin.
RIGHT: 76 year-old woman who had been found to have a large duodenal polyp three years previously; at that time biopsies were consistent with a benign adenoma without dysplasia, and she was advised to return for complete polypectomy. She was lost to follow-up for three years. Repeat endoscopy revealed enlargement of the polyp, although the gross appearance was still benign. The lesion was resected endoscopically, but there was a small focus of adenocarcinoma within 4 mm of the margin.
69 year-old woman with vomiting and weight loss. Endoscopy demonstrated raised mucosa causing partial duodenal obstruction, and entrapment of food. Biopsies were suspicious for malignancy, but not diagnostic. Histological examination of the surgically resected specimen were consistent with duodenal adenocarcinoma. There was no pancreatic involvement.
57 year-old woman undergoing endoscopy for evaluation of abdominal pain was found to have a mass in the descending duodenum. Biopsies were consistent with adenocarcinoma of small intestinal origin.
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