Papillary tumor

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1 stomach, 2 gallbladder, 3 bile duct, 4 pancreatic duct and papilla Vateri, 5 duodenum, 6 pancreas

Papillary tumors are tumors of the papilla Vateri , the point where the bile and pancreatic ducts join the duodenum . Due to their location, they cause digestive disorders, biliary congestion and inflammation of the pancreas . They can be good or bad.

Epidemiology and pathology

Papillary tumors are rare. In autopsies they are found in about every 1000 case. Malignant papillary tumors make up approx. 0.5% of malignancies of the gastrointestinal tract. In people with certain congenital syndromes such as familial adenomatous polyposis (FAP) , however, adenomas are much more common and then also show a significant tendency to degenerate (see adenoma-carcinoma sequence , 100 times increased risk of cancer). Most benign tumors are adenomas of the lining of the bowel; others may be from the uniseriate columnar epithelium . of the biliary or pancreatic duct arise. Both variants can degenerate into carcinomas under the influence of the bile . The differentiation is prognostically important and is made with the help of immunohistochemistry . Other malignant tumor types ( carcinoids , neuroendocrine tumors ) are rare.

Symptoms and diagnosis

Many papillary tumors are discovered by chance during gastrointestinal endoscopy . Others cause biliary congestion or obstructive pancreatitis (inflammation of the pancreas) with symptoms such as abdominal pain, nausea and jaundice due to the narrowing of the papilla . Malignant tumors above a certain size can cause anemia, weakness and weight loss. In the blood, the enzymes typical of liver diseases , bilirubin , the pancreatic enzymes lipase and amylase, and usually also the general inflammatory parameters, are increased. Evidence is easily possible with an endoscopy. Further methods are ERCP , ultrasound (also endoscopic ultrasound), computed tomography or magnetic resonance tomography . The final decision as to whether a tumor is benign or malignant is only made after it has been completely removed and examined microscopically by the pathologist.

Treatment and prognosis

Very small, smooth papillary tumors that neither bleed nor show induration can be classified as benign and can only be observed. All other tumors must be removed. This is possible with the endoscope for benign tumors that are not too large, provided they have not grown too deep into the papilla; other findings (> 4–6 cm or growing in depth) require a surgical procedure, which is performed under general anesthesia in a hospital. Malignant tumors must be removed with a safe margin, which usually means a partial removal of the pancreas and the surrounding lymph nodes. If the classification is uncertain, a tissue sample can first be taken endoscopically and, depending on the result, the actual procedure can be planned. Chemotherapy and radiation therapy are only used in individual cases. No guideline has yet been developed for this rare type of tumor.

Side effects depend on the type and severity of the procedure and mainly concern bleeding, intestinal injuries, narrowing of the bile ducts, and inflammation of the bile ducts and pancreas. The recurrence rate of endoscopically removed tumors is 15%. The prognosis for optic disc carcinomas (depending on the stage) is up to 60% probability of survival after 5 years, worse for the findings from the biliary epithelium.

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