Chapter 33 (page 169)

The Pyloric Sphincteric Cylinder in Health and Disease

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Chapter 33 (page 169)

Case 33.9 A.F., 66 year old male. Radiology: 2.5 cm mass lesion partially obstructing pyloric aperture. Base of gas-filled duodenal bulb normal (Fig. 33.9). Operation: small ulcerated pyloric mass causing partial obstruction. Serosal spread and lymph node metastases. Spread into proximal 2.0 cm of duodenum. Billroth II. Gastric histology: well differentiated adenocarcinoma, intestinal type. Duodenal histology: spread into submucosa for 2.0 mm and into mucosa for 1.0 mm.

Fig. 33.9. Case A.F. Small mass lesion at pyloric aperture (arrow). Base of gas-filled duodenal bulb normal.

Case 33.10 S.F., 49 year old male. Radiology: 6.0 cm nodular and constricting pyloric filling defect. Smooth, concave indentation base of duodenal bulb (Fig. 33.10). Operation: Pyloric mass with serosal spread, adherent to pancreas. Lymph node metastases. Billroth II. Gastric histology: well differentiated adenocarcinoma. Duodenal histology: spread into serosa and muscularis of duodenum. Duodenal mucosa and Brunner's glands free of tumor cells.

Fig. 33.10.Case S.F. Nodular and constricting pyloric filling defect. Smooth, concave indentation base of duodenal bulb.

Case 33.11 K.B., 69 year old female. Radiology: 6.0 cm long constricting pyloric filling defect. Base of duodenal bulb normal (Fig. 33.11). Operation: Pyloric mass with serosal spread and lymph node metastases. Billroth II. Gastric histology: poorly differentiated adenocarcinoma. Marked infiltration of pyloric ring region. Duodenal histology: some tumor cells in muscularis and small blood vessels. Brunner's glands not affected.

Fig. 33.11.Case K.B. Constricting pyloric filling defect. Base of duodenal bulb normal.

Case 33.12 E.L.J., 44 year old male. Radiology: 7.0 cm long constricting pyloric filling defect. Base of duodenal bulb normal (Fig. 33.12). Operation: large mass pyloric region with serosal spread. Duodenum appears normal. Widespread lymphatic metastases. Coeliac and para-aortic glands involved. Metastases in transverse mesocolon and spleen. Billroth II. Gastric histology: poorly differentiated adenocarcinoma (mucinous type with signet ring cells). Duodenal histology: spread into submucosa up to commencement of Brunner's glands. No infiltration of Brunner's glands or superficial mucosa.

Fig. 33.12 A-D Case E.L.J. Constricting pyloric filling defect. Base of duodenal bulb normal.