Huge periampullary tumors simulating hepatic hilar tumors - A report of three cases

Difficulties in surgical decision-making may arise when periampullary tumors are large enough to reach the hepatic hilar region, thus, making them indistinguishable from tumors originating from this part of the body on abdominal computed tomography. We present three cases of periampullary tumors (one gastrointestinal stromal tumor of the duodenum, two endocrine cell tumors of the pancreas) with preoperative image findings resembling hepatic hilar tumors. All three of the patients remained rather asymptomatic in spite of the presence of large tumors (maximal diameter of tumors ranging from 7 cm to 25 cm). Serum levels of alpha-fetoprotein, carcinoembryonic antigen, and carcinoantigen 19-9 were all within reference ranges. Image studies showed no vascular invasion. All tumors were successfully resected using pylorus-preserving pancreaticoduodenectomy. In contrast to the better-understood adenocarcinomas, most of these relatively rare periampullary tumors can be resected with promising prognoses. Therefore, it is important to identify and treat the patients with these tumors properly rather than subject the patients to conservative treatment just because of the size and location of the tumors.