PMC4821151_01
CT of the abdomen and pelvis with contrast showing a mass-like density (arrows) in the gastric antrum or proximal duodenum measuring approximately 4 cm (anterior to posterior) (a) and multiple areas of decreased attenuation (arrows) in the liver which represent metastasis (b).
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F1
A contrast-enhanced computed tomography (CT) of the abdomen and pelvis showed a markedly dilated, debris-filled stomach with no contrast beyond the gastric antrum, and a mass-like density in the gastric antrum or proximal duodenum measuring approximately 4 cm in diameter (fig. 1a). Multiple hypodense hepatic lesions (the largest being 6 cm in the right hepatic lobe) were also seen, which was consistent with metastatic disease (fig. 1b).
Upper endoscopy showing a circumferential, friable mass obliterating 80% of the lumen at the duodenal bulb preventing advancement of the scope to the second part of the duodenum.
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F2
A circumferential, friable mass at the duodenal bulb was noted, obliterating 80% of the lumen and preventing scope advancement beyond the second portion of duodenum (fig. 2).
a HE stain (x400) showing invasive adenocarcinoma with gland formation and occasional mucin production. Areas with trabecular and nested patterns are also visualized, as well as tumor cells with moderate-to-abundant eosinophilic cytoplasm (hepatoid). b Tumor cells with diffuse, strong staining for monoclonal CEA. c Tumor cells with diffuse, strong staining for AFP.
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F3
There were also areas with trabecular and nested patterns seen (fig. 3a). The tumor cells were positive for CEA, AFP, CK18, CK19, and CDX-2, but were negative for CK7, CK20, and synaptophysin (fig. 3b, c).