PMC9299241_01
Contrast-enhanced CT showed that the tumor was located in the duodenal cavity (approximately 1.8 cm x 2.2 cm) without penetrating the duodenal wall.
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F1
The values of plain and three-phase contrast-enhanced CT scans were about 35/90/90/73HU (Figure 1).
Duodenoscopic images of the tumor and pathological results of endoscopic biopsy during hospitalization. (A) Duodenoscopic images of the tumor; the red arrow indicates tumor tissue, and the blue arrow indicates duodenal papilla. (B)Histopathological examination of the biopsy (H&E staining) of the tumor, original magnification, x100. These cells were positive for Vimentin, x100 (C), CD68, x100 (D), and Ki-67 was about 50% upon immunostaining, x100 (E).
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F2
Duodenoscopy confirmed that the mass originated from the duodenal papilla and projected into the lumen of the duodenum without invading the intestinal wall (Figure 2A). Tumor cells were positive for CD68, Ki67 (50%), and Vimentin (Figures 2B-E), while negative for CD117, CD20, CD3, CD34, chromogranin A, CK7, Desmin, DOG1, HMB-45, melon-A, and Synaptophysin (data not provided).
Ultrasound, endoscopy, and biopsy results 8 years ago. Preoperative ultrasound (A) and endoscopic retrograde cholangiopancreatography (ERCP) images showed a mass (red arrow) in the distal bile duct (B), and the histological manifestation of biopsy specimen (C).
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F3
Ultrasound and endoscopic retrograde cholangiopancreatography (ERCP) were performed at that time, both of which indicated mass in the distal common bile duct (Figures 3A, B). A biopsy specimen obtained from the mass revealed blood clots and multinucleated giant cell reaction (Figure 3C).
Final pathological results after surgery. Histopathological examination of the tumor (H&E staining), original magnification, x200 (A). These cells were positive for Vimentin, x100 (B), CD68, x100 (C), and Ki-67 was about 80% upon immunostaining, x100 (D).
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F4
Immunohistochemical stains for CD68 and Vimentin were positive in the neoplastic cells, the proliferative marker Ki67 showing approximately 80% nuclear staining (Figure 4), and CD117, CD34, HMB45, CD45, CD56, S-100, smooth muscle actin (SMA), or desmin were negative (data not provided).
Contrast-enhanced CT scan 2 months after surgery revealed local recurrence and intrahepatic metastasis.
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F5
CT scan showed a recurrent duodenal mass and multiple metastatic foci in the liver (Figure 5), and the patient died of metastasis 2 weeks later.
A timeline with relevant data from the episode of care.
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F6
The episode of care is organized as a timeline in Figure 6.