PMC3932400_01
In June 2009, computed tomography (CT) and esophagogastroduodenoscopy revealed a duodenal tumor with liver metastasis. (A) CT findings: homogeneous, poorly enhanced wall thickening of the duodenum and a large, homogeneous, poorly enhanced node (2.6 cm) in the triangular area were found. (B) CT findings: innumerable homogeneously enhancing metastatic nodules in the liver were detected. (C) Endoscopic finding: ulcerofungating mass at the superior descending angle.
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F1
In June 2009, he visited a local clinic after experiencing general weakness and melena over a period of 1 month, was diagnosed with duodenal cancer with multiple liver metastases (Fig. 1A and 1B), and was transferred to our hospital. Esophagogastroduodenoscopy (EGD) (Fig. 1C) confirmed an ulcerofungating mass with poorly differentiated neuroendocrine carcinoma at the superior duodenal angle of the duodenum (Fig. 2A and 2B).
(A) Endoscopic finding: duodenal polypoid mass at the superior descending angle. (B) Immunohistochemistry finding: carcinoembryonic antigen was positive (immunohistochemistry, x 100).
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F3
In February 2011, a polyp was detected by EGD at the same site as that of the former polyp (Fig. 3A). Carcinoembryonic antigen (CEA), which is usually detected in cases of adenocarcinoma, was positive (Fig. 3B).
The tumor cells are arranged in a glandular pattern: adenocarcinoma, moderately differentiated (A, H&E, x 100; B, H&E, x 12.5). Immunohistochemistry findings: (C) CD56 was negative; (D) chromogranin A was negative; (E) synaptophysin was negative (C, D, E, immunohistochemistry, x 40).
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F4
The surgical pathology results showed moderately differentiated duodenal adenocarcinoma at the site of the primary lesion, and mild nonspecific reactive hepatitis was confirmed in the liver via immunohistochemical staining (Fig. 4).