PMC6000720_01
Portal contrast enhancement abdominal CT revealing a duodenal neoplasia (red arrow).
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There was proximal distention of the duodenum and the stomach (Fig. 1).
PET CT showing the duodenal neoplasia (red arrow) and the mesenteric lymph node (green arrow).
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The tumor marker carbohydrate antigen 19-9 (CA 19-9) was slightly increased (52.8kUI/l, normal range lower than 37 kUI/l) whereas the carcinoembryonic antigen (CEA) was within the normal range (2.8 mug/l). 18-FDG PET-CT showed activities at the last portion of duodenum, in one mesenteric lymph node (Fig. 2), and in two other focal points in the small intestine and the left colon.
Resected specimen: Distal duodenum and inferior mesenteric vein.. 1: Dilatation of the second and third duodenum; 2: Duodenal lesion; 3: Fourth duodenum; 4: Jejunum; 5: Duodenum; 6: Inferior mesenteric vein.
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A pancreas-sparing en-bloc resection of a part of the second, the third and fourth portions of duodenum combined with loco-regional lymph node dissection around the portal vein and superior mesenteric artery were performed (Fig. 3, Fig. 4).
Transverse cross section of the resected part of the duodenum.
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Histopathology demonstrated a poorly-differentiated adenocarcinoma with full-thickness invasion and extension beyond the wall with infiltration into the perivisceral fat (Fig. 5).