PMC4987505_01
This coronal CT image of patient 1 nicely reveals the large periampullary mass (large arrow), the contrast-enhanced duodenal GIST (small arrow) and a dilated gallbladder.
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Abdominal computerized tomography (CT) and Magnetic Resonance Cholangiopancreatography (MRCP) revealed an abrupt narrowing of the distal part of the main bile duct, a distended gallbladder, a periampullary mass and a solid lesion at the third duodenal portion, both contrast-enhanced (Fig. 1).
The OGD for patient 1 shows a bulging mass at the periampullary region.
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The patient underwent an oesophagogastroduodenoscopy (OGD) (Fig. 2) revealing a partially obstructing and infiltrative duodenal lesion and an irregular mass at the ampulla of Vater.
Ampulla and jejunal well-differentiated neuroendocrine tumor.Proeminente acinar growth patern are seen in this example, in jejunal ressection (a). Somatostatin staining in Immunohistochemistry (b). CD117/c-Kit expression in GIST, with cytoplasmic and membranous labeling (c). (Hematoxilin and eosin, original magnification x 50 [a], immunohistochemistry, x100 [b, c]).
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Pathology findings of the lesions were consistent with two low grade periampullary neuroendocrine tumors, one of 2.6 cm and another of 2.3 cm, and a 0.9 cm GIST of the jejunal segment (Fig. 3).
OGD view of a polypoid intraluminal lesion of 1.5 cm at the second duodenal portion of Patient 2.
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An OGD (Fig. 4) was performed and biopsy of the first lesion revealed a well - differentiated neuroendocrine tumor of the ampulla of Vater, positive for somatostatin.
Pedunculated GIST of the jejunum of Patient 2.
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Pylorus-preserving pancreaticoduodenectomy and resection of the jejunal lesion (Fig. 5) was performed.
Duodenal well-differentiated neuroendocrine tumor. This example shows a proeminent nest growth pattern (a). A chromogranin stain highlight the neoplastic cell (b).Gastrointestinal stromal tumor cells highlited by CD117/c-KIT stain(c) (Hematoxilin and eosin, original magnification x100 [a], and immunohistochemistry,x100 [b] and x200 [c]).
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Pathology findings were well-differentiated neuroendocrine adenocarcinoma at the level of the papilla, and two jejunal lesions of 2.5 cm and 0.6 cm, positive for CD-117, S-100 protein and smooth muscle actin, consistent with GIST (Fig. 6).