PMC3884199_01
a Endoscopic image depicting a 3-cm mass in the descending portion of the duodenum that is adjacent to the oral side but does not involve the papilla of Vater. The papilla of Vater is indicated by an arrow. b Endoscopic ultrasonography image showing the tumor partially invading the head of the pancreas (arrow). c Duodenography showing a protruding lesion in the descending portion of the duodenum (arrow). d Computed tomography image showing an ill-defined hypervascular mass (arrow). The tail of the pancreas had been minimally resected during a previous surgery. e Magnifying endoscopy depicting a diminished surface pattern of the gastrointestinal epithelium across the entire surface of the tumor. f Magnifying endoscopy combined with NBI depicting a diminished capillary network pattern.
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F1
EGD revealed an ulcerated polypoid mass in the descending portion of the duodenum; the mass was adjacent to the oral side, but did not involve the papilla of Vater (fig. 1a). Endoscopic ultrasonography showed the tumor to be partially invading the head of the pancreas (fig. 1b). Duodenography revealed a protruding lesion at the wall of the pancreatic side of the descending portion of the duodenum (fig. 1c). Abdominal enhanced computed tomography depicted a well-contrasted, hypervascular mass (fig. 1d). Magnifying endoscopy showed a diminished mucosal surface pattern of the gastrointestinal epithelium across the surface of the tumor (fig. 1e). Furthermore, combined with narrow-band imaging (NBI), it also showed a highly dense assembly of microvessels on the surface of the tumor that did not form a capillary network pattern (fig. 1f). Although partial resection of the pancreas had already been performed for a metastatic tumor of the pancreatic tail, the remnant pancreas was of rich volume (fig. 1d).
a Macroscopic findings of the resected specimen reveal a polypoid mass in the descending portion of the duodenum that appears ulcerative and friable. The papilla of Vater is indicated by an arrow. b Histologic findings show that the surface of the tumor was coated by granulation tissue consisting of inflammatory cells, fibrosis and edematous stroma. c Histologic image shows dysplastic clear cells containing glycogen and arranged in an alveolar pattern. d-f Immunohistochemical staining demonstrates that the clear cells are positive for vimentin (d) and CD10 (e) and negative for CK7 (f), confirming the diagnosis of RCC with clear cell histology.
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F2
Macroscopic findings of the resected specimen indicated that the polypoid mass at the descending portion of the duodenum was ulcerative and friable (fig. 2a). Histologic findings revealed that the surface of the tumor was coated by granulation tissue consisting of inflammatory cells, fibrosis and edematous stroma (fig. 2b). Furthermore, the cancerous lesion comprised clear cells containing glycogen that were arranged in an alveolar pattern (fig. 2c). Immunohistology showed that the tumor cells were positive for vimentin and CD10 and negative for CK7 (fig. 2d-f).