PMC5424694_01
A) CT image shows an intraluminal polypoidal lesion in second part of duodenum with mild duodenal wall thickening; B) endoscopy with EUS shows a large mixed echogenic submucosal lesion of size 4.0x2.8 cm with a 2 cm thick, long pedicle and a feeding artery on color Doppler leading to duodenal intussusception
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A contrasted tomography of the abdomen and pelvis (Figure 1A) revealed an intraluminal polypoidal lesion in the second part of duodenum with mild thickening of duodenal wall with few subcentimetric lymph nodes. Upper gastrointestinal endoscopy with endoscopic ultrasound (EUS, Figure 1B) showed a mixed echogenic submucosal lesion measuring 4.0x2.8 cm with a 2 cm thick, long pedicle and a feeding artery on color Doppler leading to duodenal intussusception and obstruction extending beyond the second part of duodenum.
Intraoperative pictures showing: A) duodenotomy at the junction of first and second part of duodenum reveals the lesion, B) lesion exteriorized from duodenum with stalk based in duodenum (instrument is at ampulla); C) surgical specimen
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Intraoperatively (Figure 2), an approximately 4x3 cm lesion in duodenal bulb and second part of duodenum with a 5 cm long stalk was arising from the posterior wall of first part of duodenum with ampulla at 3 cm distal to the root.
Histopathology: a lobular proliferation of Brunner's glands, accompanied by few ducts and scattered stromal elements, ulcerated surface duodenal epithelium and granulation tissue. Enlarged view shows Brunner's glands
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Histopathology (Figure 3) revealed a lobular proliferation of benign Brunner's glands, accompanied by few ducts and scattered stromal elements, ulcerated surface duodenal epithelium and granulation tissue at places.