PMC3884207_01
a Upper gastrointestinal endoscopy revealed an irregular elevated mucosa in the duodenal bulb. b The other tumor looked like a submucosal tumor with delle.
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F1
U/ml (normal 0-37 U/ml). Upper gastrointestinal endoscopy revealed an irregular elevated mucosa (fig. 1a) and a submucosal tumor with delle in the duodenal bulb (fig. 1b).
The resected specimen shows Borrmann type 2 tumor (black arrows) and submucosal tumor (white arrows).
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F2
The resected specimen showed two tumor types, in accordance with the preoperative findings (fig. 2).
a Pathological examination of the oral side tumor showed that it was consistent with normal Brunner's glands (black arrows), Brunner's gland hyperplasia (white arrow) and adenocarcinoma supposed to arise from Brunner's glands (black arrowheads) (H&E, x40). b Immunohistochemical staining revealed that the sites of normal and hyperplasia glands were positive for MUC6, but that the site of adenocarcinoma was negative (x40). c Pathological examination of the anal side tumor reveals normal Brunner's glands and adenoma supposed to arise from Brunner's glands (H&E, x40). d Immunohistochemical staining revealed that the sites of hyperplasia glands were positive for MUC6, but that the site of adenoma was negative (x40).
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F3
Pathological examination of the oral side of the tumor showed that it was consistent with normal Brunner's glands (fig. 3a, black arrows), Brunner's gland hyperplasia (fig. 3a, white arrow) and adenocarcinoma supposed to arise from Brunner's glands (fig. 3a, black arrowheads). The anal side of the tumor also revealed Brunner's gland hyperplasia and adenoma supposed to arise from Brunner's glands (fig. 3c). Immunohistochemical staining revealed that the site of normal and hyperplasia gland was positive for MUC5AC (data not shown) and MUC6 (fig. 3b, d), but the site of adenoma and adenocarcinoma was negative.