PMC5109561_01
Clinical course.
1349-7235-55-2951-g001.jpg
PMC5109561_01_1349-7235-55-2951-g001.jpg
g001
Her platelet count thereafter quickly increased (Fig. 1).
Upper gastrointestinal endoscopic examination showed a circumferential ulcerating tumor mimicking a type II-like tumor in the second portion of the duodenum (A). The tumor disappeared after 4 cycles of R-CHOP therapy (B).
1349-7235-55-2951-g002.jpg
PMC5109561_01_1349-7235-55-2951-g002.jpg
g002
EGD revealed a circumferential ulcerative tumor mimicking type 2 advanced cancer (Fig. 2A). After the 4th cycle of the therapy, the duodenal tumor was not detected by EGD (Fig. 2B).
A duodenal biopsy showed the diffuse infiltration of large lymphoid cells (Hematoxylin and Eosin staining) (A). The cells were positive for CD20 (B).
1349-7235-55-2951-g003.jpg
PMC5109561_01_1349-7235-55-2951-g003.jpg
g003
A pathological examination of the biopsied specimen showed a diffuse infiltration of large lymphoid cells which were positive for CD20 but negative for CD3 (Fig. 3).
FDG-PET/CT study showed a significant uptake in the duodenum (A) and the pelvic mass (B) before chemotherapy. After chemotherapy, the duodenum mass disappeared (C) while the pelvic mass remained (D).
1349-7235-55-2951-g004.jpg
PMC5109561_01_1349-7235-55-2951-g004.jpg
g004
An 18F-fluorodeoxy glucose (FDG) positron emission tomography (PET) study with a simultaneous whole body computed tomography (CT) scan showed a markedly increased uptake of FDG in the duodenum (Fig. 4A). An FDG-positive round mass in the right pelvic cavity was also found (Fig. 4B). An interim FDG-PET study showed that the mass in the pelvic cavity had not shrunk at all, while the duodenal lesion had completely disappeared (Fig. 4C and D).
A fixed resected specimen of the pelvic tumor. A well-demarcated mass measuring 5 cm in diameter is observed.
1349-7235-55-2951-g005.jpg
PMC5109561_01_1349-7235-55-2951-g005.jpg
g005
The tumor was a well-demarcated capsulated mass measuring 5 cm in diameter and it protruded from the intestine to the peritoneal cavity (Fig. 5).
A resected pelvic tumor contained spindle shaped cells (Hematoxylin and Eosin staining) (A). The cells were positive for CD117 (B).
1349-7235-55-2951-g006.jpg
PMC5109561_01_1349-7235-55-2951-g006.jpg
g006
A pathological examination disclosed a proliferation of spindle shaped cells with only slight mitotic activity (Fig. 6).