PMC5228711_01
Endoscopic image of the tumor: reddish mucosal nodule located in the duodenal remnant after Roux-en-Y anastomosis with small active bleeding.
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F1
During hospitalization for the last bleeding episode in our hospital, an upper GI endoscopy with a pediatric colonoscope revealed an intestinal hemorrhagic 3 x 3 cm reddish mucosal nodule extending to the submucosa (Fig. 1).
Intraoperative imaging showing partial duodenectomy delineated the lesion between the ampulla of Vater and the edge of the duodenum.
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F2
Kocher maneuver was performed followed by a duodenotomy that delineated the lesion between the ampulla of Vater and the edge of the duodenum (Fig. 2).
Resected specimen after pancreas-preserving duodenectomy of the first 2 portions of the duodenum. Note the mass on the left side of the figure, indicating a mucosal lesion.
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F3
Thus, a pancreas-preserving duodenectomy of the first 2 portions of the duodenum was performed resulting into R0 resection (Fig. 3).
Myxoid nodules with extensive hemorrhagic areas and thrombosed vessels (H&E, x 100). H&E = hematoxylin and eosin.
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F4
The lesion was characterized by the presence of extensive hemorrhagic areas (Fig. 4) and thrombosed vessels (Fig. 5) as well as by paucicellular nodules with blunt spindle cells, myxoid stroma, and well-formed capillary network (Fig. 6).
Paucicellular nodule with blunt spindle cells and myxoid stroma (H&E, x 200). H&E = hematoxylin and eosin.
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F6
The lesion was characterized by the presence of extensive hemorrhagic areas (Fig. 4) and thrombosed vessels (Fig. 5) as well as by paucicellular nodules with blunt spindle cells, myxoid stroma, and well-formed capillary network (Fig. 6).