PMC6151219_01
Abdominal MRI and abdominal contrast-enhanced CT. Abdominal MRI shows a homogeneous and well-demarcated 74 x 98 x 122 mm mass at the cranial part of the uterus (arrow), with a low signal intensity on T1-weighted image (a) and mostly low signal intensity and partially high intensity on T2-weighted image (b) (arrowhead). Abdominal contrast-enhanced CT shows a well-demarcated oval mass with a smooth margin and enhancement in the pelvis (black arrow). The enhanced arteries in the tumor are detected (black arrowhead). The tumor is supplied by the superior mesenteric artery (white arrow), and the surrounding lymph nodes are enlarged (white arrowhead) (c, d).
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Abdominal MRI revealed a homogeneous and well-demarcated 74 x 98 x 122 mm mass near the cranial end of the uterus, with a low signal intensity on T1-weighted image, and mostly low signal intensity and partially high intensity on T2-weighted image (Figures 1(a) and 1(b)). The tumor was supplied by the superior mesenteric artery, and the surrounding lymph nodes were enlarged (Figures 1(c) and 1(d)).
Upper gastrointestinal tract endoscopy and FDG-PET/CT. Upper gastrointestinal tract endoscopy shows a tumor with ulcer formation (arrowhead) in the third part of the duodenum, involving half the circumference (a). FDG-PET/CT axial image (b) and sagittal image (c) show heterogeneous uptake inside the tumor (white arrow) with SUVmax 6.3. FDG-PET/CT whole body image (d) also reveals heterogeneous uptake inside the tumor (black arrow).
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Upper gastrointestinal tract endoscopy showed an easily bleeding tumor with an ulcer in the third part of the duodenum, involving half the circumference (Figure 2(a)). FDG-PET/CT showed heterogeneous uptake inside the tumor with SUVmax 6.3 (Figures 2(b)-2(d)).
Surgical findings. Surgical findings show a 12 cm tumor mainly in the third part of the duodenum (asterisk); the duodenum and the ligament of Treitz (black arrow) are pulled in a caudal direction by the tumor (a). The horizontal part of the duodenum (arrowhead) is end-to-end anastomosed to the jejunal stump (white arrow) (b).
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Treitz caudally (Figure 3(a)). In reconstruction, end-to-end duodenojejunostomy was performed (Figure 3(b)).
Pathological findings. Pathological testing shows a solid tumor growing from the muscle layer of the duodenum through the serous membrane (a). Hematoxylin and eosin staining show uniform growth of spindle cells in an intricate manner (b). On immunostaining, alpha-smooth muscle actin is positive (c), and S-100, c-kit, and CD34 are negative (d-f).
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The duodenal mucosa was invaginated at the site of the tumor, forming a deep ulcer (Figure 4(a)). The tumor showed uniform growth of long and spindle-shaped cells in an intricate manner, and the number of nuclear divisions was 1 or less per 50 visual fields (Figure 4(b)). On immunostaining, alpha-smooth muscle actin was positive, while S-100, c-kit, and CD34 were negative (Figures 4(c)-4(f)).