PMC6796759_01
a) Findings on contrast-enhanced computed tomography. Intussusception of the third portion of the duodenum is seen, as is duodenal dilation on the oral side of the lesion in the arterial phase. b) Findings on computed tomography in the equilibrium phase. Two masses without exophytic growth in the left hepatic lobe are seen, suggesting metastasis. c) Findings on esophagogastroduodenoscopy. A protruding lesion in the third portion of the duodenum is seen, which the scope is able to pass through.
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Contrast-enhanced computed tomography (CT) showed a mass in the third portion of the duodenum presenting as intussusception (Fig. 1a). Two masses without exophytic growth in the left hepatic lobe in the equilibrium phase of contrast-enhanced CT were also observed, suggesting metastasis (Fig. 1b). Esophagogastroduodenoscopy revealed a protruding lesion in the third portion of the duodenum, with subsequent biopsy confirming that it was a GIST (Fig. 1c).
a) Findings during laparotomy. Lymph node metastasis (arrow) adjacent to the ligament of Treitz is seen. b) Findings during laparotomy after resection of the ligament of Treitz. Duodenojejunal intussusception secondary to gastrointestinal stromal tumor in the third portion of the duodenum was confirmed. c) Anastomosis. End-to-end duodenojejunostomy was performed on the left side of the superior mesenteric blood vessels.
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Laparotomy revealed lymph node metastasis, but no peritoneal metastasis and no exposure of the liver tumors to the abdominal cavity was observed (Fig. 2a). The ligament of Treitz was resected, allowing for visualization of the duodenojejunal intussusception (Fig. 2b). After the GIST and third potion of the duodenum were dissected from the pancreas, segmental duodenectomy with end-to-end duodenojejunostomy without reduction of the intussusception was performed on the left side of the superior mesenteric blood vessels (Fig. 2c).
a) Macroscopic findings. The specimen shows a smoothly marginated tumor measuring 40 x 40 x 15 mm with an erosive lesion on the mucosal side. b) Microscopic pathologic findings (hematoxylin & eosin staining). The specimen shows epithelioid/spindle tumor cells with oval nuclei, which were positive for CD117, DOG1, and CD34.
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The resected specimen showed a smoothly marginated tumor measuring 40 x 40 x 15 mm with an erosive lesion on the mucosal side and two elastic soft tumors on the serosal side (Fig. 3a). Histologic examination revealed epithelioid/spindle tumor cells with oval nuclei, which were positive for CD117, DOG1, and CD34 (Fig. 3b).