PMC4392365_01
A and B. Axial sections of the CT scan showing a large cystic lesion in relation to the duodenum with a focal solid component (white arrow). C. Endoscopic view of the duodenum showing polypoid lesion in distal part of the second part of the duodenum adjacent to what looked like a diverticulum (black arrow).
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A CT scan of the abdomen was done which showed a well defined exophytic cystic lesion measuring 15 x 8 x 10 cm arising from the second and the third part of the duodenum (Fig. 1A and B). An upper GI endoscopy was ordered which showed a polypoid lesion in distal part of the second part of the duodenum adjacent to what looked like a diverticulum (Fig. 1C).
Operative photographs. A and B. Showing a 15 x 10 cm cystic lesion arising from the third part of duodenum. C. After duodenotomy, showing the small solid component. D. Following excision, duodenoduodenostomy being done. D: duodenum; M: cystic mass, S: solid component of the cystic lesion; V: superior mesenteric vessels; L: liver; T: transverse colon.
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Per-operatively, she was found to have a 15 x 10 cm cystic lesion with a small solid component arising from the third part of the duodenum (Fig. 2A-D).
A. Line diagram showing the final surgery. B. Wide local excision of the tumor. Duodeno-duodenostomy (D), pyloric exclusion (P), gastrojejunostomy (GJ), retrograde tube duodenostomy (TD) and feeding jejunostomy (FJ).
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Additionally, a retrograde tube duodenostomy and feeding jejunostomy was done (Fig. 3A and B).
Photomicrographs showing. A. Well circumscribed sub-mucosal nodular lesion with Intersecting fascicles (H&E, 4x). B. Pleomorphic elongated cells with cigar shaped nuclei and eosinophilic cytoplasm with mitotic count < 3/50HPF (H&E, 40x). C. Tumor cells highlighted by the CD117 (c-Kit) Immunohistochemical stain (40x).
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Microscopically, a well circumscribed sub-mucosal nodular lesion (Fig 4A) with intersecting fascicles (Fig. 4B) which stained positive for CD 34 and CD 117 with a mitotic Count < 3/50HPF (Fig. 4C) was seen.