PMC4535011_01
Endoscopic finding of duodenal bulb.
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AST 60 IU, total bilirubin 3.9mg/dl, direct bilirubin 2.5mg/dl, amylase 69 U, and glucose 173mg/dl. A chest x-ray was normal. A gastrofiberscopic examination revealed extrinsic compression at the antrum, and an ulcerating mass with an elevated margin was found along the posterior wall, the greater curvature side of the duodenal bulb and the second portion of the duodenum (Fig. 1, 2).
Endoscopic finding of the second portion of the duodenum.
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AST 60 IU, total bilirubin 3.9mg/dl, direct bilirubin 2.5mg/dl, amylase 69 U, and glucose 173mg/dl. A chest x-ray was normal. A gastrofiberscopic examination revealed extrinsic compression at the antrum, and an ulcerating mass with an elevated margin was found along the posterior wall, the greater curvature side of the duodenal bulb and the second portion of the duodenum (Fig. 1, 2).
Hypotonic duodenography showes filling defect of duodenum.
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Hypotonic duodenography showed an encircling filling defect from the gastroduodenal junction to the upper border of the ampulla of Vater (Fig. 3).
CT scan shows loss of fat plane between duodenum and pancreas.
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A CT scan of the duodenum revealed a dilatation of the intrahepatic and extrahepatic duct and an enlargement of the pancreas head portion with a loss of fat plane between the duodenal second loop and pancreas mass lesion (Fig. 4).
Two discrete masses are noted. The first portion of the duodenum shows a fungating mass with raised margin and central ulceration, and the second tumorous lesion reveals an irregular thickening of the mucosal fold and slightly polypoid shape.
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The seeond tumorous lesion revealed on irregular thickening of the mucosal fold and slightly polypoid shape (Fig. 5).
The infiltrated cells are plasmacytoid in shape, with round nuclei and coarsely stippled chromatin.
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These infiltrated cells were plasmacytoid in shape, with round nuclei and coarsely stippled chromatin (Fig. 6).
Immunohistochemical staining shows strong positivity in the tumor area with T cell marker MT1.
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T cell marker MT1 (Fig. 7) and UCHL1 and showed negative results with B cell marker L26 and histiocytic marker CD68.
Flowcytometric analysis shows a diploid pattern with an Slphase percentage of 36.83.
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Table 1 shows the results of the immunohistochemical staining. Tumor ploidy was determined by flow cytometry, and it was diploid with aws phase percentage of 36.83%, which was compatible with a malignant lymphoma of intermediate grade (Fig. 8).