PMC514615_01
(a) Duodenoscopy showing a 3 x 3 cm protruding tumor with two ulcerations located opposite the ampulla of Vater in the second portion of the duodenum. (b) Hypotonic duodenography showing the donuts-shape tumor in the duodenum.
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F1
Duodenoscopy (Figure 1a) and hypotonic duodenography (Figure 1b) revealed a 3 x 3 cm protruding tumor with two ulcerations located opposite the ampulla of Vater in the second part of the duodenum.
Macroscopic and microscopic findings of the tumor. (a) Gross appearance of the tumor. The tumor was divided into two components, component A (round shape) and B (crescent shape). (b) Photomicrograph of the gross appearance of the tumor (Hematoxylin and eosin X 2). (c) Photomicrograph of the component A showing fibrous tissue, small nuclei, and clear nucleoli. (Hematoxylin and Eosin X 40). (d) Photomicrograph of the component B showing more anaplastic features typical of small-cell carcinoma, such as sheets of tightly packed anaplastic cells with round nuclei and scanty cytoplasm. (Hematoxylin and Eosin X 40).
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F2
On gross examination, the tumor showed two ulcerations and two different morphological components (Figure 2a and 2b). Histopathologically, the crescent component had more anaplastic features typical of small-cell carcinoma, such as sheets of tightly packed anaplastic cells with round nuclei and scanty cytoplasm (Figure 2c, 2d).
Immunostaining for AE1/AE3 showing (a) diffuse cytoplasmic positivity in the component A, and (b) no reactivity in the component B.
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F3
Both components showed neuroendocrine features, with immunochemistry identifying synaptophysin and AE1/AE3 (Figure 3a and 3b), and electron microscopy identifying dense core granules (Figure 4).
Ultrastructural study showed cytoplasmic dense-core granules in the component A.
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F4
Both components showed neuroendocrine features, with immunochemistry identifying synaptophysin and AE1/AE3 (Figure 3a and 3b), and electron microscopy identifying dense core granules (Figure 4).