PMC2816899_01
Duodenoscopic finding. A huge extrinsic mass causing a luminal obstruction in the proximal second portion of the duodenum, with an intact mucosa.
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F1
On palpation with a biopsy forcep, the mass was found to be soft and easily compressible (Fig. 1).
Computerized tomographic finding. A cystic lesion with a distinct wall in the second-to-third portion of the duodenum (A, B) is shown. The duodenum (closed arrow) is compressed by the cystic lesion and is displaced to the medial side of the lesion (open arrow) (A).
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F2
These findings above were consistent with a DDC (Fig. 2).
Computerized tomographic finding. Dilated intrahepatic duct (A) and a common bile duct and markedly distended the gallbladder (B) is shown.
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F3
The intrahepatic duct and common bile duct were dilated, and the gallbladder was markedly distended (Fig. 3).
Gross finding of the surgical specimen. Segments of the duodenum, duplication cyst, gallbladder and some portions of the pancreas are shown. Resection along the left margin of the cyst (arrow) (A) reveals the inner side of the cystic wall (B). A Kelly is protruding into the duodenum (B).
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F4
The duplication cyst was located along the antimesenteric border and was 9 cm in length and 2.8 cm in the inner diameter (Fig. 4).
Microscopic finding of the cyst wall obtained from the septum of the duplicated segment. Mucosal denudation and replacement by granulation tissue are seen. The cyst shares a common muscular layer with the duodenum (bottom) (H&E stain, x100).
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F5
Histologically, the cyst showed denudation of the mucosal layer, which was replaced by granulation tissue, due to the mucosal inflammation, but most parts of the cyst contained a smooth muscle layer (Fig. 5).