PMC9875979_01
Urgent endoscopy: Hemicircumferential ulcerovegetative lesion is observed, with involvement of the bulbar vertex, leading to a reduction of the luminal caliber (A), but passable with a standard endoscope (B).
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F1
An urgent endoscopic examination revealed an ulcerovegetating, hemicircumferential lesion, with involvement of the bulbar apex and extending to the second duodenal portion, with reduced luminal caliber, but passable with a standard endoscope (Figure 1).
Histological images (stained with hematoxylin-eosin) and immunohistochemistry. Histologically, a neoplasm developed in the lamina propria (A and B), consisting of epithelioid cells with slight-to-moderate pleomorphism (C and D), accompanied by a mixed inflammatory infiltrate, rich in osteoclast-like giant cells (D) and abundant histiocytes (positivity for CD 68); in immunohistochemical analysis, positivity for AE1/AE3 (E) and CK 7 (F) and diffuse positivity for vimentin (G) were observed. The absence of immunoreactivity for the remaining immunomarkers, namely neuroendocrine (synaptophysin and chromogranin A), CK20, CK5/6, Melan-A, pS100, and CD45, was noted.
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F2
Histologically, it was an undifferentiated neoplasm, constituted by epithelioid cells with light-to-moderate pleomorphism, and mixed inflammatory infiltrate, rich in giant cells of the osteoclast type without atypical characteristics and abundant histiocytes (Figure 2).
Axial computed tomography revealing a large tumor formation (arrows), measuring at least 9.5 x 6.2 cm, essentially occupying the second portion of the duodenum extending into the third. This lesion presented well-defined contours of the duodenum and no densification of adjacent fat, as well as the absence of involvement of other organs.
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F3
On the right side, it molded to the hepatic angle of the colon, and on the left side, it presented a close relation with the biliary tract and could also extend to the ampullary region (Figure 3).