PMC9852733_01
(A) gastroduodenoscopy revealed a mass lesion located in the descending part of the duodenum. (B) PET-CT scan showed a tumor in the duodenum with SUVmax = 5.5, its size was about 6.4 x 6.7 cm. (C) Contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) detected a tumor of approximately 6.5 cm in diameter that was located in duodenum. (D) Magnetic resonance cholangiopancreatography (MRCP) found that duodenal tumor caused dilation of extrahepatic bile duct and pancreatic duct. (E) CT angiography and three-dimensional reconstruction revealed donor liver's artery went from the back down side of portal vein to the front right side of it, the gastroduodenal artery is visible.
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F1
Gastroduodenoscopy revealed a mass lesion located in the descending part of the duodenum (Figure 1A). Positron emission tomography-computed tomography (PET-CT) scan showed a mixed density mass in the descending part of the duodenum, and its metabolism of fluorodeoxyglucose (FDG) increased unevenly (SUVmax = 5.5) (Figure 1B), and no metastasis to other organs. Contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) detected a tumor of approximately 6.5 cm in diameter that was located in duodenum (Figure 1C). Further, Magnetic resonance cholangiopancreatography (MRCP) found that the duodenal tumor caused dilation of extrahepatic bile duct and pancreatic duct (Figure 1D). Also, the gastroduodenal artery was clearly visible (Figure 1E).
(A) intraoperative anatomy of the donor liver's artery and gastroduodenal artery. (B) By gross appearance, the resected specimen shows a tumor with ulceration measuring 6.5 x 5 x 5 cm.
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F2
Because the patient was in good physical condition and pre-operative imaging suggested the disease as resectable, pancreatoduodenectomy (PD) was performed and complemented with pancreatojejunostomy Roux-en-Y anastomosis with peripancreatic lymph nodes dissection and vascular dissection (Figure 2A). The gross appearance of the resected specimen was a tumor with ulceration measuring 6.5 x 5 x 5 cm (Figure 2B).
(A) PET-CT detected a tumor metastasis of approximately 8.9 cm x 5.3 cm that was located in right seventh rib. (B) By gross appearance, the resected specimen shows a metastatic tumor measuring 11 cm x 7 cm x 5 cm.
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F3
In July 2019, however, MRI and PET-CT scan indicated a metastatic lesion of approximately 8.9 cm x 5.3 cm located at the right seventh rib (Figure 3A). The gross appearance of the resected specimen was a tumor measuring 11 cm x 7 cm x 5 cm (Figure 3B).
(A) the pathological picture of tumor in right seventh rib confirmed hepatocellular carcinoma metastasis under 10x microscope. (B) The pathological picture of tumor in right seventh rib confirmed hepatocellular carcinoma metastasis under 40x microscope.
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F4
Postoperative pathological examination of the tumor specimen indicated hepatocellular carcinoma metastasis (Figures 4A,B).