case_images: PMC11186382_01
case_images: Endoscopic ultrasonography and resected lesions. (A,B) Endoscopic ultrasonography shows two hypoechoic lesions (A measuring 5.5*4.3 mm and B measuring 8.4*6.4 mm) originating from muscularis propria of the duodenal bulb. (C) The resected lesions were pulled out. (D) Postoperative gastroscopy 3 months later showed the healing of the resection sites.
case_images: fmed-11-1401241-g001.jpg
case_images: PMC11186382_01_fmed-11-1401241-g001.jpg
case_images: fig1
case_images: Endoscopic ultrasonography revealed two hypoechoic lesions originating from the muscularis propria of the duodenal bulb (Figures 1A,B). The completely resected SMTs were pulled out (Figure 1C). Three months later, the patient underwent a follow-up gastroscopy that showed complete wound healing (Figure 1D).
case_images: Procedure of submucosal tunneling endoscopic resection. (A) The lesion behind the pyloric ring. (B) Submucosal injection of sodium hyaluronate, methylene blue, and glycerol fructose solution (1:1:4). (C) Submucosal tunnel incision. (D) Submucosal tunnel to the lesion. (E) En bloc resection. (F) Tunnel closure with titanium clips.
case_images: fmed-11-1401241-g002.jpg
case_images: PMC11186382_01_fmed-11-1401241-g002.jpg
case_images: fig2
case_images: It was finally resected with the method of STER (Figure 2).
case_images: Procedure of endoscopic submucosal dissection. (A) The lesion in the anterior wall. (B) Submucosal injection. (C) A circumferential mucosal incision. (D) Submucosal dissection. (E) En bloc resection. (F) Titanium clips close the wound.
case_images: fmed-11-1401241-g003.jpg
case_images: PMC11186382_01_fmed-11-1401241-g003.jpg
case_images: fig3
case_images: Another one in the anterior wall was removed by the method of ESD (Figure 3).
case_images: Pathologic examination. (A) Gross images. (B) Hematoxylin-eosin. (C) Immunohistochemistry shows positive areas for Ki-67 (< 3%). (D-F) Immunohistochemistry shows positive areas for CD56 (D), CgA (E), and synaptophysin (F). (G, H) Immunohistochemistry of somatostatin (G) and gastrin (H).
case_images: fmed-11-1401241-g004.jpg
case_images: PMC11186382_01_fmed-11-1401241-g004.jpg
case_images: fig4
case_images: Pathologic examination (Figure 4A) by hematoxylin-eosin staining (Figure 4B) and immunohistochemistry (Figures 4C-F) that were positive for Ki-67(< 3%), the cluster of differentiation 56 (CD56), chromogranin A (CgA), and synaptophysin were both consistent with a NET. Moreover, immunohistochemistry results of somatostatin (Figure 4G) and gastrin (Figure 4H) were negative, which eliminated the suspicion of somatostatinomatosis and gastrinoma.