case_images: PMC10936884_01
case_images: (Anticlockwise from top left) (1, 2): Cross-sectional image of contrast-enhanced CT scan showing a mass (thin green arrow) arising from D3 to D4 abutting the pancreas but with preserved fat planes with surrounding major vasculature. (3): PET-CT in axial plane showing the same mass with florid fluorodeoxyglucose uptake (standard uptake value = 10). (4): Fluorodeoxyglucose-PET image in coronal section showing area of increased uptake at the tumour site, with brain and bladder acting as reservoir organs
case_images: JWACS-14-113-g001.jpg
case_images: PMC10936884_01_JWACS-14-113-g001.jpg
case_images: JWAS_95_23-f001
case_images: TOMOGRAPHY (PET-CT) revealed a FlouroDeoxyGlucose-avid (FDG-avid), heterogeneously-enhancing, well-marginated, intraluminal polypoidal soft tissue density lesion at the junction of D3 and D4 segments of the duodenum, measuring 2.8 cm x 2.6 cm x 4.1 cm (transverse x anteroposterior x craniocaudal). The diagnosis was a likely primary mitotic lesion with no FDG-avid visible mitotic lesion elsewhere. The tumour was abutting the pancreas but had preserved fat planes with all surrounding structures and major vasculature spared [Figure 1].
case_images: (Anticlockwise from top left) (1) A 4 cm growth was seen at the junction of D3-D4 (mainly exophytic and partly occluding the duodenal lumen) just below the uncinate process, sparing the ampulla with no local spread to surrounding structures. (2) Resected specimen including growth with a 3 cm proximal margin and 12 cm distal margin. (3) End-to-end extramucosal all-knots-outside interrupted duodenojejunostomy done with 4-0 polydioxanone
case_images: JWACS-14-113-g002.jpg
case_images: PMC10936884_01_JWACS-14-113-g002.jpg
case_images: JWAS_95_23-f002
case_images: A retrocolic hand-sewn end-to-end duodenojejunostomy (extramucosal all-knots-outside interrupted with 4-0 polydioxanone) was performed to maintain bowel continuity [Figure 2].
case_images: (Anticlockwise from top left) Histopathological sections (1) Haematoxylin and Eosin stain in high power fluid with 40x magnification showing spindle cells with oval to elongated nuclei, vesicular chromatin, inconspicuous nucleoli with moderate amount of eosinophilic cytoplasm, Mitoses 2/high power field. (2) Immunohistochemistry in 40x magnification showing cytoplasmic and membranous positivity for discovered on gist-1. (3) Haematoxylin and Eosin stain in low power field with 10x magnification showing a storiform tumour arranged in fascicles and composed of spindle cells
case_images: JWACS-14-113-g003.jpg
case_images: PMC10936884_01_JWACS-14-113-g003.jpg
case_images: JWAS_95_23-f003
case_images: Histopathological examination confirmed the diagnosis of a GIST, mixed (predominantly spindle-cell type with low mitotic rate (<5/5 mm2) with both proximal and distal margin free of tumour cells [Figure 3].