case_images: PMC4821151_01
case_images: CT of the abdomen and pelvis with contrast showing a mass-like density (arrows) in the gastric antrum or proximal duodenum measuring approximately 4 cm (anterior to posterior) (a) and multiple areas of decreased attenuation (arrows) in the liver which represent metastasis (b).
case_images: cro-0009-0182-g01.jpg
case_images: PMC4821151_01_cro-0009-0182-g01.jpg
case_images: F1
case_images: A contrast-enhanced computed tomography (CT) of the abdomen and pelvis showed a markedly dilated, debris-filled stomach with no contrast beyond the gastric antrum, and a mass-like density in the gastric antrum or proximal duodenum measuring approximately 4 cm in diameter (fig. 1a). Multiple hypodense hepatic lesions (the largest being 6 cm in the right hepatic lobe) were also seen, which was consistent with metastatic disease (fig. 1b).
case_images: Upper endoscopy showing a circumferential, friable mass obliterating 80% of the lumen at the duodenal bulb preventing advancement of the scope to the second part of the duodenum.
case_images: cro-0009-0182-g02.jpg
case_images: PMC4821151_01_cro-0009-0182-g02.jpg
case_images: F2
case_images: A circumferential, friable mass at the duodenal bulb was noted, obliterating 80% of the lumen and preventing scope advancement beyond the second portion of duodenum (fig. 2).
case_images: a HE stain (x400) showing invasive adenocarcinoma with gland formation and occasional mucin production. Areas with trabecular and nested patterns are also visualized, as well as tumor cells with moderate-to-abundant eosinophilic cytoplasm (hepatoid). b Tumor cells with diffuse, strong staining for monoclonal CEA. c Tumor cells with diffuse, strong staining for AFP.
case_images: cro-0009-0182-g03.jpg
case_images: PMC4821151_01_cro-0009-0182-g03.jpg
case_images: F3
case_images: There were also areas with trabecular and nested patterns seen (fig. 3a). The tumor cells were positive for CEA, AFP, CK18, CK19, and CDX-2, but were negative for CK7, CK20, and synaptophysin (fig. 3b, c).