case_images: PMC514615_01
case_images: (a) Duodenoscopy showing a 3 x 3 cm protruding tumor with two ulcerations located opposite the ampulla of Vater in the second portion of the duodenum. (b) Hypotonic duodenography showing the donuts-shape tumor in the duodenum.
case_images: 1477-7819-2-28-1.jpg
case_images: PMC514615_01_1477-7819-2-28-1.jpg
case_images: F1
case_images: Duodenoscopy (Figure 1a) and hypotonic duodenography (Figure 1b) revealed a 3 x 3 cm protruding tumor with two ulcerations located opposite the ampulla of Vater in the second part of the duodenum.
case_images: Macroscopic and microscopic findings of the tumor. (a) Gross appearance of the tumor. The tumor was divided into two components, component A (round shape) and B (crescent shape). (b) Photomicrograph of the gross appearance of the tumor (Hematoxylin and eosin X 2). (c) Photomicrograph of the component A showing fibrous tissue, small nuclei, and clear nucleoli. (Hematoxylin and Eosin X 40). (d) Photomicrograph of the component B showing more anaplastic features typical of small-cell carcinoma, such as sheets of tightly packed anaplastic cells with round nuclei and scanty cytoplasm. (Hematoxylin and Eosin X 40).
case_images: 1477-7819-2-28-2.jpg
case_images: PMC514615_01_1477-7819-2-28-2.jpg
case_images: F2
case_images: On gross examination, the tumor showed two ulcerations and two different morphological components (Figure 2a and 2b). Histopathologically, the crescent component had more anaplastic features typical of small-cell carcinoma, such as sheets of tightly packed anaplastic cells with round nuclei and scanty cytoplasm (Figure 2c, 2d).
case_images: Immunostaining for AE1/AE3 showing (a) diffuse cytoplasmic positivity in the component A, and (b) no reactivity in the component B.
case_images: 1477-7819-2-28-3.jpg
case_images: PMC514615_01_1477-7819-2-28-3.jpg
case_images: F3
case_images: Both components showed neuroendocrine features, with immunochemistry identifying synaptophysin and AE1/AE3 (Figure 3a and 3b), and electron microscopy identifying dense core granules (Figure 4).
case_images: Ultrastructural study showed cytoplasmic dense-core granules in the component A.
case_images: 1477-7819-2-28-4.jpg
case_images: PMC514615_01_1477-7819-2-28-4.jpg
case_images: F4
case_images: Both components showed neuroendocrine features, with immunochemistry identifying synaptophysin and AE1/AE3 (Figure 3a and 3b), and electron microscopy identifying dense core granules (Figure 4).