case_images: PMC9320325_01
case_images: Changes in hemoglobin values between two surgeries (February 2, 2019 to July 10, 2021).
case_images: fsurg-09-935048-g001.jpg
case_images: PMC9320325_01_fsurg-09-935048-g001.jpg
case_images: F1
case_images: However, the patient was still under anemia after the operation (Figure 1).
case_images: (A,B) CTV (left) and MRI (T2WI) (right) revealed a space-occupying lesion located in the descending part of the duodenum, (C) huge tumor of the descending part of the duodenum was seen during the operation, (D) gross specimen of the dissected tumor.
case_images: fsurg-09-935048-g002.jpg
case_images: PMC9320325_01_fsurg-09-935048-g002.jpg
case_images: F2
case_images: Magnetic resonance imaging revealed duodenal malignancy, slight dilatation of the bile duct, and fatty liver (Figure 2). The gross pathology showed a 6 x 5 x 4 cm cauliflower-like protrusion lesion (Figure 2).
case_images: (A) Miliary papules were scattered on the forehead and face, (B) papilloma can be seen on the tongue, (C) some excessive keratinization can be seen on the soles of the foot, (D) melaniosis spots were on the glans of the penis.
case_images: fsurg-09-935048-g003.jpg
case_images: PMC9320325_01_fsurg-09-935048-g003.jpg
case_images: F3
case_images: Nevertheless, further physical examination revealed that the patient had macrocephaly, and dermatologic examination was remarkable (Figure 3).
case_images: Hematoxylin-eosin staining showed that adenocarcinoma cells formed glands or adenoid structures with different sizes, shapes, and irregular arrangements; the carcinoma tissue had infiltrated into the subserous layer.
case_images: fsurg-09-935048-g004.jpg
case_images: PMC9320325_01_fsurg-09-935048-g004.jpg
case_images: F4
case_images: Microscopic pathology (Figure 4) reported that the cauliflower-like elevated tumor of the duodenum was considered a hamartomatous polyp, with malignancy in some areas (80% non-mucinous adenocarcinoma, 20% mucinous adenocarcinoma).