case_images: PMC11001288_01
case_images: Selected ultrasound images at the porta hepatis (a) and at the gallbladder (b), showing ductal dilatation (cursor in a) and gallstone at the gallbladder neck (arrow in b).
case_images: crg-2024-0018-0001-538260_F01.jpg
case_images: PMC11001288_01_crg-2024-0018-0001-538260_F01.jpg
case_images: F1
case_images: Abdominal ultrasound revealed a dilated CBD of 8 mm and a single gallbladder stone (Fig. 1).
case_images: Selected endoscopic images of the duodenum showing 2 polypoid lesions (a), one of them overlying the ampulla with ulcerated surface (b).
case_images: crg-2024-0018-0001-538260_F02.jpg
case_images: PMC11001288_01_crg-2024-0018-0001-538260_F02.jpg
case_images: F2
case_images: During the ERCP, two duodenal polypoid lesions were noted, one of them overlying the ampulla of Vater, with erythematous and ulcerated surface (Fig. 2).
case_images: Selected images from ERCP. Demonstrates distal CBD filling defect denoting stone arrow in (a) and intra-and extrahepatic ductal dilatation (b).
case_images: crg-2024-0018-0001-538260_F03.jpg
case_images: PMC11001288_01_crg-2024-0018-0001-538260_F03.jpg
case_images: F3
case_images: The common bile duct was cannulated, and the cholangiogram revealed dilated extra and intrahepatic bile ducts and a lower CBD filling defect (Fig. 3).
case_images: Enhanced CT scan images of the abdomen: axial (a, b); coronal (c); and sagittal (d). Shows multiple enhancing well-defined lesions. There are at least 2 duodenal lesions: one peri-ampullary (white arrow, in b, c) and one endo-luminal (arrow head in a). Also, it shows multiple pancreaticoduodenal groove lesions (* in b, c, d). Biliary stent in place (thick white arrow in d). D: duodenum, P: pancreatic head, V: portal vein.
case_images: crg-2024-0018-0001-538260_F04.jpg
case_images: PMC11001288_01_crg-2024-0018-0001-538260_F04.jpg
case_images: F4
case_images: No distant metastasis was detected (Fig. 4).
case_images: a Small intestinal mucosa depicting nodules in between the crypts (arrows) (hematoxylin and eosin, original magnification x100). b Higher magnification revealing the nodules composed of round cells with amphophilic cytoplasm (hematoxylin and eosin, original magnification x400). c, d Chromogranin A and synaptophysin, respectively, highlighting the neoplastic cells as well as non-neoplastic neuroendocrine cells within the glands (original magnification x200).
case_images: crg-2024-0018-0001-538260_F05.jpg
case_images: PMC11001288_01_crg-2024-0018-0001-538260_F05.jpg
case_images: F5
case_images: Immunohistochemical studies of the nodules showed positive reactivity for CK7, CDX2, CD56, chromogranin A, and synaptophysin and stained negative for CD20 (Fig. 5).
case_images: Octreoscan: axial SPECT-CT (a) and frontal planar (b) images show an abnormal focal area of avid octreotide uptake (dotted arrow in b and red cursor on a). This is seen posterior and inferior to the fourth part of the duodenum. No other abnormal activity seen. On axial enhanced CT done earlier (c), the uptake corresponds to well-defined heterogeneous soft tissue (arrow in c). D, duodenum; J, jejunal loop.
case_images: crg-2024-0018-0001-538260_F06.jpg
case_images: PMC11001288_01_crg-2024-0018-0001-538260_F06.jpg
case_images: F6
case_images: Two left para-aortic lymph nodes, the larger one measuring 2.6 cm x 2.8 cm, showed intense radiotracer uptake (Fig. 6).