case_images: PMC6800942_01
case_images: Macroscopic and microscopic views of the duodenal adenocarcinoma. (a) Appearance of the lesion on endoscopy showing central depression but otherwise unremarkable overlying mucosa. (b) Low power. Microphotography of the duodenal lesion with an inverted pattern of growth and normal appearing overlying mucosa. (c) Medium power. Microphotography of the duodenal lesion shows tightly packed tubules consistent with pyloric gland origin. (d) Medium power. Focus of the invasive duodenal adenocarcinoma with cytological atypia, nuclear pleomorphism, and increased nuclear to cytoplasmic ratio consistent with malignancy. (e) Medium power. Immunohistochemistry of the duodenal lesion shows extensive positive staining for gastric-type mucin MUC6, a marker consistent with pyloric gland origin.
case_images: CRIGM2019-3434620.001.jpg
case_images: PMC6800942_01_CRIGM2019-3434620.001.jpg
case_images: fig1
case_images: The lesion had central depression and minor ulceration but otherwise normal appearing mucosa on endoscopy (Figure 1(a)). T1bN0M0) (Figures 1(b) and 1(c)). The focus of the duodenal adenocarcinoma featured prominent cytological atypia, nuclear pleomorphism and increased nuclear to cytoplasmic ratio consistent with malignancy (Figure 1(d)). Immunohistochemistry of the lesion showed positive staining for gastric-type mucins MUC5AC and MUC6 (Figure 1(e)).