Adenocarcinoma arising from heterotopic pancreas at the third portion of the duodenum

Figure 1 Contrast-enhanced computed tomography, duodenofiberoscopy, and hypotonic duodenography. A: Abdominal CT scan shows a poorly enhanced mass around the third portion of the duodenum (arrow); B: Duodenofiberoscopic findings reveal submucosal tumors at the third portion of the duodenum (arrowheads); C: Hypotonic duodenography reveals stenosis at the third portion of the duodenum. CT: Computed tomography.

Figure 2 Intraoperative findings. A: During surgery, the tumor with the umbilication was located in front of the Treitz ligament; B: Examination of the resected specimen revealed a normal duodenal surface.

Figure 3 Histological examinations. A: The resected part of the duodenum shows a moderately differentiated tubular adenocarcinoma [Hematoxylin and eosin (HE), × 40]; B: Only the islet cells are present within and near the tumor (HE, × 200). HE: Hematoxylin and eosin.

Figure 4 Immunohistochemical staining: positive staining. A: Cytokeratin (CK) 7 (× 100); B: Neural cell adhesion molecule (CD56) (× 200); C: Chromogranin A (× 200); D: Synaptophysin (× 200); E: Insulin (× 200); F: Mucin 1 (MUC1).

Figure 5 Immunohistochemical staining: negative staining. A: Cytokeratin (CK) 20 (× 100); B: Mucin 2 (MUC2) (× 200).

Figure 6 Chronological change of the serum level of CA19-9. Pre-ope: Preoperation; POM: Post operative month; S-1: Tegafur-gimeracil-ditrydropyrimidine dehydrogenase; CDDP: Cisplatin; PET-CT: Positron emission and computed tomography; GEM: Gemcitabine; CVAD: Central venous access device.