Duodenal neuroendocrine tumor-tertiary care centre experience: A case report

Table 1 World Health Organization 2022 classification of epithelial neuroendocrine neoplasms for neoplasms for gastrointestinal, and pancreaticobiliary tract

Neuroendocrine neoplasms	Classification	Diagnostic criteria
Well differentiated neuroendocrine tumor (NET)	NET, grade 1	< 2 mitoses/2 mm2 and/or Ki67 < 3%
	NET, grade 2	2-20 mitoses/2 mm2 and/or Ki67 3-20%
	NET, grade 3	> 20 mitoses/2 mm2 and/or Ki67 > 20%
Poorly differentiated neuroendocrine carcinoma (NEC)	Small cell NEC	> 20 mitoses/2 mm2 and/or Ki67 > 20% (often > 70%), and small cell cytomorphology
	Large cell NEC	> 20 mitoses/2 mm2 and/or Ki67 > 20% (often > 70%), and large cell cytomorphology

Table 2 Synopsis of duodenal neuroendocrine tumors cases in our center

Age/ gender	Clinical presentation	UGIE	CECT abdomen	EUS (linear EUS probe was used)	Management
57 yr, male	Bloating, epigastric pain for 2 yr, vomiting for 15 d	Two nodular lesions with mucosal erosions in D1	Normal	Two small sessile nodular lesions measuring 5 mm in the posterior wall of D1 from the second layer, homogenous echotexture, regular margins with no vascularity	Endoscopic submucosal resection
52 yr, male	Epigastric pain for 15 d, melena for 1 d	Polypoid lesion of size 2 cm-2.5 cm in the lateral wall of D1 with superficial erosions	Lobulated, homogenously enhancing endoluminal lesion involving the D1 and D2 part of duodenum measuring 4.2 cm × 3 cm, partially involving the ampullary region of the duodenum with the normal common bile duct, pancreas shows tiny focal discrete areas of calcification with atrophy in the neck of the pancreas, there is also dilatation of pancreatic duct (5 mm) with features suggestive of chronic pancreatitis, few sub centimetric lymph nodes were noted in precaval region behind the uncinate process	5 cm × 3 cm small homogenous submucosal swelling arising from the second layer in the D2 with no definite margins and no surface irregularity and no vascularity, heteroechoic pancreas with no calculi	Whipple procedure
53 yr, male	Epigastric pain for 3 mo	Single sessile polypoidal lesion of size 0.5 cm × 0.5 cm in D1 with normal overlying mucosa	Normal	Single small sessile lesion measuring 5mm in the superior wall of D1 from the second layer, homogenous echotexture, regular margins with no vascularity	Endoscopic submucosal resection
35 yr, male	Heartburn, epigastric pain, recurrent oral aphthous ulcerations for 4 mo	3 nodular sub centimetric lesions in the anterior wall of the D1 segment of the duodenum	Normal	3 small sessile lesions largest measuring 8mm in the anterior wall of D1 arising from the second layer, homogenous echotexture, regular margins with no vascularity	Endoscopic submucosal resection
50 yr, male	Melena for 4 mo	2 small polyps with ulceration in the D1 segment	Normal	2 small sessile lesions largest measuring 5 mm in the anterior wall of D1 from the second layer, homogenous echotexture, regular margins with no vascularity	Endoscopic submucosal resection

EUS: Endoscopic ultrasound.