1/8. Extraluminal gastrointestinal stromal tumour in the second portion of the duodenum.The preoperative diagnosis of extraluminal gastrointestinal stromal tumours in the duodenum is difficult to establish due to their rare occurrence and the lack of pathognomonic signs. This report describes the case of a 61-year-old woman who suffered from an immunohistologically confirmed gastrointestinal stromal tumour in the second portion of the duodenum. Preoperative, abdominal, multislice computed tomography showed an extraluminal but intramural tumour located between the head of the pancreas and the duodenum. Rapid postprocessing analysis by three-dimensional, volume-rendered images revealed a strong arterial blood supply and an early draining vessel into the superior mesenteric vein during the portal-venous phase. The combination of endoscopic ultrasonography and non-invasive multislice computed tomography provided an early suggestion of gastrointestinal stromal tumour.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/8. glomus tumor of the duodenum: a case report.We describe a rare case of glomus tumor of the duodenum. The tumor was detected in a 46-year-old man being investigated for episodes of gastrointestinal bleeding. The excised specimen showed a 2.3 x 1.5 x 1.5 cm gray-tan tumor involving the mucosa and the submucosa. The overlying mucosa was focally ulcerated. Histologically, the tumor had a solid pattern of sharply demarcated, round glomus cells with prominent pericytoma-like vessels of varying sizes. The neoplastic cells stained for vimentin, smooth muscle actin, and focally for synaptophysin. These histologic and immunohistochemical features are consistent with a diagnosis of glomus tumor of the duodenum.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/8. Partial resection of the second portion of the duodenum for gastrointestinal stromal tumor after effective transarterial embolization.We report herein the case of 64-year-old man with gastrointestinal stromal tumor (GIST), who was treated by partial resection of the duodenum after preoperative transarterial embolization. He presented to our hospital with a history of tarry stools, dizziness, and severe anemia (hemoglobin, 7.5 g/dl). Gastroduodenal endoscopy revealed the presence of a submucosal tumor in the second portion of the duodenum. The presence of the tumor was subsequently confirmed by double-contrast gastrointestinal radiography and abdominal computed tomography. Super-selective angiography showed tumor staining fed from the anterior and posterior superior pancreaticoduodenal arteries, and the inferior pancreaticoduodenal artery. Two weeks after transarterial embolization through these vessels, the tumor size was found to have shrunk to 40% of its original size. Partial resection of the duodenum was performed and absence of tumor cells at the surgical margin was confirmed by intraoperative frozen-section examination. Histopathological examination revealed that the duodenal submucosal tumor consisted of spindle cells, and immunohistochemical analysis revealed positive tumor staining for c-kit protein, CD34 and alpha-smooth muscle actin (SMA), and negative staining for desmin and S-100; the positivity rate for MIB-1 staining was 2.2%. Based on these findings, the tumor was diagnosed as a GIST of low-grade malignancy, classified as the muscular type. It is considered that preoperative treatment of duodenal GISTs, such as transarterial embolization, may be useful for reducing the extent of resection, from pancreaticoduodenenctomy to a partial resection.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/8. Hemorrhagic duodenal lipoma managed by endoscopic resection.The patient, an 81-year-old woman, was admitted to our hospital for a detailed examination; the chief complaint being melena. An upper gastrointestinal roentgenologic study revealed a submucosal tumor with a smooth surface and a stalk measuring 50 mm at the third part of the duodenum. endoscopy depicted it as a yellowish submucosal tumor. Based on computed tomography and fluoroscopy of the small intestine, a diagnosis of duodenal lipoma was made. The esophagus, stomach, and the small and large intestines were free of lesions so the duodenal lipoma was judged to be the hemorrhagic source. The tumor was endoscopically polypectomized using a 2-channel scope. The excised specimen, measuring 50 x 20 x 20 mm, was covered by a normal duodenal mucosa with small ulcers in part. Photomicrographic findings included a tumor that was composed of mature adipose tissue in the submucosa, which coincided with a diagnosis of lipoma. Small ulcers had formed in part, exposing vessels, thus indicating the cause for hemorrhage. lipoma is a benign tumor; and if the lesion is found to be pedunculated and an endoscope can reach it for treatment, minimally invasive endoscopic procedures should be selected.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/8. lymphangioma of the duodenum: an ultrastructural study.Two cases of duodenal lymphangioma were diagnosed by endoscopy, and light and electron microscopic findings are reported. Ultrastructural studies showed smooth muscle cells around lymphatic vessels, and amyelinic nerve fibers and smooth muscle cells in the interstitium. On the basis of the ultrastructural features, a hamartomatous rather than tumoral origin is suggested for the duodenal lymphangioma. Lymphangiectatic cysts of Letulle and lymphangiectasia are discussed in the differential diagnosis. Submucosal lymphangiomas of the small bowel might be considered lymphangiectatic cysts.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/8. Multiple paraganglioneuromas.We report multiple paraganglioneuromas which occurred in a 40-year-old-man. Thirty-two tumours with similar histological appearance have been reported previously and most of them showed a striking predilection to occur in the second portion of the duodenum. In this case, three masses were detected; one was located in the periampullary region of duodenum with a polypoid appearance, the others were well defined masses in peri-pancreatic tissue adjacent to large vessels. histology revealed two cellular components, epithelioid cells with NSE immunoreactivity and S-100 protein containing spindle-shaped cells. Moreover, on electron microscopical examination, three different epithelioid cell types were seen. Type I was a figure differentiating to ganglion cells, type II to paraganglion cells, type III was a hybrid form of ganglion and paraganglion cells. Paraganglioneuroma revealed the histopathology of ganglioneuroma, paraganglioma and also a mixed appearance. In this respect the tumour may be considered to originate in undifferentiated neural crest cells and develop organoid differentiation.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/8. Segmental resection of the duodenum for treating leiomyosarcoma associated with von Recklinghausen's disease: a case report.We report a case of leiomyosarcoma originating from the second portion of the duodenum and associated with von Recklinghausen's disease. A 62-year-old man was admitted to our hospital complaining of abdominal pain and melena. A 5 cm tumor in the descending part of the duodenum was detected by hypotonic duodenography, CT, ultrasonography and endoscopy. angiography revealed the tumor to be supplied by the mesenteric artery of the transverse colon. A segmental resection of the distal part of the duodenum was performed, preserving the head of the pancreas. Histologically, the tumor was a leiomyosarcoma, and the surgical margin was free of tumor cells. This surgery is safer than pancreatoduodenectomy, and is appropriate for treating non-epithelial tumors in the distal part of the duodenum in the absence of invasion of the head of the pancreas and regional lymph node metastasis. When carrying out the procedure, it is essential to ligate the branch of the pancreaticoduodenal vessels as close as possible to the duodenal side in order to preserve the blood supply to the pancreatic head.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/8. granular cell tumor of the duodenum: a case report.granular cell tumor (GCT) in the duodenum is an extremely rare disease: only one case has been listed in a review, to date. We reported a 47-yr-old Japanese male case with GCT of the duodenum. Clinically, melena caused by bleeding from the tumor was the only symptom. The tumor cells showed abundant, granular eosinophilic cytoplasm. Although this tumor was clinically and histologically benign, highly developed tumor microvessels were demonstrated both angiographically and histologically, suggesting malignant potential of the tumor.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |