Case ReportCASE REPORTS AND CLINICAL OBSERVATIONS
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Ewing Sarcoma/Primitive Neuroectodermal Tumor Involving the Duodenum

Dawood A. Tafti, Ilsup Yoon, Jesse Fitzgerald, Adam Graeber and Paul Clark
Ochsner Journal March 2022, 22 (1) 94-99; DOI: https://doi.org/10.31486/toj.21.0040

Article Figures & Data

Figures

  • Figure 1.
    Figure 1.

    (A) Anteroposterior view of the abdomen after administration of oral contrast (Omnipaque, GE Healthcare) demonstrates narrowed third and fourth segments of the duodenum secondary to mass effect (black arrowhead). (B) Coronal and (C) axial computed tomography (CT) images demonstrate a heterogeneous mass arising from the superior and anterior walls of the third segment of the duodenum (white arrowheads). Approximately 90 mL of Visipaque 320 (GE Healthcare) was administered intravenously. (D) Fluorodeoxyglucose (F 18-FDG) positron emission tomography/CT demonstrates the same mass with intense metabolic activity (white arrow). Approximately 7.15 mCi of F 18-FDG was administered intravenously. The patient's blood glucose level just prior to imaging was 90 mg/dL. Time from F 18-FDG injection to scan was 51 minutes.

  • Figure 2.
    Figure 2.

    Gross examination demonstrated a 5.2-cm tumor posttreatment (arrowhead) in the right retroperitoneum affixed to the duodenum. The long single suture marks the distal surgical margin (asterisk), and the short single suture marks the proximal surgical margin (black arrow). The double suture on the left represents the tumor margin abutting the superior mesenteric artery (white arrows).

  • Figure 3.
    Figure 3.

    Histologic and immunohistochemistry features of the retroperitoneal tumor. (A) Solid and sheet-like configurations of densely packed tumor cells demonstrate indistinct cell borders, scant cytoplasm, fine chromatin, and inconspicuous nucleoli (hematoxylin and eosin, magnification ×100). The boxed region in the upper left corner shows a tumor cell undergoing mitosis (magnification ×400). The tumor is positive for (B) CD99 and negative for (C) vimentin and (D) WT1 (nonnuclear staining) (magnification ×200).

Tables

  • Table.

    Reports of Ewing Sarcoma/Primitive Neuroectodermal Tumors Involving the Duodenum

    StudyAge/SexDescribed LocationUnique Imaging FeaturesUnique Pathologic FeaturesSize
    Adair et al, 20011321/FDuodenum and jejunumIntussusception of the duodenumN/R6 × 6 × 4 cm
    Kie et al, 20031120/FFirst and second portion of the duodenumN/RInvasion of the whole layer of duodenum and focal extension to the pancreatic head6.5 cm
    Huang et al, 20211441/MDescending duodenumEnhancing on CTN/RN/R
    Present case, 202266/FTransverse duodenumHeterogenous on CT; intense FDG uptake on PET-CTMultiloculated hemorrhagic mass10.3 × 8.8 × 12.3 cm

    • CT, computed tomography; F, female; FDG, fluorodeoxyglucose; M, male; N/R, not reported; PET, positron emission tomography.

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