Two cases of duodenal ductal adenoma with intraepithelial neoplasia

WANG Bo; QIAO Li; LIU Haiyang; YE Tao; CHEN Zhongguang

doi:10.3969/j.issn.2096-9058.2025.02.012

Abstract：Two patients,both female,aged 69 and 67 years,showed elevated lesions by duodenal endoscopy.Under the microscope,the central expansion of the gland tube in the mucosal muscle layer was covered with high columnar epithe-lial cells,focal papillary growth,and some areas showed a pseudostratified growth mode.Most nuclei were located at the base,and lymphocyte and plasma cell infiltration were seen in the stroma.In case 1,some areas had enlarged nuclei,en-larged nucleo-to-cytoplasm ratio,significant nucleoli,disappeared nuclear polarity,heterogeneous nuclei on the surface of the gland cavity,visible nuclear division,distorted gland structure,and back-to-back arrangement of some glands.In case 2,the nucleus was mildly enlarged and deeply stained,with visible nuclear division and crowded glandular structure.Immunohistochemical staining in cases 1 and 2:tumor cells were positive for MUC5AC,negative for CDX2,MUC2,CD56,CgA,Syn,and S-100,and the Ki-67 proliferation index was 20%and 5%,respectively.Case 1 was diagnosed as duodenal ductal adenoma with high-grade intraepithelial neoplasia,and case 2 as duodenal ductal adenoma with low-grade intraepithelial neoplasia.Both were treated with endoscopic mucosal lesion resection,with good prognosis.