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Special Feature |

Image of the Month—Quiz Case FREE

Julien Jarry, MD; Alexandre Rault, MD; Thierry Peycru, MD; Antonio Sa Cunha, MD; Denis Collet, MD
[+] Author Affiliations

Author Affiliations: Department of Digestive Surgery, University Hospital Haut Leveque, Pessac, France.


Section Editor: Carl E. Bredenberg, MD


Arch Surg. 2011;146(1):113. doi:10.1001/archsurg.2010.298-a.
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Published online

A 74-year-old man was hospitalized for chronic diarrhea and weight loss. His medical history included hypertension and peptic gastric ulcers, which were treated with atenolol and proton pump inhibitors, respectively. He had no history of travel in tropical regions. Laboratory test results and a colonoscopy were normal. An abdominal computed tomographic scan revealed evidence of a hypervascularized mass, 4 cm in diameter, located in the first part of the duodenum associated with a pericephalic pancreatic adenopathy, 22 mm in diameter (Figure 1), both hyperfixating on a somatostatin receptor scintigraphy (Figure 2). There were no other fixating lesions on the somatostatin receptor scintigraphy.

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Figure 1

Abdominal computed tomographic scan.

Graphic Jump Location

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Figure 2

Somatostatin receptor scintigraphy.

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WHAT IS THE DIAGNOSIS?

A.  Peutz-Jegher hamartoma

B.  Sporadic duodenal macrogastrinoma

C.  Celiac disease

D.  Duodenal vipoma

Figures

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Figure 1

Abdominal computed tomographic scan.

Graphic Jump Location
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Figure 2

Somatostatin receptor scintigraphy.

Graphic Jump Location

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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