Journal List > J Korean Surg Soc > v.79(Suppl 1) > 1011225

Suh, Shin, Lee, Kim, Han, and Jang: Gastric Outlet Obstruction due to Submucosal Neurofibromatous Proliferation of Duodenal Bulb in Neurofibromatosis Type 1 Patient

Abstract

Neurofibromatosis type 1 (NF1; also known as von Recklinghausen's neurofibromatosis) is inherited in an autosomal dominant fashion, although it can also arise due to spontaneous mutation. Gastrointestinal involvement of NF1 is seen in 10% to 25% and causes symptoms in fewer than 5%. Histologically, the gastro intestinal (GI) manifestation of NF1 occurs in three forms: hyperplasia of the gut neural tissue, stromal tumors, and duodenal or periampullary endocrine tumors. A 31-year-old female, diagnosed with NF1, presented with poor oral intake and vomiting for 10 days prior to admission. Preoperative gastrofiberscopic finding was gastric outlet obstructing polypoid duodenal bulb lesion. The patient underwent hemigastrectomy with antecolic gastrojejunostomy due to gastric outlet obstruction. The final pathologic report was submucosal neurofibromatous proliferation with Brunner's gland hyperplasia located at the duodenal bulb in the NF1 patient. We report this case with a review of literatures.

Figures and Tables

Fig. 1
Preoperative gastrofiberscopic findings of duodenal bulb polyp like lesion through the pyloric ring.
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Fig. 2
Abdominopelvis MD-CT coronal scan revealed severely distended stomach due to gastric outlet obstruction.
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Fig. 3
The arrow indicates an ill defined nodular elevated lesion in the duodenal bulb, measuring 3.6×3.2×1.0 cm (The gross specimen of resected stomach).
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Fig. 4
(A) Low-power view reveals neurofibromatous proliferation and Brunner's gland hyperplasia in the submucosa (H&E, ×12.5). a = Brunner's gland hyperplasia in the submucosa; b = Myenteric plexus neural hyperplasia. (B) High-power view reveals interlacing bundles of neurons, schwann cells and fibroblasts (H&E, ×200). (C) The neural cells reveal positive immunoreactivity for S-100 protein (×200).
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