Complaints of nausea

A 32-year-old man was guided to a clinic due to complaints of nausea. He was found to have an abdominal mass by ultrasonography and consulted the hospital for further examination. CT revealed an equally enhancing mass, 5.2 cm in diameter, adjacent to the duodenum. In addition, MRI showed a slightly iso-intensity signal equal to smooth muscle on T1-weighted imaging, a slightly high-intensity signal on T2-weighted imaging, and a high-intensity signal on diffusion-weighted imaging. Endoscopic ultrasonography showed a well-demarcated hypoechoic mass adjacent to the duodenum. In addition, the Doppler echo pattern indicated abundant blood flow. As shown in the figure, PET-CT shows increased fluorodeoxyglucose uptake in the mass.

Histologically, the lymph follicles were markedly increased throughout the cortex and medulla with vascular proliferation and hyalinization in the intra- or extra-follicles. As shown in the figure, the germinal centres were atrophic and surrounded by concentrically arranged layers of small lymphocytes.