1130-0108/2015/107/2/109-110 REVISTA ESPAÑOLA DE ENFERMEDADES DIGESTIVAS COPYRIGHT © 2015 ARÁN EDICIONES, S. L. REV ESP ENFERM DIG (Madrid Vol. 107, N.º 2, pp. 109-110, 2015 PICTURES IN DIGESTIVE PATHOLOGY Duodenal Ewing’s sarcoma: Unusual location and atypical EWRS-1 translocation Ernesto Jesús Barzola-Navarro 1 , José Ángel Flores-García 1 , Diego López-Guerra 1 , Cristina Tejera-Pérez 2 , Nerea Rodríguez-Díez 3 , Aurea Gómez-Durán 4 , Alejandro Rubio-Fernández 4 and Gerardo Blanco-Fernández 1 1 Hepatobiliary and Pancreatic Surgery Unit, 2 Endocrine Unit, 3 Digestive Unit, and 4 Pathology Unit. Hospital Universitario de Badajoz. Badajoz, Spain CASE REPORT A 20-year-old woman was admitted, because 5 months before admission, she started having epigastric abdominal pain and lost weight. On examination the patient was pale, had abdominal pain when deep palpation was applied. In laboratory tests, a microcytic hypochromic anemia was found. Results of computed tomography (CT) of the abdomen showed a rounded heterogeneous mass adjacent to the pancreas (Fig. 1). An oral endoscopy revealed in the fourth duodenum portion a neoplastic appearance of an ulcer, where a biopsy was taken (Fig. 2). The pathological and immunohistochemistry studies showed neoplastic cells positive for CD99, FLI-1 (friend leukemia integration 1 transcription factor), and CD 117. With a suspected sarcoma, a molecular study of traslocation t (11; 22), (q24; q12) in the locus 22q12 of EWSR1 gene (Ewing sarcoma breakpoint region 1) was done (Fig. 3). These findings were compatible with Ewing’s sarcoma (ES). The surgery performed was cephalic pancreaticoduodenectomy (Fig. 4). Fig. 1. Abdominal scan: Solid mass of 40 mm in diameter situated in the third and fourth duodenum portion. Fig. 2. Endoscopy: Ulcer of neoplastic appearance with thickened edges and fibrin at the bottom.