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Case Reports
. 2008 Sep 30:6:105.
doi: 10.1186/1477-7819-6-105.

Segmental resection of the duodenum for gastrointestinal stromal tumor (GIST)

Rudolf Mennigen  1 , Heiner H Wolters, Bernd Schulte, Friedrich W Pelster
Affiliations
Case Reports

Segmental resection of the duodenum for gastrointestinal stromal tumor (GIST)

Rudolf Mennigen et al. World J Surg Oncol. .

Abstract

Background: Gastrointestinal stromal tumors (GIST) are the most frequent mesenchymal tumors of the gastrointestinal tract. The biological appearance of these tumors reaches from small lesions with benign appearance to aggressive sarcomas. Only 3-5% of GISTs are localized in the duodenum. There is a controversy, if duodenal GISTs should be treated by a duodenopancreatectomy or by a limited resection of the duodenum.

Case presentation: A 29-year-old man presented with an acute upper gastrointestinal bleeding from a submucosal tumor located in the proximal part III of the duodenum, 3 cm distal of the papilla of Vater. After an emergency laparotomy with ligation of tumor-feeding vessels in a primary hospital, definitive surgical therapy was performed by partial resection of the duodenum with a duodenojejunostomy. Histology revealed a GIST with a diameter of 2.5 cm and <5 mitoses/50 high power fields, indicating a low risk of malignancy. Therefore no adjuvant therapy with Imatinib was initiated.

Conclusion: GISTs of the duodenum are a rare cause of upper gastrointestinal bleeding. Partial resection of the duodenum is a warranted alternative to a duodenopancreatectomy, as this procedure has a lower operative morbidity, while providing comparable oncological results.

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Figures

Figure 1
Figure 1
Computed tomography. The computed tomography showed an enhancing tumor of the duodenal wall (arrowheads) with a maximal diameter of 2.5 cm. No metastases were visualized.
Figure 2
Figure 2
Operative view. Exophytic tumor of the proximal third part of the duodenum (arrowhead).
Figure 3
Figure 3
Operative technique. Reconstruction by a lateroterminal duodenojejunostomy at the level of the ampulla of Vater. P: pancreas, V: ampulla of Vater, T: tumor, J: jejunum.
Figure 4
Figure 4
Macroscopic appearance of the resected specimen. The distance to the proximal resection margin was 0.5 cm. A great portion of the tumor was located subserosal. The duodenal mucosa was bulged by the sumucosal tumor.
Figure 5
Figure 5
Histology. Microscopic appearance of the GIST located in the submucosa of the duodenum (left; H&E, original magnification ×10). It consists of small spindle-like tumor cells (middle; H&E, original magnification ×20) with CD117 – positivity (right; original magnification ×10).
See this image and copyright information in PMC

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