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. 2021 Aug:85:106263.
doi: 10.1016/j.ijscr.2021.106263. Epub 2021 Aug 3.

An incidental finding of duodenal GIST in a patient with penetrating abdominal trauma: A case report

Jeremia J Pyuza  1 , Elichilia R Shao  2 , Kenan Bosco  3 , Jay Lodhia  4 , Alex Mremi  5
Affiliations

An incidental finding of duodenal GIST in a patient with penetrating abdominal trauma: A case report

Jeremia J Pyuza et al. Int J Surg Case Rep. 2021 Aug.

Abstract

Introduction and importance: Duodenal Gastrointestinal stromal tumors (GISTs) are rare mesenchymal tumors of the digestive tract. The tumors are derived from interstitial cells of Cajal and usually they present as gastrointestinal bleeding or non-specific abdominal pain, but they can also be asymptomatic even when they have reached considerable size.

Case presentation: We report a case of a 40-year-old male presented to our emergency department after sustaining a stab wound on the abdomen. Abdominal imaging tests weren't done; instead an emergency laparotomy was undertaken upfront in an attempt to catch up with a "golden hour". Intra-operatively, an incidental solid mass measuring 4 × 5 cm was noted on the third/fourth portion of the interior duodenal flexure. Histopathologically, the lesion demonstrated spindled shaped cells which were immunopositive for positive CD117. The patient fared well postoperatively and during subsequent follow up visits.

Clinical discussion: High-risk GISTs have malignant potential. In some cases, GIST is diagnosed as incidentally finding, mostly during surgical procedure, upper endoscopy or radiological studies related to GI tract. Surgical resection is recommended curative option and its extension depends on different factors. Tyrosine kinase inhibitors are of the utmost importance in high-risk and metastatic disease.

Conclusion: Even considerably large duodenal GISTs can be asymptomatic, thus incidentally found during an abdomino-pelvic imaging tests. Histopathological evaluation of the operative specimen plays a key role in assessing the need of adjuvant therapy, with a significant impact on the patients' survival.

Keywords: Duodenal; Emergency; GIST; Incidental; Laparotomy.

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Conflict of interest statement

All authors have declared that no competing interests exist.

Figures

Fig. 1
Fig. 1
A-3 cm laceration on the anterior surface of the left lobe of liver, not actively bleeding (arrow).
Fig. 2
Fig. 2
Duodenal solid mass in the third/fourth (D3/D4) portion on the interior duodenal flexure; the mass was measuring 4 × 5 cm, (arrow).
Fig. 3
Fig. 3
Photomicroscopy of GIST demonstrating bland spindle cells with faintly eosinophilic cytoplasm in a syncytial pattern, H&E staining 20× original magnifications (A); 100× original magnification (B); immunopositivity of tumour cells with c-kit/CD117, 20× (C), and 60× (D) original magnifications respectively.
See this image and copyright information in PMC

References

    1. Miettenen M., Losot A. Gastrointestinal stromal tumors: pathology and prognosis at different sites. Semin. Diagn. Pathol. 2006;23:70–83. - PubMed
    1. Nilsson B., Bümming P., Meis-Kindblom J.M., Odén A., Dortok A., Gustavsson B., Sablinska K., Kindblom L.G. Gastrointestinal stromal tumors: the incidence, prevalence, clinical course, and prognostication in the preimatinib mesylate era–a population-based study in western Sweden. Cancer. 2005 Feb 15;103(4):821–829. - PubMed
    1. for the SCARE Group. Agha R.A., Franchi T., Sohrabi C., Mathew G. The SCARE 2020 guideline: updating consensus Surgical CAse REport (SCARE) guidelines. Int. J. Surg. 2020;84:226–230. - PubMed
    1. Lee S.J., Song K.B., Lee Y.J., Kim S.C., Hwang D.W., Lee J.H. Clinicopathologic characteristics and optimal surgical treatment of duodenal gastrointestinal stromal tumor. J. Gastrointest. Surg. 2019 Feb;23(2):270–279. - PubMed
    1. Zhang S., Tian Y., Chen Y., Zhang J., Zheng C., Wang C. Clinicopathological characteristics, surgical treatments, and survival outcomes of patients with duodenal gastrointestinal stromal tumor. Dig. Surg. 2019;36(3):206–217. - PubMed