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Metastatic duodenal GIST: role of surgery combined with imatinib mesylate.

Mohiuddin K, Nizami S, Munir A, Memon B, Memon MA - Int Semin Surg Oncol (2007)

Bottom Line: We present a case of a young man treated with a combined modality of surgery and imatinib for an advanced duodenal GIST.He remains asymptomatic and disease free 42 months following this combined approach.Treatment with imatinib has dramatically improved the outlook for patients with advanced, unresectable and/or metastatic disease.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan. drkamran@cyber.net.pk

ABSTRACT

Background: The best possible treatment of metastatic high grade large duodenal GIST is controversial. Surgery (with or without segmental organ resection) remains the principal treatment for primary and recurrent GIST. However, patients with advanced duodenal GIST have a high risk of early tumour recurrence and short life expectancy.

Method: We present a case of a young man treated with a combined modality of surgery and imatinib for an advanced duodenal GIST.

Results: He remains asymptomatic and disease free 42 months following this combined approach.

Conclusion: Treatment with imatinib has dramatically improved the outlook for patients with advanced, unresectable and/or metastatic disease.

No MeSH data available.


Related in: MedlinePlus

Macroscopic appearance of duodenal GIST specimen.
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Figure 4: Macroscopic appearance of duodenal GIST specimen.

Mentions: A 56 year old man, who was on regular aspirin following coronary artery bypass surgery, presented with an eight month history of intermittent malaena requiring an emergency admission to the hospital. At the time of admission the only positive finding was that of pallor. His full blood count revealed microcytic anaemia with haemoglobin of 7 g/dl. He was therefore transfused 4 units of packed red cells. He underwent an urgent upper gastrointestinal endoscopy which revealed a bulge in the 2nd part of the duodenum without any visible mucosal abnormality or intraluminal blood. The duodenal biopsies revealed mild duodenitis and the CLO test for Helicobacter Pylori was negative. A computerized tomography scan of the abdomen demonstrated a well demarcated enhancing 9.5 × 9.0 cm mass arising from the lateral wall of the 2nd part of the duodenum without any intra-abdominal lymphadenopathy or liver metastases (Figure 1). A provisional diagnosis of duodenal GIST was entertained. The patient underwent an elective exploratory laparotomy which revealed a 10 × 10 cm fleshy friable multi-lobulated exophytic mass arising from the anterior wall of the 2nd part of duodenum on a narrow pedicle (Figure 2). Tumour deposits were also seen on the adjacent mesocolon. A wedge excision of the antimesenteric portion of the duodenum containing the pedicle was performed (Figure 3, 4). A frozen section of the duodenum was obtained to confirm tumour free margins before primarily closing it with 2/0 Vicryl in an interrupted fashion. Also the adjacent mesocolon containing tumour deposits was also excised and the defect closed with interrupted sutures. The patient's postoperative recovery was uneventful and he was discharged home seven days later. Histopathology revealed that the tumour consists of spindle cells which in areas were arranged in fascicles. There was associated haemorrhage and the cells exhibited moderate pleomorphism. Furthermore the duodenal margins were free from tumour (R0 resection). Immunohistochemistry was strongly positive for CD117. Moreover, the mesocolon deposits consists of spindle shaped cells once again positive for CD117. The final diagnosis was that of a high grade metastatic gastrointestinal stromal tumour (GIST).


Metastatic duodenal GIST: role of surgery combined with imatinib mesylate.

Mohiuddin K, Nizami S, Munir A, Memon B, Memon MA - Int Semin Surg Oncol (2007)

Macroscopic appearance of duodenal GIST specimen.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC1851968&req=5

Figure 4: Macroscopic appearance of duodenal GIST specimen.
Mentions: A 56 year old man, who was on regular aspirin following coronary artery bypass surgery, presented with an eight month history of intermittent malaena requiring an emergency admission to the hospital. At the time of admission the only positive finding was that of pallor. His full blood count revealed microcytic anaemia with haemoglobin of 7 g/dl. He was therefore transfused 4 units of packed red cells. He underwent an urgent upper gastrointestinal endoscopy which revealed a bulge in the 2nd part of the duodenum without any visible mucosal abnormality or intraluminal blood. The duodenal biopsies revealed mild duodenitis and the CLO test for Helicobacter Pylori was negative. A computerized tomography scan of the abdomen demonstrated a well demarcated enhancing 9.5 × 9.0 cm mass arising from the lateral wall of the 2nd part of the duodenum without any intra-abdominal lymphadenopathy or liver metastases (Figure 1). A provisional diagnosis of duodenal GIST was entertained. The patient underwent an elective exploratory laparotomy which revealed a 10 × 10 cm fleshy friable multi-lobulated exophytic mass arising from the anterior wall of the 2nd part of duodenum on a narrow pedicle (Figure 2). Tumour deposits were also seen on the adjacent mesocolon. A wedge excision of the antimesenteric portion of the duodenum containing the pedicle was performed (Figure 3, 4). A frozen section of the duodenum was obtained to confirm tumour free margins before primarily closing it with 2/0 Vicryl in an interrupted fashion. Also the adjacent mesocolon containing tumour deposits was also excised and the defect closed with interrupted sutures. The patient's postoperative recovery was uneventful and he was discharged home seven days later. Histopathology revealed that the tumour consists of spindle cells which in areas were arranged in fascicles. There was associated haemorrhage and the cells exhibited moderate pleomorphism. Furthermore the duodenal margins were free from tumour (R0 resection). Immunohistochemistry was strongly positive for CD117. Moreover, the mesocolon deposits consists of spindle shaped cells once again positive for CD117. The final diagnosis was that of a high grade metastatic gastrointestinal stromal tumour (GIST).

Bottom Line: We present a case of a young man treated with a combined modality of surgery and imatinib for an advanced duodenal GIST.He remains asymptomatic and disease free 42 months following this combined approach.Treatment with imatinib has dramatically improved the outlook for patients with advanced, unresectable and/or metastatic disease.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan. drkamran@cyber.net.pk

ABSTRACT

Background: The best possible treatment of metastatic high grade large duodenal GIST is controversial. Surgery (with or without segmental organ resection) remains the principal treatment for primary and recurrent GIST. However, patients with advanced duodenal GIST have a high risk of early tumour recurrence and short life expectancy.

Method: We present a case of a young man treated with a combined modality of surgery and imatinib for an advanced duodenal GIST.

Results: He remains asymptomatic and disease free 42 months following this combined approach.

Conclusion: Treatment with imatinib has dramatically improved the outlook for patients with advanced, unresectable and/or metastatic disease.

No MeSH data available.


Related in: MedlinePlus