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

Mennigen R, Wolters HH, Schulte B, Pelster FW - World J Surg Oncol (2008)

Bottom Line: The biological appearance of these tumors reaches from small lesions with benign appearance to aggressive sarcomas.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.Therefore no adjuvant therapy with Imatinib was initiated.

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Affiliation: Department of General and Visceral Surgery, Muenster University, Muenster, Germany. rudolf.mennigen@uni-muenster.de

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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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.
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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.

Mentions: Computed tomography visualized the tumor of the duodenum with a diameter of 1.8 × 2.3 × 2.5 cm (Figure 1). The scan showed no metastases. 2 days after the initial emergency surgery, the patient underwent definitive surgery at our institution. No recurrent bleeding occurred since the emergency ligation of tumor-feeding vessels.


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

Mennigen R, Wolters HH, Schulte B, Pelster FW - World J Surg Oncol (2008)

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.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2567321&req=5

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.
Mentions: Computed tomography visualized the tumor of the duodenum with a diameter of 1.8 × 2.3 × 2.5 cm (Figure 1). The scan showed no metastases. 2 days after the initial emergency surgery, the patient underwent definitive surgery at our institution. No recurrent bleeding occurred since the emergency ligation of tumor-feeding vessels.

Bottom Line: The biological appearance of these tumors reaches from small lesions with benign appearance to aggressive sarcomas.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.Therefore no adjuvant therapy with Imatinib was initiated.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of General and Visceral Surgery, Muenster University, Muenster, Germany. rudolf.mennigen@uni-muenster.de

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.

Show MeSH
Related in: MedlinePlus