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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.

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.

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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.
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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.

Mentions: In the opened specimen, the tumor diameter was 2.5 cm (Figure 4). The distance to the proximal resection margin was 0.5 cm; overall length of the duodenal segment was 9 cm. Histology revealed a GIST with a typical spindle cell pattern of the tumor cells (Figure 5). There was focal necrosis. The main tumor mass was located subserosal. The tumor had a thin fibrous capsule, and it reached the muscularis mucosae, without penetrating it. There was a regular duodenal mucosa covering the tumor. Immunohistochemistry showed a strong positivity for KIT (CD117) and CD34, while desmin and smooth muscle actin were negative (Figure 5). Mitotic activity was < 5/50 high power fields. No formal lymph node dissection had been performed, and as expected no lymph nodes were detected in the resected specimen.


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

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

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

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

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.
Mentions: In the opened specimen, the tumor diameter was 2.5 cm (Figure 4). The distance to the proximal resection margin was 0.5 cm; overall length of the duodenal segment was 9 cm. Histology revealed a GIST with a typical spindle cell pattern of the tumor cells (Figure 5). There was focal necrosis. The main tumor mass was located subserosal. The tumor had a thin fibrous capsule, and it reached the muscularis mucosae, without penetrating it. There was a regular duodenal mucosa covering the tumor. Immunohistochemistry showed a strong positivity for KIT (CD117) and CD34, while desmin and smooth muscle actin were negative (Figure 5). Mitotic activity was < 5/50 high power fields. No formal lymph node dissection had been performed, and as expected no lymph nodes were detected in the resected specimen.

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