A Case Presentation of Gastrointestinal Stromal Tumor of Duodenum
Main Article Content
Keywords
cancer intervention, duodenum, tumor, surgery
Abstract
A gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of the gastrointestinal tract. It is caused by the mutation in KIT and PDGFRα genes. It constitutes <1% of all gastrointestinal tumors. Duodenal GISTs constitute 4.5% of all GISTs. We report a 61-year-old lady, presented with generalized abdominal pain, vomiting, abdominal distension, and nausea for the last 3 years. Physical examination showed a pallor and on abdominal examination, a large palpable mass was extending from the pelvis to the right upper quadrant of the abdomen. The CT scan showed a large heterogeneously echogenic mass in the abdomen and pelvis with no lymphadenopathy and distant metastasis in this region. Laparotomy showed a large globular mass extending from the pelvis to the right upper quadrant of the abdomen adherent to the wall of a third part of the duodenum. Complete surgical resection of tumor done with an intact capsule. Microscopic examination showed neoplastic spindle cells with tumor necrosis. An immunohistochemical study confirmed GIST.
References
1. Blay JY, Serrano C, Heinrich MC, et al. Ripretinib in patients with advanced gastrointestinal stromal tumours (INVICTUS): A double-blind, randomised, placebo-controlled, phase 3 trial. Lancet Oncol. 2020;21(7):923–34. https://doi.org/10.1016/S1470-2045(20)30168-6
2. Akahoshi K, Oya M, Koga T, et al. Current clinical management of gastrointestinal stromal tumor. World J Gastroenterol. 2018;24(26):2806–17. PMID: 30018476; PMCID: PMC6048423. https://doi.org/10.3748/wjg.v24.i26.2806
3. Theiss L, Contreras CM. Gastrointestinal stromal tumors of the stomach and esophagus. Surg Clin North Am. 2019;99(3):543– 53. PMID: 31047041.https://doi.org/10.1016/j.suc.2019.02.012
4. Ibrahim A, Chopra S. Succinate dehydrogenase-deficient gastrointestinal stromal tumors. Arch Pathol Lab Med. 2020;144(5):655–60. Epub 2019 Jun 6. PMID: 31169996. https://doi.org/10.5858/arpa.2018-0370-RS
5. Al-Share B, Alloghbi A, Al Hallak MN, et al. Gastrointestinal stromal tumor: A review of current and emerging therapies. Cancer Metastasis Rev. 2021 Apr 19. Epub ahead of print. PMID: 33876372. https://doi.org/10.1007/s10555-021-09961-7
6. Coe TM, Fero KE, Fanta PT, et al. Population-based epidemiology and mortality of small malignant gastrointestinal stromal tumors in the USA. J Gastrointest Surg. 2016;20(6):1132–40. Epub 2016 Mar 29. PMID: 27025710; PMCID: PMC4880518. https://doi.org/10.1007/s11605-016-3134-y
7. Kohno S, Aoki H, Ogawa M, et al. Significance of primary malignant tumors on the outcome of patients with resected gastrointestinal stromal tumors. In Vivo. 2020;34(3):1201–5. PMID: 32354910; PMCID: PMC7279818. https://doi.org/10.21873/invivo.11893
8. Milanetto AC, Pacciani S, Fassan M, et al. Pancreatic neuroendocrine neoplasms and gastrointestinal stromal tumors: A single-institution experience of a rare association and review of the literature. Pancreas. 2020;49(7):918–23. PMID: 32658075. https://doi.org/10.1097/MPA.0000000000001599
9. Daumová M, Vanˇková B, Švajdler Met al. Immunohistochemistry and molecular genetics in the differential diagnostics of mesenchymal lesions of gastrointestinal tract. Cesk Patol. 2020;56(4):212–20. PMID: 33736442.
10. El-Menyar A, Mekkodathil A, Al-Thani H. Diagnosis and management of gastrointestinal stromal tumors: An up-to-date literature review. J Cancer Res Ther. 2017;13(6):889–900. https://doi.org/10.4103/0973-1482.177499. PMID: 29237949.
11. Weerts ZZRM, Masclee AAM, Witteman BJM, et al. Efficacy and safety of peppermint oil in a randomized, double-blind trial of patients with irritable bowel syndrome. Gastroenterology. 2020;158(1):123–36. Epub 2019 Aug 27. PMID: 31470006. https://doi.org/10.1053/j.gastro.2019.08.026
12. Søreide K. Cancer biology of small gastrointestinal stromal tumors (<2 cm): What is the risk of malignancy? Eur J Surg Oncol. 2017;43(7):1344–9. Epub 2017 Feb 9. PMID: 28222971. https://doi.org/10.1016/j.ejso.2017.01.240
13. Tryggvason G, Hilmarsdottir B, Gunnarsson GH, et al. Tyrosine kinase mutations in gastrointestinal stromal tumors in a nationwide study in Iceland. APMIS. 2010;118(9):648–56. PMID: 20718716. https://doi.org/10.1111/j.1600-0463.2010.02643.x
14. Zhang JQ, Zeng S, Vitiello GA, et al. Macrophages and CD8+ T cells mediate the antitumor efficacy of combined CD40 ligation and imatinib therapy in gastrointestinal stromal tumors. Cancer Immunol Res. 2018;6(4):434–47. Epub 2018 Feb 21. PMID: 29467128; PMCID: PMC6203303. https://doi.org/10.1158/2326-6066.CIR-17-0345
15. Trindade AJ, Benias PC, Alshelleh M, et al. Fine-needle biopsy is superior to fine-needle aspiration of suspected gastrointestinal stromal tumors: a large multicenter study. Endosc Int Open. 2019;7(7):E931–6. Epub 2019 Jul 11. PMID: 31304239; PMCID: PMC6624113. https://doi.org/10.1055/a-0953-1640
16. Hansen T, Titze U, Trachte F, et al. [Uncommon tumor of the gastric wall]. Pathologe. 2020 Dec 23. German. Epub ahead of print. PMID: 33355706. https://doi.org/10.1007/s00292-020-00886-6
17. Kanda T, Masuzawa T, Hirai T, et al. Surgery and imatinib therapy for liver oligometastasis of GIST: A study of Japanese Study Group on GIST. Jpn J Clin Oncol. 2017;47(4):369–72. PMID: 28073945. https://doi.org/10.1093/jjco/hyw203
18. Nagami Y, Ominami M, Otani K, et al. Endoscopic submucosal dissection for adenocarcinomas of the esophagogastric junction. Digestion. 2018;97(1):38–44. Epub 2018 Feb 1. PMID: 29393168. https://doi.org/10.1159/000484111
19. Mantese G. Gastrointestinal stromal tumor: Epidemiology, diagnosis, and treatment. Curr Opin Gastroenterol. 2019;35(6):555–59. PMID: 31577561. https://doi.org/10.1097/MOG.0000000000000584
20. Park J, Yoo HM, Sul HJ, et al. Genetic characterization of molecular targets in Korean patients with gastrointestinal stromal tumors. J Gastric Cancer. 2020;20(1):29–40. Epub 2019 Dec 27. PMID: 32269842; PMCID: PMC7105413. https://doi.org/10.5230/jgc.2020.20.e2
21. Menge F, Jakob J, Kasper B, et al. P. Clinical presentation of gastrointestinal stromal tumors. Visc Med. 2018;34(5):335–40. Epub 2018 Oct 13. PMID: 30498699; PMCID: PMC6257088. https://doi.org/10.1159/000494303
22. Hashmi AA, Faraz M, Nauman Z, et al. Clinicopathologic features and prognostic grouping of gastrointestinal stromal tumors (GISTs) in Pakistani patients: An institutional perspective. BMC Res Notes. 2018;11(1):457. PMID: 29996918; PMCID: PMC6042430. https://doi.org/10.1186/s13104-018-3562-8
23. Gronchi A, Bonvalot S, Poveda Velasco A, et al. Quality of surgery and outcome in localized gastrointestinal stromal tumors treated within an international intergroup randomized clinical trial of adjuvant imatinib. JAMA Surg. 2020;155(6):e200397. Epub 2020 Jun 17. PMID: 32236507; PMCID: PMC7113837. https://doi.org/10.1001/jamasurg.2020.0397
2. Akahoshi K, Oya M, Koga T, et al. Current clinical management of gastrointestinal stromal tumor. World J Gastroenterol. 2018;24(26):2806–17. PMID: 30018476; PMCID: PMC6048423. https://doi.org/10.3748/wjg.v24.i26.2806
3. Theiss L, Contreras CM. Gastrointestinal stromal tumors of the stomach and esophagus. Surg Clin North Am. 2019;99(3):543– 53. PMID: 31047041.https://doi.org/10.1016/j.suc.2019.02.012
4. Ibrahim A, Chopra S. Succinate dehydrogenase-deficient gastrointestinal stromal tumors. Arch Pathol Lab Med. 2020;144(5):655–60. Epub 2019 Jun 6. PMID: 31169996. https://doi.org/10.5858/arpa.2018-0370-RS
5. Al-Share B, Alloghbi A, Al Hallak MN, et al. Gastrointestinal stromal tumor: A review of current and emerging therapies. Cancer Metastasis Rev. 2021 Apr 19. Epub ahead of print. PMID: 33876372. https://doi.org/10.1007/s10555-021-09961-7
6. Coe TM, Fero KE, Fanta PT, et al. Population-based epidemiology and mortality of small malignant gastrointestinal stromal tumors in the USA. J Gastrointest Surg. 2016;20(6):1132–40. Epub 2016 Mar 29. PMID: 27025710; PMCID: PMC4880518. https://doi.org/10.1007/s11605-016-3134-y
7. Kohno S, Aoki H, Ogawa M, et al. Significance of primary malignant tumors on the outcome of patients with resected gastrointestinal stromal tumors. In Vivo. 2020;34(3):1201–5. PMID: 32354910; PMCID: PMC7279818. https://doi.org/10.21873/invivo.11893
8. Milanetto AC, Pacciani S, Fassan M, et al. Pancreatic neuroendocrine neoplasms and gastrointestinal stromal tumors: A single-institution experience of a rare association and review of the literature. Pancreas. 2020;49(7):918–23. PMID: 32658075. https://doi.org/10.1097/MPA.0000000000001599
9. Daumová M, Vanˇková B, Švajdler Met al. Immunohistochemistry and molecular genetics in the differential diagnostics of mesenchymal lesions of gastrointestinal tract. Cesk Patol. 2020;56(4):212–20. PMID: 33736442.
10. El-Menyar A, Mekkodathil A, Al-Thani H. Diagnosis and management of gastrointestinal stromal tumors: An up-to-date literature review. J Cancer Res Ther. 2017;13(6):889–900. https://doi.org/10.4103/0973-1482.177499. PMID: 29237949.
11. Weerts ZZRM, Masclee AAM, Witteman BJM, et al. Efficacy and safety of peppermint oil in a randomized, double-blind trial of patients with irritable bowel syndrome. Gastroenterology. 2020;158(1):123–36. Epub 2019 Aug 27. PMID: 31470006. https://doi.org/10.1053/j.gastro.2019.08.026
12. Søreide K. Cancer biology of small gastrointestinal stromal tumors (<2 cm): What is the risk of malignancy? Eur J Surg Oncol. 2017;43(7):1344–9. Epub 2017 Feb 9. PMID: 28222971. https://doi.org/10.1016/j.ejso.2017.01.240
13. Tryggvason G, Hilmarsdottir B, Gunnarsson GH, et al. Tyrosine kinase mutations in gastrointestinal stromal tumors in a nationwide study in Iceland. APMIS. 2010;118(9):648–56. PMID: 20718716. https://doi.org/10.1111/j.1600-0463.2010.02643.x
14. Zhang JQ, Zeng S, Vitiello GA, et al. Macrophages and CD8+ T cells mediate the antitumor efficacy of combined CD40 ligation and imatinib therapy in gastrointestinal stromal tumors. Cancer Immunol Res. 2018;6(4):434–47. Epub 2018 Feb 21. PMID: 29467128; PMCID: PMC6203303. https://doi.org/10.1158/2326-6066.CIR-17-0345
15. Trindade AJ, Benias PC, Alshelleh M, et al. Fine-needle biopsy is superior to fine-needle aspiration of suspected gastrointestinal stromal tumors: a large multicenter study. Endosc Int Open. 2019;7(7):E931–6. Epub 2019 Jul 11. PMID: 31304239; PMCID: PMC6624113. https://doi.org/10.1055/a-0953-1640
16. Hansen T, Titze U, Trachte F, et al. [Uncommon tumor of the gastric wall]. Pathologe. 2020 Dec 23. German. Epub ahead of print. PMID: 33355706. https://doi.org/10.1007/s00292-020-00886-6
17. Kanda T, Masuzawa T, Hirai T, et al. Surgery and imatinib therapy for liver oligometastasis of GIST: A study of Japanese Study Group on GIST. Jpn J Clin Oncol. 2017;47(4):369–72. PMID: 28073945. https://doi.org/10.1093/jjco/hyw203
18. Nagami Y, Ominami M, Otani K, et al. Endoscopic submucosal dissection for adenocarcinomas of the esophagogastric junction. Digestion. 2018;97(1):38–44. Epub 2018 Feb 1. PMID: 29393168. https://doi.org/10.1159/000484111
19. Mantese G. Gastrointestinal stromal tumor: Epidemiology, diagnosis, and treatment. Curr Opin Gastroenterol. 2019;35(6):555–59. PMID: 31577561. https://doi.org/10.1097/MOG.0000000000000584
20. Park J, Yoo HM, Sul HJ, et al. Genetic characterization of molecular targets in Korean patients with gastrointestinal stromal tumors. J Gastric Cancer. 2020;20(1):29–40. Epub 2019 Dec 27. PMID: 32269842; PMCID: PMC7105413. https://doi.org/10.5230/jgc.2020.20.e2
21. Menge F, Jakob J, Kasper B, et al. P. Clinical presentation of gastrointestinal stromal tumors. Visc Med. 2018;34(5):335–40. Epub 2018 Oct 13. PMID: 30498699; PMCID: PMC6257088. https://doi.org/10.1159/000494303
22. Hashmi AA, Faraz M, Nauman Z, et al. Clinicopathologic features and prognostic grouping of gastrointestinal stromal tumors (GISTs) in Pakistani patients: An institutional perspective. BMC Res Notes. 2018;11(1):457. PMID: 29996918; PMCID: PMC6042430. https://doi.org/10.1186/s13104-018-3562-8
23. Gronchi A, Bonvalot S, Poveda Velasco A, et al. Quality of surgery and outcome in localized gastrointestinal stromal tumors treated within an international intergroup randomized clinical trial of adjuvant imatinib. JAMA Surg. 2020;155(6):e200397. Epub 2020 Jun 17. PMID: 32236507; PMCID: PMC7113837. https://doi.org/10.1001/jamasurg.2020.0397
Article Sidebar
Published
Jun 28, 2021
Article Details
How to Cite
A Case Presentation of Gastrointestinal Stromal Tumor of Duodenum. (2021). Journal of Renal and Hepatic Disorders, 5(1), 49-53. https://doi.org/10.15586/jrenhep.v5i1.112
Section
Case Reports Hepatology
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.