A gastrointestinal stromal tumor of the duodenum masquerading as a pancreatic head tumor

Abstract

Gastrointestinal stromal tumor (GIST) represents the most common kind of mesenchymal tumor that arises from the alimentary tract. GIST is currently defined as a gastrointestinal tract mesenchymal tumor showing CD117 (c-kit protein) positivity at immunohistochemistry. Throughout the whole length of the gastrointestinal tract, GIST arises most commonly from the stomach followed by the small intestine, the colorectum, and the esophagus. Only 3%-5% of GISTs occur in the duodenum, and especially, if GIST arises from the C loop of the duodenum, it can be difficult to differentiate from the pancreas head mass because of its anatomical proximity. Here, we report a case of duodenal GIST, which was assessed as a pancreatic head tumor preoperatively.

Management and Outcome of Gastrointestinal Stromal Tumors of the Duodenum

“…3,4 The commonest site of origin is the stomach (60-70% of cases), followed by the small intestine (30%) and rarely from the rectum (5%), esophagus, colon, and appendix. 5,6 GISTs may arise in extra intestinal sites in up to 5% of cases. 5,6 Duodenal GISTs comprise a relatively small subset of GISTs with a reported frequency of 6-21% of surgically resected GISTs.…”

A duodenal stromal tumor mimicking a pancreatic head tumor: one case report and literature review

“…The tumors are frequently located in close relationship to the ampulla of Vater, this determining surgical treatment strategy. An extensive search of the English literature found only for previous case reports [3,6,7,14] and one case series [8] describing duodenal GISTs presenting as a pancreatic head cancers. The GISTs in the case reports were both also suspected to be neuroendocrine tumors and were treated by a pylorus-preserving pancreaticoduodenectomy and a segmental resection of the duodenum and duodenojejunostomy and pancreatic head resection with duodenal segmentectomie respectively.…”

“…Therefore, lymphadenectomy is not recommended [16,18,19]. This seems true for duodenal GIST as local lymph node invasion has never been described, even after PD [4,6,9]. The size of surgical margins along the digestive tract segment of formally defined involved are not, however there is little submucosal spread in GIST and clear margins of 1 or 2 cm are recommended [3,9,15,16,19,20].…”

A gastrointestinal stromal tumor of the third portion of the duodenum treated by wedge resection: A case report

“…However, CT and MRI seem to be the best imaging modalities for assessment of the primary lesion and detection of metastases [12] , although CT scans are not always helpful in specifying the origin of the mass. In several cases reported in the literature, the mass was misdiagnosed as arising from the head of the pancreas [13] . There is currently uniform agreement that the surgical treatment of choice for GISTs is resection of the tumor with clear surgical margins, including adjacent organs as necessary [12] .…”