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Current Medical Imaging

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ISSN (Print): 1573-4056
ISSN (Online): 1875-6603

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Case Report

A Fistulized Giant Duodenal Stromal Tumor in a Young Patient: A Case Report With Literature Review for Tomographic Diagnosis

Author(s): Gulsum Kilickap*

Volume 20, 2024

Published on: 14 April, 2023

Article ID: e240223214013 Pages: 4

DOI: 10.2174/1573405619666230224110231

Price: $65

Abstract

Background: Duodenal gastrointestinal stromal tumors (GISTs) are rare tumors of the gastrointestinal tract. It should be considered in the differential diagnosis of periampullary region pathologies.

Case Report: A 24-year-old male patient applied to the general surgery department with the complaint of long-standing abdominal pain, nausea and vomiting after meals, and 8-10 kg weight loss in 1 month. Three-phase dynamic abdominopelvic CT showed that the 1st and the 2nd segments of the duodenum were dilated. At this level, a peripherally intensely contrasted heterogeneous mass lesion, 91x70x46 mm in size, was observed. There was oral contrast and air values in the center of the mass. A fistulized mass connected with the duodenal wall was considered in the differential diagnosis. In the surgical exploration, a soft, vascularized mass fistulized to the 2nd segment of the duodenum was observed. Pathological diagnosis was reported as GIST.

Conclusion: GISTs arise from the precursors of Cajal Interstitial cells of the gastrointestinal tract. Contrast-enhanced CT is the preferred diagnostic method for staging, risk stratification, and follow-up. We presented a young case with a giant duodenal GIST and discussed differential diagnosis and some diagnostic properties.

[1]
Parab TM, DeRogatis MJ, Boaz AM, et al. Gastrointestinal stromal tumors: A comprehensive review. J Gastrointest Oncol 2018; 10(1): 144-54.
[http://dx.doi.org/10.21037/jgo.2018.08.20] [PMID: 30788170]
[2]
Liu Z, Zheng G, Liu J, et al. Clinicopathological features, surgical strategy and prognosis of duodenal gastrointestinal stromal tumors: A series of 300 patients. BMC Cancer 2018; 18(1): 563.
[http://dx.doi.org/10.1186/s12885-018-4485-4] [PMID: 29764388]
[3]
Cai PQ, Lv XF, Tian L, et al. CT characterization of duodenal gastrointestinal stromal tumors. AJR Am J Roentgenol 2015; 204(5): 988-93.
[http://dx.doi.org/10.2214/AJR.14.12870] [PMID: 25905932]
[4]
Shen C, Chen H, Yin Y, et al. Duodenal gastrointestinal stromal tumors: Clinicopathological characteristics, surgery, and long-term outcome. BMC Surg 2015; 15(1): 98.
[http://dx.doi.org/10.1186/s12893-015-0084-3] [PMID: 26276408]
[5]
Mandrioli M, Mastrangelo L, Masetti M, et al. Characterization of malignant gastrointestinal stromal tumors—a single center experience. J Gastrointest Oncol 2017; 8(6): 1037-45.
[http://dx.doi.org/10.21037/jgo.2017.10.09] [PMID: 29299364]
[6]
Mazur MT, Clark HB. Gastric stromal tumors reappraisal of histogenesis. Am J Surg Pathol 1983; 7(6): 507-20.
[http://dx.doi.org/10.1097/00000478-198309000-00001] [PMID: 6625048]
[7]
Akahoshi K, Oya M, Koga T, Shiratsuchi Y. Current clinical management of gastrointestinal stromal tumor. World J Gastroenterol 2018; 24(26): 2806-17.
[http://dx.doi.org/10.3748/wjg.v24.i26.2806] [PMID: 30018476]
[8]
Hirota S, Isozaki K, Moriyama Y, et al. Gain-of-function mutations of c-kit in human gastrointestinal stromal tumors. Science 1998; 279(5350): 577-80.
[http://dx.doi.org/10.1126/science.279.5350.577] [PMID: 9438854]
[9]
Heinrich MC, Corless CL, Duensing A, et al. PDGFRA activating mutations in gastrointestinal stromal tumors. Science 2003; 299(5607): 708-10.
[http://dx.doi.org/10.1126/science.1079666] [PMID: 12522257]
[10]
Kindblom LG, Remotti HE, Aldenborg F, Meis-Kindblom JM. Gastrointestinal pacemaker cell tumor (GIPACT): Gastrointestinal stromal tumors show phenotypic characteristics of the interstitial cells of Cajal. Am J Pathol 1998; 152(5): 1259-69.
[PMID: 9588894]
[11]
Nishida T, Hirota S. Biological and clinical review of stromal tumors in the gastrointestinal tract. Histol Histopathol 2000; 15(4): 1293-301.
[PMID: 11005253]
[12]
Fletcher CDM, Berman JJ, Corless C, et al. Diagnosis of gastrointestinal stromal tumors: A consensus approach. Hum Pathol 2002; 33(5): 459-65.
[http://dx.doi.org/10.1053/hupa.2002.123545] [PMID: 12094370]
[13]
Joensuu H. Risk stratification of patients diagnosed with gastrointestinal stromal tumor. Hum Pathol 2008; 39(10): 1411-9.
[http://dx.doi.org/10.1016/j.humpath.2008.06.025] [PMID: 18774375]
[14]
Lee ES, Lee JM. Imaging diagnosis of pancreatic cancer: A state-of-the-art review. World J Gastroenterol 2014; 20(24): 7864-77.
[http://dx.doi.org/10.3748/wjg.v20.i24.7864] [PMID: 24976723]
[15]
Verde F, Hruban RH, Fishman EK. Small bowel gastrointestinal stromal tumors. J Comput Assist Tomogr 2017; 41(3): 407-11.
[http://dx.doi.org/10.1097/RCT.0000000000000526] [PMID: 27824674]
[16]
Kim JY, Lee JM, Kim KW, et al. Ectopic pancreas: CT findings with emphasis on differentiation from small gastrointestinal stromal tumor and leiomyoma. Radiology 2009; 252(1): 92-100.
[http://dx.doi.org/10.1148/radiol.2521081441] [PMID: 19561251]
[17]
Miettinen M, Lasota J. Gastrointestinal stromal tumors - definition, clinical, histological, immunohistochemical, and molecular genetic features and differential diagnosis. Virchows Arch 2001; 438(1): 1-12.
[http://dx.doi.org/10.1007/s004280000338] [PMID: 11213830]
[18]
Emory TS, Sobin LH, Lukes L, Lee DH, O’Leary TJ. Prognosis of gastrointestinal smooth-muscle (stromal) tumors: dependence on anatomic site. Am J Surg Pathol 1999; 23(1): 82-7.
[http://dx.doi.org/10.1097/00000478-199901000-00009] [PMID: 9888707]
[19]
Okasha H, Amin H, Al-Shazli M, Nabil A, Hussein H, Ezzat R. A duodenal gastrointestinal stromal tumor with a large central area of fluid and gas due to fistulization into the duodenal lumen, mimicking a large duodenal diverticulum. Endosc Ultrasound 2015; 4(3): 253-6.
[http://dx.doi.org/10.4103/2303-9027.163018] [PMID: 26374586]

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