Search

Abstract Background Due to rarity of duodenal GISTs, clinicians have few information about its clinical features, diagnosis, management and prognosis. Case report We report a case of promptly diagnosed duodenal GIST in a 61-year-old Egyptian man presented shocked with severe attack of hematemesis and melena. Upper gastroduodenal endoscopy was done and revealed a large ulcerating bleeding mass at first part of duodenum 4 hemo-clips were applied with good hemostasis. An exploratory laparotomy and distal gastrectomy, duodenectomy and gastrojejunostomy were performed. The morphology of the mass combined with immunohistochemistry was consistent with duodenal gastrointestinal stromal tumours (GISTs) of high risk type. The patient is on amatinib one tablet daily and he was well with no evidence of tumor recurrence. Conclusion despite being rare, emergency presentation with sudden severe, life-threatening hemorrhagic shock duodenal GISTs might be a cause of potentially lethal massive combined upper and lower gastrointestinal bleeding which is the key feature of this rare and challenging tumor.

Background: Due to rarity of duodenal GISTs, clinicians have few information about its clinical features, diagnosis, management and prognosis. Case report: We report a case of promptly diagnosed duodenal GIST in a 61-year-old Egyptian man presented shocked with severe attack of hematemesis and melena. Upper gastroduodenal endoscopy was done and revealed a large ulcerating bleeding mass at first part of duodenum 4 hemo-clips were applied with good hemostasis. An exploratory laparotomy and distal gastrectomy, duodenectomy and gastrojejunostomy were performed. The morphology of the mass combined with immunohistochemistry was consistent with duodenal gastrointestinal stromal tumours (GISTs) of high risk type. The patient is on amatinib one tablet daily and he was well with no evidence of tumor recurrence. Conclusion: despite being rare, emergency presentation with sudden severe, life-threatening hemorrhagic shock duodenal GISTs might be a cause of potentially lethal massive combined upper and lower gastrointestinal bleeding which is the key feature of this rare and challenging tumor. [ABSTRACT FROM AUTHOR]

Background The second part of the duodenum is the most common part to be involved with duodenal gastrointestinal tumors (D2-GISTs). Localized resection (LR) and pancreaticoduodenectomy (PD) are two viable options for curative resection. The aim of this study is to compare the middle-term outcomes in patients with D2-GIST after either LR or PD in a single institution. Patients and Methods Overall, 53 patients with non-metastatic D2-GIST were analyzed. Either LR or PD was executed depending on the involvement of the ampulla of Vater. The tumors were stratified in accordance with the Miettinen classification for tumor behavior. The patients were followed up for 3 years for recurrence and survival. Results Thirty-two of the patients were females (60%) and 21 males (40%), with a mean age of 55 ± 8 years. Bleeding was the most common presentation in 19 patients (36%). LR was performed in 41 patients (77%), whereas PD was performed in 12 patients (23%). Three-year survival and recurrence were comparable between the two groups. The disease-free survival at 3 years was 85% and 92% in LR and PD group, respectively. The PD group had a significantly longer operative time and a higher incidence of postoperative pancreatic fistula. Otherwise, no statistically significant difference was calculated. A significantly shorter survival was calculated in those with a mitotic index of >5 and also for tumors classified as high grade in accordance with the Miettinen classification. 71% of those with recurrence had high mitotic index > 5/hpf. Conclusions LR for D2-GIST is an acceptable alternative to PD with satisfactory middle-term outcomes. For tumors involving the ampulla of Vater, PD is still indicated. Furthermore, tumor biology predicts the likelihood of survival and recurrence.

The second part of the duodenum is the most common part to be involved with duodenal gastrointestinal tumors (D2-GISTs). Localized resection (LR) and pancreaticoduodenectomy (PD) are two viable options for curative resection. The aim of this study is to compare the middle-term outcomes in patients with D2-GIST after either LR or PD in a single institution. Overall, 53 patients with non-metastatic D2-GIST were analyzed. Either LR or PD was executed depending on the involvement of the ampulla of Vater. The tumors were stratified in accordance with the Miettinen classification for tumor behavior. The patients were followed up for 3 years for recurrence and survival. Thirty-two of the patients were females (60%) and 21 males (40%), with a mean age of 55 ± 8 years. Bleeding was the most common presentation in 19 patients (36%). LR was performed in 41 patients (77%), whereas PD was performed in 12 patients (23%). Three-year survival and recurrence were comparable between the two groups. The disease-free survival at 3 years was 85% and 92% in LR and PD group, respectively. The PD group had a significantly longer operative time and a higher incidence of postoperative pancreatic fistula. Otherwise, no statistically significant difference was calculated. A significantly shorter survival was calculated in those with a mitotic index of >5 and also for tumors classified as high grade in accordance with the Miettinen classification. 71% of those with recurrence had high mitotic index > 5/hpf. LR for D2-GIST is an acceptable alternative to PD with satisfactory middle-term outcomes. For tumors involving the ampulla of Vater, PD is still indicated. Furthermore, tumor biology predicts the likelihood of survival and recurrence. [ABSTRACT FROM AUTHOR]

Duodenal gastrointestinal stromal tumors (D-GISTs) are a rare subtype of GISTs, accounting for only 4% to 5% of all GIST cases. This case report details the presentation, diagnosis, and management of a 48-year-old female who presented with melena and anemia and was eventually diagnosed with a D-GIST. The tumor was identified through imaging studies, and histopathology performed after surgical resection revealed a submucosal neoplasm composed of spindle cells with extensive hemorrhage and necrosis. Given the tumor's rarity and its challenging presentation, which can mimic other conditions such as pancreatic masses, the case underscores the importance of considering D-GIST in differential diagnoses of duodenal or pancreatic lesions. Surgical resection remains the cornerstone of treatment, with adjuvant therapy considered in high-risk cases to prevent recurrence., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Amin et al.)

Gastrointestinal stromal tumors (GISTs) originating in the duodenal wall constitute the most challenging localization of this gastrointestinal neoplasm. Duodenal GISTs are relatively uncommon. The prevalence of duodenal GIST is very low, accounting for 5% to 7% or less of all surgically resected GISTs. Most published reports on duodenal GIST are case reports or small case series. Consequently, the unspecific clinical manifestations, radiologic diagnosis, appropriate surgical treatment, prognostic factors, and survival constitute a subject of current controversy. This review addresses the management of duodenal GISTs trying to establish and define surgical options according to GIST localization within the duodenum. Most articles concerning duodenal GISTs state that unlike tumors involving other sites of the gastrointestinal tract, the optimal procedure for duodenal GISTs has not been well characterized in the surgical literature. However, when carefully reviewing the published literature on the subject, it was possible to identify common surgical approaches to duodenal GISTs which are fairly standard among different authors. All approaches take into account the GIST localization within the duodenal wall and its anatomic relationships to decide whether local resection or the Whipple operation should be performed. Using this knowledge, defined surgical options for duodenal GISTs according to their localization within the duodenum are being proposed. Besides the current controversy regarding the indications for the Whipple procedure, the other most important issue remaining to be addressed is the implementation of laparoscopic surgery for this challenging tumor. [ABSTRACT FROM AUTHOR]

• Duodenal GISTs are rare tumors of the digestive tract and although frequently symptomatic, they can also be diagnosed incidentally. • The management of GISTs should be conducted by a multidisciplinary team. • Surgery is the only potentially curative treatment for non-metastatic GISTs and the gold standard for local disease. • The recurrence of GISTs appears to have a stronger connection to the tumor biology rather than the kind of surgery performed. • High-risk GISTs have a formal indication for adjuvant therapy with a tyrosine kinase inhibitor. Duodenal GISTs are rare mesenchymal tumors of the digestive tract. They usually present as gastrointestinal bleeding or non-specific abdominal pain, but they can also be asymptomatic. High-risk GISTs have malignant potential. Surgical resection is the only curative option and its extension depends on different factors. Tyrosine kinase inhibitors are of the utmost importance in high-risk and metastatic disease. We herein report the case of a 75-year-old male, referred to our general surgery outpatient clinic, with an asymptomatic duodenal mass incidentally diagnosed during an abdominopelvic ultrasonography. Abdominal CT suggested GIST. Since no other lesions were found, a segmental duodenectomy was performed and the patient recovery was uneventful. Histologic exam confirmed the presence of a high-risk GIST, therefore adjuvant therapy with imatinib was initiated. Duodenal involvement by GISTs is rare, even more in its third/fourth portions. The widespread clinical use of radiological exams such as ultrasonography may lead to the diagnosis of asymptomatic masses. Surgical treatment is the gold-standard giving the malignant potential of these neoplasms. There are risk stratification scores that may be used to assess the need for adjuvant therapy. Even large GISTs can by asymptomatic. Giving their malignant potential, early diagnosis and treatment are crucial. The histologic findings and genetic profile have an impact on the patient's survival. [ABSTRACT FROM AUTHOR]

GIST or gastrointestinal stromal tumors are the most common mesenchymal tumors of the GI tract showing mostly positive c-kit (CD-117) in immuno-histochemical staining. Most of the times, early diagnosis is missed. Usually, patients present with anemia. Sometimes, the patient can present in emergency with massive GI bleed or intestinal obstruction. The aim of this paper was to make the clinicians aware about the varied presentations of GIST. Presenting herewith is our single-center experience of management of patients of GIST with review of the available literature. [ABSTRACT FROM AUTHOR]

Introduction: Segmental duodenal resections (DR) have been increasingly performed for the treatment of primary duodenal tumours. The aim of the study is to review the indications for, clinical and operative details, and outcomes of patients undergoing elective DR. Material and Methods: We retrospectively reviewed all patients who underwent elective segmental DR for the treatment of primary duodenal tumours, at a single institution between January 2007 and December 2013. Demographic data, clinical presentation, preoperative investigations, operative details, postoperative complications/mortality and histopathological results were recorded. Results: In the study period, 11 duodenal resections were performed (7 male, median age 61 years). Thirty-six percent of the patients presented with anaemia. Surgical resection included two or more segments in seven patients. The most frequently resected part of the duodenum was segment 3 ( n = 7). Median operative time was 191 min and blood loss was 675 ml. End-to-end and end-to-side anastomoses were performed in equal numbers. The pathology of resected specimens included adenocarcinoma ( n = 4), gastrointestinal stromal tumour (GIST) ( n = 1), adenoma ( n = 5) and lymphoma ( n = 1). Median hospital stay was 14 days. Overall, 30-day morbidity rate was 82 % (78 % Clavien 2 or less). Conclusions: Segmental duodenal resection is a safe and effective surgical technique for the resection of primary duodenal tumours. [ABSTRACT FROM AUTHOR]

Background Duodenal GISTs represent 3–5% of all GISTs with limited understanding of patient outcomes. We conducted a retrospective analysis of primary localized duodenal GISTs. Methods Patients were identified via a survey from 16 FSG centers ( n = 105), and a group of 9 patients enrolled in the BFR14 trial. Data were collected from the original database and patient files, in agreement with French legislation. Results 114 patients were included, with a median age of 57. Tumors originated mainly in D2 (33%), or D3 (24%), with a median size of 5 cm. 109 patients had resection of the primary tumor; with a Local Resection (LR, n = 82), a pancreaticoduodenectomy (PD, n = 23), and data were missing for 4 patients. Resections were R0 ( n = 87, 79%), R1 ( n = 8, 7%), R2 ( n = 6). Tumor characteristics were: KIT+ ( n = 104), CD34+ ( n = 58). Miettinen risk was low ( n = 43), and high ( n = 52). Imatinib was administered preoperatively ( n = 11) and post-operatively ( n = 20). With a median follow-up of 36 months (2–250), 98 patients are alive, and 33 relapsed. The 5-year OS and EFS rates are 86.5% and 54.5%. EFS was similar for patients in the LR and the PD groups ( P > 0.05 ). In multivariate analysis, ECOG PS, and CD34 expression are independent prognostic factors on OS. Miettinen risk and spindle cell type are independent predictive factors for relapse. Conclusions Patients with resected duodenal GIST have a reasonably favorable prognosis. This study favors a preservation of pancreas when there are no anatomical constraints. LR exhibit similar survival and smaller morbidity then PD. [ABSTRACT FROM AUTHOR]

Duodenal gastrointestinal stromal tumors (GIST) constitute the most challenging location for the treatment of this neoplasm. Duodenal GIST are relatively uncommon tumors, their prevalence is very low accounting for 5% to 7% or less of all surgically resected GIST. Most published reports on duodenal GIST are case reports or case series. Consequently, the clinical manifestations, radiologic diagnosis, appropriate surgical treatment, and prognostic factors constitute a subject of current controversy. Most articles concerning duodenal GISTs state that unlike tumors involving other sites of the gastrointestinal tract, the optimal procedure for duodenal GISTs has not been well characterized. However, when carefully reviewing the published literature on the subject, it was found that surgical approaches to duodenal GISTs are fairly standard among different authors. All take into account the location of GIST in the duodenum and its anatomic relationships to decide whether local resection or Whipple operation should be performed. Using this common sense knowledge, defined surgical options for duodenal GISTs according to their localization within the duodenal frame are proposed. [ABSTRACT FROM AUTHOR]

Background: Although gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract, they are very rare. This study evaluated clinical and histopathological characteristics of duodenal GISTs to identify factors useful in predicting prognosis for patients with these tumors. Methods: A retrospective study was performed on 20 patients who had undergone surgery between 1987 and 2009 for duodenal GISTs. Clinical, histopathological, and immunohistochemical data were evaluated. Survival analyses were conducted using Kaplan-Meier estimates. Results: In 12 patients (60%), duodenal GISTs were diagnosed incidentally. Eight cases (40%) were classified as high risk grade GISTs. Skeinoid fibers (SkF), which are eosinophilic globular hyaline deposits in the extracellular interstitium of the tumor, were found in 12 patients. Skeinoid fibers were not recognized in 8 cases, and these included 3 cases (37.5%) where tumors recurred after surgery and the patient died. Tumors without SkF were larger (81 ± 92 vs. 23 ± 8 mm, P < 0.001) and had a higher mitotic count (224.0 ± 336.6 vs. 0.0 ± 0.0 /50 high-power field, P < 0.001) than those with SkF. Survival time was shorter in patients with tumors lacking SkF (52.9 ± 50.7 vs. 108.9 ± 86.5 months, P = 0.019). Conclusions: We have identified clinical and histopathological characteristics that were useful in predicting the prognosis of patients with duodenal GISTs. In this study, 60% of the tumors were found incidentally, SkF were not recognized in tumors from 40% of patients, and all cases of post-operative tumor recurrence and death occurred in this subgroup of patients. [ABSTRACT FROM AUTHOR]

Abstract: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. Almost 95% of GISTs express a specific stem cell growth factor receptor (c-kit; protein, CD117), as shown by an immunohistochemical analysis. About 70% of GISTs appear in the stomach, 20% in the small intestine and 10% in the colon, rectum and other sites of the GI tract and peritoneal cavity. Duodenal GISTs account for nearly 0.1% of all GI tumors. Two cases presented in the report demonstrate the critical importance of preoperative imaging for the choice of a surgical procedure for a duodenal GIST. In the case of a big decaying tumor of the second portion of the duodenum penetrating into the pancreatic head, the Whipple procedure was performed, whereas a pancreas-preserving duodenumectomy, type 1b, was done for a relatively small tumor of the third part of the duodenum without adventitia and lymphatic node involvement. [Copyright &y& Elsevier]