Uchida Hiroki, Sasaki Atsushi, Iwaki Kentaro, Tominaga Masayuki, Yada Kazuhiro, Iwashita Yukio, Shibata Kohei, Matsumoto Toshifumi, Ohta Masayuki, Kitano Seigo
First Department of Surgery, Oita University Faculty of Medicine, 1-1 Hasama-machi, Oita 879-5593, Japan.
J Hepatobiliary Pancreat Surg. 2005;12(4):324-7. doi: 10.1007/s00534-005-0985-0.
We report the case of a 53-year-old woman with a gastrointestinal stromal tumor (GIST) of the duodenum that showed only extramural growth, mimicking a pancreatic tumor. Preoperatively, computed tomography (CT) and angiography revealed a hypervascular mass, 3.0 cm in diameter, in the pancreatic head. Hypotonic duodenography showed compression of the second and third portions of the duodenum by the pancreatic lesion. Endoscopic examination showed no specific mucosal abnormalities in the duodenal lumen. The pancreatic head tumor was diagnosed preoperatively as a nonfunctioning islet cell tumor of the pancreas, and the patient underwent pylorus-preserving pancreaticoduodenectomy. A hard mass was palpated intraoperatively in the pancreatic head region, and neither peritoneal dissemination nor metastasis was detected. Histologically, the tumor was composed of spindle-shaped cells with a fascicular growth pattern, and only a few mitotic features were seen. Immunohistochemically, most of the tumor cells were positive for c-kit oncoprotein and CD34, but negative for alpha-smooth muscle actin and S-100 protein. Therefore, this neoplasm was finally diagnosed as a duodenal GIST of the uncommitted type. This is a rare case of a duodenal GIST with exclusively extramural growth mimicking a pancreatic head tumor.
我们报告了一例53岁女性十二指肠胃肠道间质瘤（GIST）病例，该肿瘤仅表现为壁外生长，酷似胰腺肿瘤。术前，计算机断层扫描（CT）和血管造影显示胰头有一个直径3.0 cm的高血运肿块。低张十二指肠造影显示胰腺病变压迫十二指肠第二和第三段。内镜检查显示十二指肠腔内无特异性黏膜异常。术前将胰头肿瘤诊断为胰腺无功能胰岛细胞瘤，患者接受了保留幽门的胰十二指肠切除术。术中在胰头区域可触及一个硬肿块，未发现腹膜播散或转移。组织学上，肿瘤由呈束状生长模式的梭形细胞组成，仅见少数有丝分裂特征。免疫组化显示，大多数肿瘤细胞c-kit癌蛋白和CD34呈阳性，但α-平滑肌肌动蛋白和S-100蛋白呈阴性。因此，该肿瘤最终被诊断为未定型十二指肠GIST。这是一例罕见的十二指肠GIST，仅壁外生长，酷似胰头肿瘤。
