Castillo Ofelia, Frisancho Oscar, Contardo Carlos, Morales Domingo, Garatea Rafael
Dpto. del Aparato Digestivo, Hospital Nacional Edgardo Rebagliati Martins, EsSALUD, Lima, Perú, (HNERM).
Rev Gastroenterol Peru. 2010 Jul-Sep;30(3):241-6.
Female of 64 years old, who two years ago was hospitalized in another institution for treatment of an abscess in the right liver lobe. During that hospitalization, it was found a duodenal tumor by tomography; however, no further studies or follow up on this finding was done. Prior to actual hospitalization, she was seen in a private clinic and treated with antibiotics for a suggestive"organized abscess" in the pancreatic head diagnosed by tomography. She presented with fever, abdominal pain and a palpable abdominal tumor in the right upper quadrant for a month. We realized a three-phase multislice spiral tomography with pancreatic curved reconstruction, which allowed to identified an ovoid tumor of 80 x 60 mm, with an area of central necrosis and intense contrast enhancement (arterial phase), located between the second and third duodenal portion, near the head of the pancreas. An upper endoscopy showed an extrinsic compression of the third duodenal portion. The patient underwent tumor resection without complication and the histologic diagnosis of the surgical specimen revealed a duodenal stromal tumor (GIST) with extraluminal transmural growth. We presented this case because of its unusual presentation of this tumor.
一名64岁女性，两年前因右肝叶脓肿在另一家机构住院治疗。在那次住院期间，通过断层扫描发现了十二指肠肿瘤；然而，对于这一发现未进行进一步的检查或随访。在实际住院前，她在一家私人诊所就诊，因断层扫描诊断为胰头“机化性脓肿”而接受了抗生素治疗。她出现发热、腹痛以及右上腹可触及腹部肿块一个月。我们进行了一次带有胰腺曲面重建的三期多层螺旋断层扫描，发现一个80×60毫米的椭圆形肿瘤，有中央坏死区域且在动脉期有强烈的对比增强，位于十二指肠第二和第三部分之间，靠近胰头。上消化道内镜检查显示十二指肠第三部分有外在压迫。患者接受了肿瘤切除，无并发症，手术标本的组织学诊断显示为十二指肠间质瘤（胃肠道间质瘤），有腔外透壁生长。我们展示这个病例是因为该肿瘤的表现不寻常。
