Mokhtare Marjan, Taghvaei Tarang, Tirgar Fakheri Hafez
GI Fellow, Department of Gastroenterology, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran.
Assistant Professor, Department of Gastroenterology, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran.
Middle East J Dig Dis. 2013 Jan;5(1):47-51.
Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastrointestinal tract. The biological pattern of these tumors ranges from benign-appearing small lesions to malignant sarcomas. Only 3%-5% of GISTs are found in the duodenum. A duodenal GIST is a rare source of upper gastrointestinal bleeding. A remarkable percentage of duodenal GISTs are localized in the third and fourth part of the duodenum and may not be noticed on standard upper endoscopy. Push enteroscopy is sometimes advisable to find these lesions. Surgical resection either limited or pancreaticoduodenectomy can be the treatment of choice. In general, adjuvant therapy with imatinib has been proved to extend survival in patients with GIST.The current case, a 24-year-old male, presented with acute upper gastrointestinal bleeding from a submucosal ulcerated tumor located in the distal third part of the duodenum, 3 cm distal from the papilla of Vater. After primary care and blood transfusion in a local hospital, partial resection of the duodenum was performed as a definitive surgical therapy. Histopathology showed a GIST with a diameter of 3 cm and moderately malignant according to tumor grade, and <5 mitoses/10 high power field (HPF).
胃肠道间质瘤（GIST）是胃肠道最常见的间叶组织肿瘤。这些肿瘤的生物学特性范围从看似良性的小病变到恶性肉瘤。仅3%-5%的GIST发生于十二指肠。十二指肠GIST是上消化道出血的罕见原因。相当一部分十二指肠GIST位于十二指肠第三和第四部分，在标准的上消化道内镜检查中可能未被发现。有时建议采用推进式小肠镜检查来发现这些病变。手术切除，无论是局限性切除还是胰十二指肠切除术，都可能是首选的治疗方法。一般来说，已证实伊马替尼辅助治疗可延长GIST患者的生存期。本例为一名24岁男性，因位于十二指肠远端第三部分、距十二指肠乳头3 cm处的黏膜下溃疡性肿瘤导致急性上消化道出血。在当地医院进行初步治疗和输血后，实施了十二指肠部分切除术作为确定性手术治疗。组织病理学显示为直径3 cm的GIST，根据肿瘤分级为中度恶性，且每10个高倍视野（HPF）有<5个核分裂象。
