Harris Patrick S, Romano John, Russ Kirk B, Shoreibah Mohamed G, Baig Kondal Rao Kyanam Kabir
Tinsley Harrison Internal Medicine Residency, University of Alabama at Birmingham, Birmingham, AL.
Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, SC.
Ochsner J. 2020 Summer;20(2):236-238. doi: 10.31486/toj.18.0167.
Gastrointestinal stromal tumors (GISTs), although exceedingly rare, are the most common mesenchymal tumors in the gastrointestinal (GI) tract. GISTs are often asymptomatic; approximately 10% are found incidentally on imaging or endoscopy for other indications, although GI bleeding, intestinal obstruction, and perforation can occur. We present a case of upper GI bleeding from a duodenal GIST. Proton-pump inhibitor (PPI) therapy resulted in complete endoscopic ulcer healing, yet a discrete mass lesion was identified on endoscopic ultrasound (EUS). A 70-year-old female presented with upper GI bleeding, and a duodenal ulcer was identified with esophagogastroduodenoscopy (EGD). Computed tomography (CT) scan of the abdomen and pelvis showed duodenal bulb thickening without clear mass. The ulcer was treated with 1:10,000 concentration epinephrine, injected in 4 quadrants around the ulcer base. The patient's GI bleeding resolved, and she was discharged with a referral for outpatient EUS follow-up. One month later, EUS showed resolution of the ulcer after PPI therapy but also showed a lesion consistent with GIST that was confirmed by cytologic analysis. The patient was started on imatinib therapy and had no further bleeding. Initial EGD and CT findings could have easily been attributed to duodenal peptic ulcer disease for which follow-up endoscopy is not routinely recommended given the low risk of malignancy. However, because of the high index of suspicion on the part of the referring physicians, duodenal GIST was diagnosed. This case extends the spectrum of the presentation, evaluation, and diagnosis of GISTs and stresses the importance of keeping this rare disease on the provider's differential, even after routine workup shows no findings of tumor.
胃肠道间质瘤（GISTs）虽然极为罕见，但却是胃肠道（GI）中最常见的间充质肿瘤。GISTs通常无症状；约10%在因其他指征进行影像学检查或内镜检查时偶然发现，不过也可能发生胃肠道出血、肠梗阻和穿孔。我们报告一例十二指肠GIST导致上消化道出血的病例。质子泵抑制剂（PPI）治疗使内镜下溃疡完全愈合，但在内镜超声（EUS）检查中发现了一个离散的肿块病变。一名70岁女性因上消化道出血就诊，经食管胃十二指肠镜检查（EGD）发现十二指肠溃疡。腹部和盆腔计算机断层扫描（CT）显示十二指肠球部增厚但无明确肿块。在溃疡底部周围的4个象限注射1:10,000浓度的肾上腺素治疗溃疡。患者的胃肠道出血得到缓解，出院时被转诊进行门诊EUS随访。1个月后，EUS显示PPI治疗后溃疡已愈合，但也显示出一个与GIST一致的病变，经细胞学分析得以证实。患者开始接受伊马替尼治疗，未再出血。最初的EGD和CT检查结果很容易被归因于十二指肠消化性溃疡病，鉴于其恶性风险较低，通常不建议进行后续内镜检查。然而，由于转诊医生的高度怀疑，十二指肠GIST得以确诊。该病例扩展了GISTs的临床表现、评估和诊断范围，并强调即使在常规检查未发现肿瘤的情况下，也应将这种罕见疾病纳入医生的鉴别诊断之中。
