Hu Danqiong, Duan Yangri, Chen Yonghua, Li Bingfeng, Du Yechun, Shi Shuimei
Department of Gastroenterology, The Third People's Hospital of Yuhang District Hangzhou 311100, Zhejiang, China.
Department of Emergency, The Third People's Hospital of Yuhang District Hangzhou 311100, Zhejiang, China.
Am J Transl Res. 2022 Nov 15;14(11):8279-8285. eCollection 2022.
Gastrointestinal stromal tumors (GISTs) rarely occur in the duodenum, and only a few cases have been reported. Its clinical manifestations are not specific, and the imaging examination results are not typical, so a preoperative diagnosis is difficult. Pathologic examinations and genetic testing after surgical resection are the main diagnostic methods. Here, a case of duodenal stromal tumor complicated by gastrointestinal perforation is reported. A 57-year-old man presented with paroxysmal abdominal pain and bloating for 7 days. Contrast-enhanced computed tomography of the abdomen revealed a large mass (10 cm in diameter) in the right upper abdomen, which was considered neoplastic. The mass was anterior and inferior to the head of the pancreas, and medial to the mesenteric vessels. The tumor surrounded the descending and horizontal parts of the duodenum, and it ruptured into the lumen of the descending duodenum. After the patient underwent tumor resection, we found a rupture of the descending duodenal opening. After that, duodenal fistula drainage, gastrostomy, jejunostomy, small intestinal adhesion release and abdominal irrigation drainage were performed. Immunohistochemical staining results were as follows: CD34 (-), desmin (-), S-100 (-), CD117 (9.7) (+), DoG-1 (+), SDHB (+), Ki-67 (+5%). Based on these results, the lesion was finally diagnosed as duodenal GIST. The patient underwent surgical resection without targeted therapy and recovered well.
Duodenal stromal tumors often present with gastrointestinal bleeding and other clinical symptoms, requiring urgent surgery. Complete resection of the tumor is an effective surgical method. Extended resection does not prolong survival. However, surgical treatment should be determined according to the size and location of the tumor and its relationship to the pancreas. This highly malignant duodenal stromal tumor was >10 cm, accompanied by gastrointestinal perforation and necrosis. Surgical resection was required while protecting the organ function.
胃肠道间质瘤（GISTs）很少发生于十二指肠，仅有少数病例报道。其临床表现不具有特异性，影像学检查结果也不典型，因此术前诊断困难。手术切除后的病理检查及基因检测是主要诊断方法。在此，报道一例十二指肠间质瘤合并胃肠道穿孔的病例。一名57岁男性，阵发性腹痛、腹胀7天。腹部增强CT显示右上腹有一巨大肿块（直径10cm），考虑为肿瘤性病变。肿块位于胰头前下方，肠系膜血管内侧。肿瘤包绕十二指肠降部和水平部，并破入十二指肠降部肠腔。患者行肿瘤切除术后，发现十二指肠降部开口处破裂。之后，进行了十二指肠瘘引流、胃造瘘、空肠造瘘、小肠粘连松解及腹腔冲洗引流。免疫组化染色结果如下：CD34（-），结蛋白（-），S-100（-），CD117（9.7）（+），DOG-1（+），SDHB（+），Ki-67（+5%）。基于这些结果，最终诊断该病变为十二指肠GIST。患者未接受靶向治疗而行手术切除，恢复良好。
十二指肠间质瘤常表现为胃肠道出血等临床症状，需要紧急手术。完整切除肿瘤是有效的手术方法。扩大切除并不能延长生存期。然而，手术治疗应根据肿瘤的大小、位置及其与胰腺的关系来确定。该高恶性十二指肠间质瘤直径>10cm，伴有胃肠道穿孔和坏死。在保护器官功能的同时需要进行手术切除。
