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Abera SA, Tadesse AK, Abera KA, Zegeye KB, Ibrahim MA, Feleke AA, Gebrehiwet CL, Mengistu SB, Alemu HT, Molla YD. Duodenal gastrointestinal stromal tumor presenting with life-threatening upper GI bleeding in a young patient: A case report and literature review. Clin Case Rep 2024; 12:e8796. [PMID: 38634092 PMCID: PMC11022307 DOI: 10.1002/ccr3.8796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 02/28/2024] [Accepted: 03/07/2024] [Indexed: 04/19/2024] Open
Abstract
Key Clinical Message Duodenal GISTs are rare and challenging tumors. Acute life-threatening upper GI bleeding is a possible presentation of duodenal GISTs. Surgery is the standard treatment for localized duodenal GISTs. Imatinib is an effective adjuvant therapy for duodenal GISTs. Abstract GIST is the most common mesenchymal neoplasm of the gastrointestinal tract, accounting for 1%-2% of gastrointestinal tumors. They originate from the interstitial cells of Cajal and are rare in patients younger than 30 years. The stomach is the most common site, followed by the small intestine and colon. GISTs are caused by a gain-of-function mutation in the proto-oncogene receptor tyrosine kinase, with activating mutations in KIT being the most common. Most GISTs are asymptomatic. Even if gastrointestinal bleeding is the most common complication life-threatening hemorrhage is extremely uncommon. We present a case of a 31-year-old male patient presented with massive active hematemesis and melena with hemorrhagic shock. The patient presented with massive hematemesis and melena of 1 h duration. Endoscopy showed pulsating active bleeding from the third part of the duodenum which was difficult to manage via endoscopy. Histopathologic evaluation showed spindle cell type GIST. Intraoperatively, there was a nodular mass with active bleeding on the third part of the duodenum. Duodenectomy with end-to-end anastomosis was done. Discharged with no postoperative complication and was put on imatinib. There are considerable challenges that arise in the diagnosis and treatment of duodenal gastrointestinal stromal tumors (GISTs) when they present with life-threatening upper gastrointestinal hemorrhage. In order to achieve the best possible outcomes for patients, it is crucial to have a comprehensive understanding of the clinical presentation, diagnostic methods, and treatment approaches.
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Affiliation(s)
- Samuel Addisu Abera
- Department of Anatomic Pathology, College of Medicine and Health SciencesUniversity of GondarGondarEthiopia
| | - Amanuel Kassa Tadesse
- Department of Anatomic Pathology, College of Medicine and Health SciencesUniversity of GondarGondarEthiopia
| | - Kirubel Addisu Abera
- Department of Anatomic Pathology, College of Medicine and Health SciencesUniversity of GondarGondarEthiopia
| | - Kassa Berie Zegeye
- Department of Anatomic Pathology, College of Medicine and Health SciencesUniversity of GondarGondarEthiopia
| | - Mohammed Alemu Ibrahim
- Department of Surgery, College of Medicine and Health SciencesUniversity of GondarGondarEthiopia
| | - Ashenafi Amsalu Feleke
- Department of Surgery, College of Medicine and Health SciencesUniversity of GondarGondarEthiopia
| | - Cheru lilay Gebrehiwet
- Department of Surgery, College of Medicine and Health SciencesUniversity of GondarGondarEthiopia
| | - Segenet Bizuneh Mengistu
- Department of Internal medicine, College of Medicine and Health SciencesUniversity of GondarGondarEthiopia
| | | | - Yohannis Derbew Molla
- Department of Surgery, College of Medicine and Health SciencesUniversity of GondarGondarEthiopia
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He Z, Du C, Cheng B, Feng J, Wang N, Ma Y, Li L, Zhang B, Wang H, Tang P, Chai N, Linghu E. Endoscopic resection for the treatment of gastric gastrointestinal stromal tumors: a retrospective study from a large tertiary hospital in China. Surg Endosc 2024; 38:1398-1405. [PMID: 38148402 DOI: 10.1007/s00464-023-10619-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 11/28/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND AND AIMS With the continuous development of endoscopic technology, endoscopic resection (ER) has gradually become an optional method for the treatment of gastric gastrointestinal stromal tumors (GISTs). However, studies with a large sample or a long follow-up are lacking. Therefore, this research aims to evaluate the efficacy and safety of ER for gastric GISTs in the real-world setting with more than 300 enrolled patients and a follow-up period longer than 45 months. METHODS From January 2013 to February 2023, 409 patients with a pathological diagnosis of GISTs after ER were retrospectively enrolled in this study. After excluding 86 patients with non-gastric GISTs, we assessed 323 patients with gastric GISTs. The main outcome measures were en bloc resection, complete resection, residual disease, recurrence, and complications. RESULTS There were 194 (60.06%) females and 129 (39.94%) males, and the median age of the included patients was 58 years (51, 63). The median tumor size was 15.0 (10.0, 20.0) mm. According to the modified NIH criteria, 246 (75.85%) patients were classified as very low risk, 62 (19.20%) were classified as low risk, 12 (3.72%) were classified as moderate risk, and 3 (0.93%) were classified as high risk. A total of 287 (88.85%) patients achieved en bloc resection, and 287 (88.85%) also achieved complete resection. Only one patient showed residual and no recurrent lesions were noted during the follow-up. Regarding complications, three patients had complications, with a complication rate of 0.93%, and no severe complications requiring surgical intervention occurred. CONCLUSION ER is an appropriate alternative method for the treatment of gastric GISTs, with an en bloc resection rate of 88.85% and a complication rate of 0.93%. No recurrence was noted during follow-up, even for GISTs with piecemeal resection.
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Affiliation(s)
- Zhengting He
- Senior Department of Gastroenterology, The First Medical Center of PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
| | - Chen Du
- Senior Department of Gastroenterology, The First Medical Center of PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
| | - Bingqian Cheng
- Senior Department of Gastroenterology, The First Medical Center of PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
| | - Jiancong Feng
- Senior Department of Gastroenterology, The First Medical Center of PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
| | - Nanjun Wang
- Senior Department of Gastroenterology, The First Medical Center of PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
| | - Yan Ma
- Senior Department of Gastroenterology, The First Medical Center of PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
| | - Longsong Li
- Senior Department of Gastroenterology, The First Medical Center of PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
| | - Bo Zhang
- Senior Department of Gastroenterology, The First Medical Center of PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
| | - Hongbin Wang
- Senior Department of Gastroenterology, The First Medical Center of PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
| | - Ping Tang
- Senior Department of Gastroenterology, The First Medical Center of PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
| | - Ningli Chai
- Senior Department of Gastroenterology, The First Medical Center of PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China.
| | - Enqiang Linghu
- Senior Department of Gastroenterology, The First Medical Center of PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China.
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