C34 Introduction: Gastrointestinal stromal tumors (GIST) involving the duodenum are rarely reported. The present surgical opinions is divided regarding the optimal method for the resection of duodenal GIST with some investigators supporting the selective use of limited resection (LR) versus others who prefer pancreaticoduodenectomy (PD).  Methods: A retrospective review of 22 patients who underwent surgery for a GIST or suspected GIST involving the duodenum at a single institution was performed. Comparison was made between GIST versus other non-GIST benign submucosal tumors and between results of LR versus PD.  Results: There were 15 GISTs, 1 leiomyosarcoma and 6 other non-GIST benign submucosal tumors. 20 patients underwent curative resection including 7 PDs and 13 LRs. Surgery with palliative intent was performed in 2 patients with advanced duodenal leiomyosarcoma and GIST respectively. All 7 PDs were performed for GIST and all 6 patients with benign non-GIST submucosal tumors underwent LR. Comparison between the clinicopathological features of GIST and other benign tumors demonstrated that patient demographics and clinical presentation were similar and that size was the only statistically significant distinguishing factor. Comparison between LR versus PD demonstrated that LR was associated with a significantly shorter operation time but both had similar morbidity and mortality rates. Seven patients with GIST underwent LR and 7 underwent PD. The median follow-up of the 14 patients was 42 (range, 2-174) months and all were alive at follow-up. The long-term outcomes of patients who underwent LR versus PD were similar in terms of disease-specific specific survival and recurrence rates. Two patients (1 moderate risk and 1 high risk GIST) who underwent PD and 1 patient (high risk GIST) who underwent LR developed recurrences and all 3 recurrences occurred at distant sites.  Conclusion: Benign non-GIST submucosal tumors should always be considered in the differential diagnosis of small duodenal submucosal tumors. LR is a viable treatment option in patients with suspected GIST involving the duodenum provided that complete resection with clear margins can be obtained. PD should be reserved for patients where LR is not technically feasible.

Outcome after surgical treatment of suspected gastrointestinal stromal tumors involving the duodenum: Is limited resection appropriate?

An extramural gastrointestinal stromal tumor of the duodenum mimicking a pancreatic head tumor

Introduction: Duodenal neoplasms are relatively rare entity, most often being cases of duodenal invasion by malignant masses developed in the duodenopancreatic region. The malignant infiltration of duodenum can be made either by a primary malignant duodenal tumor, either by invasion of a neighborhood malignancies, the most common being pancreatic cancer. The differentiation between these two malignant entities is absolutely necessary for the type of treatment chosen. Materials and methods: The paper comprises a retrospective study, which includes 147 patients admitted and treated in a period of 7 years, being analyzed the images and the examinations results performed during 2009-2015, which were confronted with surgery protocols, where applicable, or endoscopic explorations and histological examination results. Results: In the study group, 25 had been diagnosed with primary duodenal adenocarcinomas and the rest were pancreatic adenocarcinomas which invaded the duodenum. In terms of radioimaging , were analyzed the localization of tumors on the duodenal segment, the presence and the characteristics of lacunas and stenoses, the dimension of duodenal wall infiltrated by the tumor, and also the modifications of bile ducts. Conclusions: If endoscopy cannot be performed, radio-imaging exams remain the only methods that can guide the starting point of a malignant tumor in duodenopancreatic region. It is important to know whether the tumor has duodenal or pancreatic origin for establish therapeutic strategy, the survival rate being different.

/pdf/malignant-duodenal-lesion-duodenal-tumor-vs-pancreatic-tumor-1xqrmvuh4q.pdf

Malignant Duodenal Lesion - Duodenal Tumor Vs Pancreatic Tumor - Semiological Radioimaging Characteristics

Duodenal gastrointestinal stromal tumours (D-GISTs) are a rare disease. It may arise commonly from the second or third part of the duodenum and can be erroneously diagnosed as a pancreatic head tumour due to proximity and morphology on imaging studies. We present a case of a 60-year-old woman who presented with abdominal pain and was diagnosed as a case of pancreatic neuroendocrine tumour on radiologic imaging and granulomatous lesion on aspiration cytology. A ~5×3 cm mass was noted in the pancreatic head on laparotomy, and pancreatoduodenectomy was performed. Histopathology reported an exophytic GIST arising from the second part of the duodenum. Hence, D-GIST can invade the pancreas and mimic pancreatic head tumours; therefore, these tumours should be kept in the differential diagnosis of an atypical pancreatic head mass.

Duodenal gastrointestinal stromal tumour imitating as pancreatic head tumour

Background Gastrointestinal stromal tumor (GIST) of the ampulla of Vater is a rare occurrence. To the best of our knowledge, there has been no published review on this rare tumor in the English literature so far. Summary In this review, we will discuss all the reported details of the published cases, including demography, clinical presentation, imaging, gross pathology and histopathology, immunohistochemical findings, treatment modalities, and outcome of cases with the diagnosis GIST from the ampulla of Vater in the last 20 years. Key Message Twenty-five cases of GIST in the ampulla of Vater have been reported in the last 20 years in the English literature. GIST in the ampulla of Vater are usually small tumors (<5 cm) in middle-age patients. The majority of the patients present with lower GI bleeding and abdominal pain. Imaging findings are not characteristic, and most of the patients without biopsy and with no histologic diagnosis were operated with the primary impression of adenocarcinoma, neuroendocrine tumor, and GIST. Perioperative tissue biopsy has been accurate in <70% of the cases. The majority of the reported cases of GISTs in the ampulla of Vater have been low risk with spindle-cell morphology, low mitotic figures, and minimal atypia; reactive for C-KIT and DOG-1; and nonreactive for SMA, desmin, and S100. In the majority of the cases, duodenectomy with or without Whipple's operation has been performed, and most of the cases showed good prognosis.

/pdf/gastrointestinal-stromal-tumor-of-the-ampulla-of-vater-a-1y8i2o0aqb.pdf

Gastrointestinal Stromal Tumor of the Ampulla of Vater: A Narrative Review.

Backround
Duodenal gastrointestinal stromal tumors are rare tumors. When these tumors arise from the second part of the duodenum they can easily be misdiagnosed as a pancreatic head cancer.

A duodenal stromal tumor mimicking a pancreatic head tumor: one case report and literature review

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A duodenal stromal tumor mimicking a pancreatic head tumor: one case report and literature review