Artikel
Large duodenal GIST tumor: case report of a rare entity and therapeutic consequences
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Veröffentlicht: | 23. April 2012 |
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Gliederung
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Introduction: Preoperative diagnosis of tumors of the mid and upper abdomen can usually be established with high accuracy by means of radiology studies in conjunction with serum tests. However, large intraperitoneal masses may be difficult to accurately assign to a specific organ
Materials and methods: We report on a 41 year-old male patient suffering from a large (12x10cm) right upper quadrant tumor. Preoperative CAT-scan suggested an exophytic tumor of the right hemiliver in a non-cirrhotic patient. However, preoperative serum tumor markers and liver function tests were normal. Due to the inconclusive constellation, a diagnostic laparoscopic procedure was scheduled.
Results: Single port preparation of the tumor could be completed without adding any additional trocar. The strong vascularized tumor did not arise from the liver, but infiltrated the right kidney and showed a small area of ingrowth into the duodenal serosa. Assuming a sarcoma of the right kidney, an open en-bloc resection with oncological nephrectomy was performed. On postoperative day seven, severe duodenal bleeding required an emergency relaparotomy and a full-thickness resection of the former contact area of the duodenal wall was performed. The further postoperative course was uneventful.
Histology surprisingly revealed a malignant gastrointestinal stroma tumor arising from the duodenal wall. Imatinib therapy was started and led to livethreatening angioneurotic edema with multiple intestinal fistulas. Thorough local treatment allowed recovery within 6 months.
Conclusion: Gastrointestinal stroma tumors may also occur as primary tumors of the omentum, mesentery or retroperitoneum.