A CASE OF GASTROINTESTINAL STROMAL TUMOR OF THE DUODENUM WITH DIFFICULTY IN DIAGNOSIS

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  • KOBAYASHI Taira
    Department of Surgery, Hiroshima City Medical Association-administered Aki City Hospital
  • SHIMBARA Kanae
    Department of Surgery, Hiroshima City Medical Association-administered Aki City Hospital
  • YOKOYAMA Takashi
    Department of Surgery, Hiroshima City Medical Association-administered Aki City Hospital

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  • 診断に難渋した十二指腸ＧＩＳＴの１例

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Abstract

An 88-year-old man who had been aware of an abdominal tumor since May 2001 was seen at the hospital. Abdominal echography and abdominal CT scan revealed a 6-cm sized tumor with heterogeneous internal structure and plenty with vessels, locating near the greater curvature of the stomach, on the left side of the duodenum, and in contact with the pancreas body. Abdominal magnetic resonance imaging scan demonstrated that a branch of the gastroduodenal artery fed the tumor. Since the tumor was well movable, the tumor arising from the greater omentum or stomach seemed likely. A possibility of malignancy could not be ruled out, and so laparotomy was performed. During surgery, we saw the tumor arising from the transverse part of the duodenum and partially invading the pancreas capsule. A partial resection of the duodenum and a partial pancreatectomy were carried out. Histopathologically the tumor arose from the proper muscle of the duodenum, and was positive for c-kit, CD34 and S100 protein and negative for SMA on immunostainings. The tumor was diagnosed as gastrointestinal stromal tumor (GIST) with a low grade of malignancy showing differentiation to the nervous system.

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