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Therapeutic Challenges in the Management of Bleeding Duodenal Gastrointestinal Stromal Tumor: a Case Report and Review of Literature

  • Mgmt. of Complex Cases in GI Oncology
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Abstract

Introduction

Duodenum is an uncommon site for the gastrointestinal stromal tumors (GISTs). Though the principles of management are the same of that elsewhere in the gastrointestinal tract, the anatomical complexity poses challenges in deciding the most appropriate treatment. A bleeding GIST further compounds the difficulty in managing such patients.

Case Report

A twenty-eight-year-old female presented with bleeding duodenal lesion secondary to mucosal ulceration. Imaging confirmed large heterogeneous lesion arising from the second part of duodenum. Surgery was planned in view of persistent blood transfusion requirement. Pancreaticoduodenectomy was done and the patient had an uneventful postoperative period.

Discussion

Review of literature of duodenal GIST especially regarding the tough decisions that have to be made in the diagnosis and management of bleeding lesions has been done.

Conclusion

The availability of various options in addressing bleeding duodenal GIST should make the surgeon choose the best modality for the patient weighing the pros and cons of each modality.

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References

  1. Beham AW, Schaefer IM, Schuler P, Cameron S, Ghadimi BM. Gastrointestinal stromal tumors. Int J Color Dis. 2012;27(6):689–700. https://doi.org/10.1007/s00384-011-1353-y.

    Article  Google Scholar 

  2. Cavallaro G, Polistena A, D'Ermo G, Pedulla G, De Toma G. Duodenal gastrointestinal stromal tumors: review on clinical and surgical aspects. Int J Surg. 2012;10(9):463–5. https://doi.org/10.1016/j.ijsu.2012.08.015.

    Article  CAS  PubMed  Google Scholar 

  3. Arvind M, Sathiamurthy N, Jin TW. Management of bleeding duodenal GIST. Int J Surg Res. 2013;2(3):16–20. https://doi.org/10.5923/j.surgery.20130203.02.

    Article  Google Scholar 

  4. Seya T, Tanaka N, Yokoi K, Shinji S, Oaki Y, Tajiri T. Life-threatening bleeding from gastrointestinal stromal tumor of the stomach. J Nippon Med Sch. 2008;75(5):306–11.

    Article  PubMed  Google Scholar 

  5. Cheng AW, Chiu PW, Chan PC, Lam SH. Endoscopic hemostasis for bleeding gastric stromal tumors by application of hemoclip. J Laparoendosc Adv Surg Tech A. 2004;14(3):169–71. https://doi.org/10.1089/1092642041255522.

    Article  PubMed  Google Scholar 

  6. Fletcher CD, Berman JJ, Corless C, Gorstein F, Lasota J, Longley BJ, et al. Diagnosis of gastrointestinal stromal tumors: a consensus approach. Hum Pathol. 2002;33(5):459–65.

    Article  PubMed  Google Scholar 

  7. Chung JC, Chu CW, Cho GS, Shin EJ, Lim CW, Kim HC, et al. Management and outcome of gastrointestinal stromal tumors of the duodenum. J Gastrointest Surg. 2010;14(5):880–3. https://doi.org/10.1007/s11605-010-1170-6.

    Article  PubMed  Google Scholar 

  8. Hoeppner J, Kulemann B, Marjanovic G, Bronsert P, Hopt UT. Limited resection for duodenal gastrointestinal stromal tumors: surgical management and clinical outcome. World J Gastrointest Surg. 2013;5(2):16–21. https://doi.org/10.4240/wjgs.v5.i2.16.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Liang X, Yu H, Zhu LH, Wang XF, Cai XJ. Gastrointestinal stromal tumors of the duodenum: surgical management and survival results. World J Gastroenterol. 2013;19(36):6000–10. https://doi.org/10.3748/wjg.v19.i36.6000.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Shen C, Chen H, Yin Y, Chen J, Han L, Zhang B, et al. Duodenal gastrointestinal stromal tumors: clinicopathological characteristics, surgery, and long-term outcome. BMC Surg. 2015;15:98. https://doi.org/10.1186/s12893-015-0084-3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Cai PQ, Lv XF, Tian L, Luo ZP, Mitteer RA Jr, Fan Y, et al. CT characterization of duodenal gastrointestinal stromal tumors. AJR Am J Roentgenol. 2015;204(5):988–93. https://doi.org/10.2214/AJR.14.12870.

    Article  PubMed  Google Scholar 

  12. Peracchi M, Gebbia C, Basilisco G, Quatrini M, Tarantino C, Vescarelli C, et al. Plasma chromogranin A in patients with autoimmune chronic atrophic gastritis, enterochromaffin-like cell lesions and gastric carcinoids. Eur J Endocrinol. 2005;152(3):443–8. https://doi.org/10.1530/eje.1.01862.

    Article  CAS  PubMed  Google Scholar 

  13. Retes FA, Martins BC, Sorbello MP, Sato CF, Kawaguti FS, Maluf-Filho F, et al. Endoscopic hemostasis of a bleeding gastric gastrointestinal stromal tumor (GIST) with endoloop placement. Arq Bras Cir Dig. 2015;28(1):89–90. https://doi.org/10.1590/S0102-67202015000100023.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Arezzo A, Verra M, Miegge A, Morino M. Loop-and-let-go technique for a bleeding, large sessile gastric gastrointestinal stromal tumor (GIST). Endoscopy. 2011;43(Suppl 2 UCTN):E18–9. https://doi.org/10.1055/s-0030-1255889.

    Article  PubMed  Google Scholar 

  15. Beddy P, McGrath A, Reynolds JV, Ryan JM. Primary embolization of a symptomatic gastrointestinal stromal tumor. J Vasc Interv Radiol. 2009;20(8):1099–101. https://doi.org/10.1016/j.jvir.2009.05.020.

    Article  PubMed  Google Scholar 

  16. Kurihara N, Kikuchi K, Tanabe M, Kumamoto Y, Tsuyuki A, Fujishiro Y, et al. Partial resection of the second portion of the duodenum for gastrointestinal stromal tumor after effective transarterial embolization. Int J Clin Oncol. 2005;10(6):433–7. https://doi.org/10.1007/s10147-005-0503-z.

    Article  PubMed  Google Scholar 

  17. Shin JH. Recent update of embolization of upper gastrointestinal tract bleeding. Korean J Radiol. 2012;13(Suppl 1):S31–9. https://doi.org/10.3348/kjr.2012.13.S1.S31.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Lamba G, Gupta R, Lee B, Ambrale S, Liu D. Current management and prognostic features for gastrointestinal stromal tumor (GIST). Exp Hematol Oncol. 2012;1(1):14. https://doi.org/10.1186/2162-3619-1-14.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Hecker A, Hecker B, Bassaly B, Hirschburger M, Schwandner T, Janssen H, et al. Dramatic regression and bleeding of a duodenal GIST during preoperative imatinib therapy: case report and review. World J Surg Oncol. 2010;8:47. https://doi.org/10.1186/1477-7819-8-47.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Tewari M, Hazrah P, Kumar V, Shukla HS. Options of restorative pancreaticoenteric anastomosis following pancreaticoduodenectomy: a review. Surg Oncol. 2010;19(1):17–26. https://doi.org/10.1016/j.suronc.2009.01.002.

    Article  PubMed  Google Scholar 

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Correspondence to Harjeet Singh.

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Krishnamurthy, G., Singh, H., Sharma, V. et al. Therapeutic Challenges in the Management of Bleeding Duodenal Gastrointestinal Stromal Tumor: a Case Report and Review of Literature. J Gastrointest Canc 50, 170–174 (2019). https://doi.org/10.1007/s12029-018-00197-3

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  • DOI: https://doi.org/10.1007/s12029-018-00197-3

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