Duodenal GIST

Case contributed by Dr Tamer O. Abdo

Presentation

Non-specific abdominal pain

Patient Data

Age: 60
Gender: Male
CT

Abdomen CT

There is a large bilobed solid and cystic mass lesion measuring about 16 x 12.5 x 12 cm which appears to be arising from the inferior aspect of the pancreatic head/duodenum. The mass is displacing the 2nd part of duodenum. The mentioned mass enhances peripherally and has enhancing septae. No calcifications seen in the lesion.

No dilatation of the pancreatic duct or CBD. The rest of the pancreas appears normal.

Differential diagnosis include large cystic pancreatic tumor like cystadenoma/cystadenocarcinoma, GIST and lieomyoma/leiomyosarcoma. 

Mild ascites with high density is seen mainly in th pelvis.

No enlarged lymph nodes.

CT

Follow up CT after an 8 week course of Imatinib

There is a significant reduction in the size and enhancement of the previously described mixed solid and cystic lesion arising from the duodenum wall and inferior surface of the pancreatic head, now measuring about 10 x 6.2 x 5.3 cm.

Case Discussion

GISTs in the duodenum are rare (less than 5%). Primary duodenal GISTs are generally large, well-defined, heterogeneously enhancing, hypervascular masses with a prominent mixed growth pattern on CT. Ulceration and gas are relatively common features.

Surgical resection is the primary mode of treatment for GISTs. Up to 50% of all GISTs will have evidence of metastatic disease at the time of presentation.

Adjuvant chemotherapy with Imatinib is effective in the majority of cases and has had a dramatic impact on prognosis, as with this case. 

PlayAdd to Share

Case information

rID: 70178
Published: 7th Aug 2019
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included
Institution: Ibn Al Haitham hospital

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.