Gastrointestinal stromal tumour - duodenal

Case contributed by A.Prof Frank Gaillard

Presentation

Abdominal pain and distension.

Patient Data

Age: 80 years
Gender: Male
Modality: X-ray

Multiple air fluid levels are present. A soft tissue mass appear present in the right upper quadrant with central air attenuation. 

CT obtained soon after. Pain resolved.

Modality: CT

A large lobulated irregularsoft tissue mass is situated in the right half of the abdomen. It appears toarise from the junction of second and third parts of the duodenum and tocontain a cavity partially filled with contrast material and air. Itmeasures 11.7 x 6.9 x 9 cm which is significantly larger than at the time ofthe previous study where it was reported as measuring 3 x 4 x 4 centimetres.

No focal lesions are seen in the liver, spleen, pancreas or adrenals. A 6cm cyst arises from the mid pole of the right kidney. The kidneys areotherwise normal in appearance. There is no retroperitoneal or pelvic lymphnode enlargement & no free fluid. Incidental findings of a small paraumbilical hernia and a small hiatus hernia are noted. No focal bonylesions. 

Patient went on to have a biopsy. 

MICROSCOPIC DESCRIPTION

The sections show fragments of a tumour comprising spindle cells with  plump, frequently cigar-shaped, nuclei, arranged in sweeping fascicles.  There is moderate nuclear pleomorphism but only 1 mitosis per 50 high power fields.  There are areas of haemorrhage within the tissue fragments (which may represent surgical artifact) and one fragment shows a single small focus of necrosis.  The lesion contains a light, diffuse infiltrate of lymphocytes and plasma cells and in some areas there are a few neutrophils. Immunoperoxidase stains show that the tumour cells are positive for smooth muscle actin and negative for S-100 and c-Kit +ve. 

FINAL DIAGNOSIS

Gastrointestinal stromal tumour of uncertain malignant potential showing smooth muscle differentiation.  

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Case Information

rID: 18304
Case created: 28th Jun 2012
Last edited: 28th Sep 2016
Inclusion in quiz mode: Included

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