Hepatopancreatoduodenectomy for metastatic duodenal gastrointestinal stromal tumor

BACKGROUND: Duodenal gastrointestinal stromal tumors, which are rare, comprise 3%-5% of all gastrointestinal stromai tumors. We present a case of a metastatic duodenal gastrointestinal stromal tumor that was successfully treated by simultaneous tight hemihepatectomy and pancreaticoduodenectomy. METHODS: A 50-year-old woman was admitted to our department for the treatment of a possible metastatic duodenal gastrointestinal stromal tumor (GIST). At laparotomy a large duodenal tumor was found displacing the head of the pancreas. A 3 cm in diameter lesion in the posterior aspect of segment Ⅷ of the liver was also noted. Simultaneous right hepatectomy and pancreaticoduodenectomy were performed. RESULTS: Histological examination revealed a high grade metastatic duodenal GIST strongly positive for c-kit, CD34, and vimentin. The patient had no additional therapy. A follow-up of 21 months showed that the patient is very well and there is no evidence of recurrent diseases. CONCLUSIONS: Malignant stromai tumors of the duodenum are rarely encountered. They are usually slow growing, and may be amenable to curative surgery, even after occurrence of metastases. Resection of localized liver metastasis is still advocated when feasible, since imatinib does not provide a complete or long-term response. Combined surgical resection is an efficacious treatment for patients with metastatic duodenal gastrointestinal stromal tumor.

High-frame-rate contrast-enhanced ultrasound findings of liver metastasis of duodenal gastrointestinal stromal tumor:A case report and literature review

BACKGROUND Liver metastasis of duodenal gastrointestinal stromal tumor(GIST)is rare.Most reports mainly focus on its treatment and approaches to surgical resection,while details on its contrast-enhanced ultrasound(CEUS)findings are lacking.The diagnosis and imaging modalities for this condition remain challenging.CASE SUMMARY A 53-year-old Chinese man presented with mild signs and symptoms of the digestive tract.He underwent routine examinations after GIST surgery.Magnetic resonance imaging showed a 2.3 cm hepatic space-occupying lesion.All the laboratory test results were within normal limits.For further diagnostic confirmation,we conducted high frame rate CEUS(H-CEUS)and found a malignant perfusion pattern.Heterogeneous concentric hyper-enhancement,earlier wash-in than the liver parenchyma,and two irregular vessel columns could be observed at the periphery of the lesion during the arterial phase.Ultrasound-guided puncture biopsy was used to confirm the diagnosis of the lesion as liver metastasis of duodenal GIST.Imatinib was prescribed after biopsy,and the patient’s clinical course was monitored.CONCLUSION H-CEUS is useful for detecting microcirculation differences,wash-in patterns,and vascular morphogenesis and diagnosing liver metastasis of duodenal GIST.

Investigation of the factors influencing surgical treatment of duodenal gastrointestinal stromal tumors

BACKGROUND Duodenal gastrointestinal stromal tumor(DGIST)is a rare tumor with a specific anatomic site and biological characteristics.As the incidence of lymph node metastasis is very low,the main treatment method is surgery.Two main surgical techniques(local resection and Whipple)are performed in patients with DGISTs.The critical question is which surgical technique to choose.AIM To identify factors influencing the choice of surgery for DGISTs.METHODS The clinicopathological data of patients with DGISTs who underwent surgery between January 1999 and January 2021 were analyzed.We used the Student’s ttest or Mann-Whitney U-test and theχ2 test or Fisher’s exact test to determine the differences between the two groups of patients.Furthermore,we used logistic analysis to identify the relevant factors and independent factors related to the type of surgery.The Kaplan-Meier method was used to analyze the patient’s survival information and Cox regression analysis was performed to determine prognostic risk factors.RESULTS Overall,86 patients were analyzed,including 43 men(50%)and 43 women(50%).We divided the patients into two groups based on surgical technique(local resection or Whipple surgery).There were no differences in the age,mitotic figures,and complications between the two groups;however,the tumor size,tumor location,risk grade,postoperative hospital stay,and abdominal drainage time were significantly different.Based on univariate logistic analysis,the Whipple procedure was chosen if the tumor size was≥5.0 cm,the tumor was located in the descending part of the duodenum,or the risk grade was medium or high.In our research,the five-year overall survival rate of patients was more than 90%.We also describe two DGIST patients with liver metastases at first diagnosis and analyzed their management in order to provide advice on complicated cases.CONCLUSION The Whipple procedure was performed if the primary tumor was in the descending part of the duodenum,tumor size was≥5.0 cm,or the tumor risk grade was medium or high.

Effectiveness and safety of endoscopic resection for duodenal gastrointestinal stromal tumors:A single center analysis

BACKGROUND Endoscopic resection for duodenal gastrointestinal stromal tumors(GISTs)is still considered a great challenge with a high risk of complications,including perforation,bleeding,tumor rupture,and residual tumor.AIM To assess the effectiveness and safety of endoscopic resection for duodenal GISTs.METHODS Between January 2010 and January 2022,11 patients with duodenal GISTs were treated with endoscopic resection.Data were extracted for the incidence of complete resection,bleeding,perforation,postoperative infection,recurrence,and distant metastasis.RESULTS The incidence of successful complete resection of duodenal GISTs was 100%.Three cases(27.3%)had suspected positive margins,and the other 8 cases(72.7%)had negative vertical and horizontal margins.Perforation occurred in all 11 patients.The success rate of perforation closure was 100%,while 1 patient(9.1%)had suspected delayed perforation.All bleeding during the procedure was managed by endoscopic methods.One case(9.1%)had delayed bleeding.Postoperative infection occurred in 6 patients(54.5%),including 1 who developed septic shock and 1 who developed a right iliac fossa abscess.All 11 patients recovered and were discharged.The mean hospital stay was 15.3 d.During the follow-up period(14-80 mo),duodenal stenosis occurred in 1 case(9.1%),and no local recurrence or distant metastasis were detected.CONCLUSION Endoscopic resection for duodenal GISTs appears to be an effective and safe minimally invasive treatment when performed by an experienced endoscopist.

Segmental duodenectomy for gastrointestinal stromal tumor of the duodenum

AIM: To evaluate the results of segmental duodenectomy (SD) and pancreaticoduodenectomy (PD) for duodenal gastrointestinal stromal tumor (GIST) and help clinicians with surgical management. METHODS: All patients who underwent surgery for non-metastatic GIST of the duodenum in a single institution since 2000 were prospectively followed up. Seven patients (median age 51 years, range: 41-73 years) were enrolled: five underwent SD and two underwent PD. RESULTS: All the patients had a complete resection (R0), with no postoperative morbidity and mortality. Among the SD group, GIST was classified as low risk in two patients, intermediate risk in two, and high risk in one, according to the Fletcher scale, (vs two high risk patients in the PD group). With a median followup of 41 (18-85) mo, disease-free survival (DFS) rateswere 100% after SD and 0% after PD (P < 0.05). The median DFS was 13 mo in the PD group. CONCLUSION: Whenever associated with clear surgical margins, SD is a reliable and curative option for most duodenal GISTs, and is compatible with longterm DFS.

Pancreas-preserving segmental duodenectomy for gastrointestinal stromal tumor of the duodenum and splenectomy for splenic angiosarcoma

BACKGROUND: Gastrointestinal stromal tumors are the most common mesenchymal tumors of the gastrointestinal tract and occur rarely in the duodenum. Splenic angiosarcoma is an aggressive neoplasm with an extremely poor prognosis. METHODS: We report a case of a 70-year-old man hospitalized for abdominal pain in the upper quadrants, dyspepsia and nausea, previously treated for Hodgkin lymphoma 30 years ago. Abdominal CT showed a solid nodular lesion in the third portion of the duodenum, the presence of retropancreatic, aortic and caval lymph nodes, and four nodular splenic masses. 111 In-octreotide scintigraphy revealed pathological tissue accumulation in the duodenal region, and in the retropancreatic, retroduodenal, aortic and caval lymph nodes, suggesting a nonfunctioning neuroendocrine peripancreatic tumor. RESULTS: At exploratory laparotomy, an exophytic soft tumor was found originating from the third portion of the duodenum. Pancreas-preserving duodenectomy with duodenojejunostomy, splenectomy and lymphnodectomy of retropancreatic aortic and caval lymph nodes were performed. Pathological evaluation and immunohistochemical studies showed the presence of a duodenal gastrointestinal stromal tumor with low mitotic activity and a well-differentiated angiosarcoma localized to the spleen and invading lymph nodes.CONCLUSIONS: We speculated that the angiosarcoma and duodenal gastrointestinal stromal tumors of this patient were due to the treatment of Hodgkin lymphoma with radiotherapy 30 years ago. Pancreas-preserving segmental duodenectomy can be used to treat non-malignant neoplasms of the duodenum and avoid extensive surgery. Splenectomy is the treatment of choice for localized angiosarcomas but a strict follow-up is mandatory because of the possibility of recurrence.

Efficacy of imatinib dose escalation in Chinese gastrointestinal stromal tumor patients

AIM： To investigate the efficacy and safety of imatinib dose escalation in Chinese patients with advanced gas- trointestinal stromal tumor （GIST）.

Duodenal giant stromal tumor combined with ectopic varicose hemorrhage:A case report

BACKGROUND Gastrointestinal stromal tumors(GISTs)are mesenchymal tissue tumors originating from Cajal cells,presenting diverse clinical manifestations due to the different sizes,locations,and growth patterns of the lesions.Duodenum is an uncommon site of GISTs,more with gastrointestinal obstruction and bleeding as the first symptoms.Ectopic duodenal varix,as a rare varix occurring outside the gastroesophageal region,is the main type of heterotopic varices and an unusual cause of gas-trointestinal hemorrhage.The etiology is mainly seen in liver cirrhosis,portal hypertension,vasculitis,portal vein embolism and obstruction caused by various factors.Reports of duodenal stromal tumor combined with ectopic variceal hemorrhage are rarely seen;however,when it occurs,the situation can sometimes be urgent and life-threatening,especially when traditional endoscopy and imaging fail to detect the lesion timely.CASE SUMMARY We report a 52-year-old female patient who had no obvious inducement to develop black stool.Gastroscopy in a local hospital revealed that the duodenal horizontal ectopic varices were ruptured and bleeding.After metal clamping hemostasis,she still had gastrointestinal bleeding and was transferred to our hospital.Gastroscopy showed that active bleeding was still seen in the horizontal part of duodenum,and suspicious submucosal eminence was seen in the bleeding part.Abdominal computed tomography showed a huge stromal tumor of duodenum,specimens were pathologically confirmed after surgery.After a 3-mo follow-up,no gastrointestinal hemorrhage and complications occurred.CONCLUSION Ectopic variceal hemorrhage is rare but sometimes fatal.It may be combined with stromal tumor,which can be diagnosed by multiple methods.Endoscopic and surgical treatment are effective.

十二指肠间质瘤预后危险因素分析及不同手术治疗方式的远期预后比较

目的探讨影响十二指肠间质瘤(duodenal GIST)预后的相关因素及不同手术方式对其远期预后的影响。方法从SEER数据库中提取2000年-2019年诊断为duodenal GIST的患者资料,对其进行回顾性分析。采用多因素Cox比例风险模型,分析影响患者预后的危险因素,使用Kaplan-Meier法,分析内镜治疗组和外科手术组远期预后的差异。结果共纳入473例患者,中位年龄59岁,肿瘤中位直径50 mm。65.1%的患者初诊时为局限期,共390例(82.4%)患者接受手术治疗。其中,内镜治疗46例(11.8%),外科手术344例(88.2%)。多因素Cox分析结果显示,年龄>73岁、男性、肿瘤直径>67 mm和发生远处转移,是影响duodenal GIST患者肿瘤特异性生存期(CSS)的独立危险因素(P<0.05),接受内镜或外科手术治疗是CSS的独立保护因素(P<0.05)。内镜治疗和外科手术治疗duodenal GIST患者的长期生存率相似(5年CSS为84.8%和88.2%,10年CSS为80.1%和80.6%,15年CSS为71.2%和72.3%,P>0.05)。结论年龄>73岁、男性、肿瘤直径>67 mm和肿瘤出现远处转移,是影响duodenal GIST预后的独立危险因素,内镜治疗和外科手术治疗duodenal GIST的长期生存率无明显差异。

十二指肠间质瘤临床分析30例

目的：分析十二指肠间质瘤的临床特征并探讨其外科治疗及预后因素．方法：回顾性分析我科1993-2006年30例十二指肠间质瘤的临床资料．运用SPSS统计软件进行生存分析,采用Kaplan Meier法和log-rank检验进行单因素生存预后分析,多因素分析采用Cox模型．结果：十二指肠间质瘤最常见症状为右上腹隐痛不适、消化道出血,发病部位以十二指肠降段多见．全组1,3,5 a生存率分别为92．95％,84．87％,69．15％．单因素分析Fletcher风险分级(X^2=10．570,P=0．0143),肿瘤大小(X^2=7．883,P=0．0485),核分裂象(＞5,≤5：X^2=14．155,P=0．0002),是否伴发远处转移(X^2=22．519,P=0．0000)具有显著性,是否行根治术(X^2= 17．8180,P=0．0000)比较差异具有显著性,多因素分析表明核分裂象是独立的预后影响因素．结论：十二指肠间质瘤宜采用局部切除为主的根治性手术,本组病例核分裂象是判断预后的独立因素．

十二指肠胃肠道间质瘤的外科治疗及预后分析

目的:探讨十二指肠胃肠道间质瘤(gastrointesinal stromal tumor,GIST)的诊断、外科治疗和预后。方法:回顾性分析2006年3月至2012年10月收治11例十二指肠GIST病人的临床资料,并与同期治疗胃和小肠GIST病人的临床特征及预后进行比较。结果:11例病人CT的检出率为100%,内镜病理检出率为25%。均行手术切除治疗。2例行胰十二指肠切除术,7例行肿瘤局部切除术,2例行十二指肠节段切除术;围手术期无病人死亡,2例分别于术后10个月和2年出现复发、转移。十二指肠GIST病人的1年和2年无复发生存率为91%(10/11)和82%(9/11),预后略差于胃和小肠GIST。结论:十二指肠GIST的术前诊断应综合应用内镜和影像学技术,以提高其确诊率。治疗首选手术切除,根据肿瘤位置和大小合理选择手术方法。低危病人手术后基本可以治愈,中、高危病人术后应配合伊马替尼辅助治疗。该病的预后略逊于胃和小肠GIST。

十二指肠胃肠道间质瘤外科治疗与预后因素分析

目的:探讨十二指肠胃肠道间质瘤的诊断、手术方式和预后因素。方法:回顾性分析18例经病理证实的十二指肠胃肠道间质瘤的临床资料,包括临床症状、诊断方法、病灶部位、手术方式、病理结果和预后等。结果:18例均行手术切除治疗,11例行十二指肠肿瘤局部切除术,3例行胰十二指肠切除术(Child术),2例行肠段切除术,2例行胃大部切除术;经24个月到7年随访,5例死于转移和复发,其余13例生存,生活质量良好。随访资料显示性别、年龄、肿瘤大小和手术方法与病人的复发和死亡率无关;导致病人复发和死亡唯一危险因素是肿瘤的危险度分级。结论:上消化道出血是十二指肠胃肠道间质瘤最为常见的症状。多因素分析显示,高危分级是十二指肠胃肠道间质瘤的独立预后因素;根据肿瘤部位和大小来决定手术方式。

十二指肠间质瘤的多层螺旋CT表现及与病理对照

目的:探讨多层螺旋CT表现对十二指肠间质瘤的诊断价值。方法:回顾性分析经手术病理证实的19例十二指肠间质瘤的螺旋CT表现及其三维重组图像,并与病理结果对照。结果:本组19例间质瘤中,良性4例,交界性3例,恶性12例;5例侵犯周围器官。十二指肠间质瘤的CT表现为类圆形、分叶状或形态不规则的软组织肿物,以向肠腔外生长为主(n=14),肿块内密度均匀或呈混杂密度影。增强扫描显示,肿块呈明显均匀强化(n=2)或呈中央不规则无强化区而周边强化较明显(n=16)。结论:十二指肠间质瘤的CT表现有一定特征性,多层螺旋CT表现有助于定位和定性诊断。

十二指肠间质瘤的研究进展

十二指肠间质瘤是常见的十二指肠原发肿瘤.目前的研究多将十二指肠间质瘤视为消化系间质瘤的一部分进行.但因为十二指肠有着特殊的位置和重要脏器毗邻,故其诊断和治疗有着一定的特殊性.本文着重介绍了十二指肠间质瘤诊断以及治疗上的特殊之处,特别是根据肿瘤的情况选择合适的手术方式,并联合有效的靶向治疗以取得良好的评价,对临床工作具有指导意义.

十二指肠间质瘤临床诊治分析

目的：探讨十二指肠间质瘤的临床特点、诊疗方法。方法：14例十二指肠GIST患者,男性8例,女性6例;年龄33~72岁,平均年龄55.3岁。14例患者中8例有反复柏油便,6例有餐后饱胀感、反酸嗳气,6例有腹痛、上腹部不适,4例有腹部包块。病变部位：降部12例,球部2例。对14例患者的临床资料进行回顾性分析。结果：14例十二指肠GIST患者以消化道出血、上腹部疼痛不适、腹部包块为常见症状,发病部位以降部多见,CT及胃镜检出率均为100%,均行手术治疗。肿瘤局部切除术8例,十二指肠节段切除术4例,胰十二指肠切除术2例。围手术期无患者死亡。10例患者术后服用格列卫治疗。14例患者随访25月~10年,1例于术后11个月复发并出现腹腔转移,并于术后25个月死亡,13例患者随访期内均未发现复发,生活质量佳。结论：十二指肠GIST缺乏特异性的临床表现,综合应用内镜及影像学检查有助于提高术前检出率,确诊主要依靠病理组织学检查及免疫组化检测。治疗方法为手术治疗与分子靶向治疗结合的个性化综合治疗。

十二指肠间质瘤的临床病理学特点和外科治疗进展

十二指肠胃肠道间质瘤(gastrointestinal stromal tumors,GISTs)是起源于消化道卡哈尔间质细胞(interstitial cells of Cajal,ICCs)一种少见的亚群。虽然影像学、内镜技术和病理免疫组织化学已经取得显著的进步,但术前仍很难达到完全确诊。内镜超声下细针穿刺活检被认为是诊断的金标准,具有很高的敏感性和特异性,GISTs诊断率高达80%。对于非转移性原发的十二指肠GISTs,获得显微镜下阴性切缘的手术切除仍是潜在治愈性治疗手段,但由于胰十二指肠区域的复杂解剖,最佳治疗策略仍具有挑战性。复发风险和无瘤生存时间取决于肿瘤大小、核分裂数和美国国立卫生研究院(national institutes of health,NIH)复发风险分层,而不是手术方式。伊马替尼作为新辅助治疗,对治疗复发和转移性GISTs起到重要作用。对十二指肠GISTs的病理生理和治疗方式的全面深入研究将有利于发现更新且更有效的治疗方式。

伴十二指肠球部溃疡出血的小肠间质瘤1例及临床分析

本文报道了1例临床工作中遇到的空肠间质瘤合并大出血的病例,起病危急,主要表现为黑便伴头晕、心悸,患者入院后出现失血性休克,初始确诊疾病为常规的消化性溃疡出血。但治疗过程中随着疾病的演变,患者仍有活动性出血,后通过腹腔动脉CTA检查,最终确诊为空肠间质瘤同时合并十二指肠球部溃疡并出血。该病例患者经内科、介入科及普外科多科协作治疗,最终痊愈出院。本病例虽然入院时患者的临床症状误导了临床医生对疾病的判断,但本研究着重从消化道出血的鉴别诊断思路入手,对胃肠间质瘤加以分析与讨论,以期为消化科临床医师在日后工作中遇到类似患者提供相关参考。

十二指肠间质瘤的危险因素

背景：由于十二指肠间质瘤的发病率较低，所以其危险因素尚不可知。目的：探索十二指肠间质瘤的临床病理特征及手术治疗方法。方法：回顾性分析青岛大学附属医院2005年4月至2014年11月收治的28例十二指肠间质瘤资料。结果与结论：十二指肠问质瘤患者的1，3，5年生存率分别为92％，80％和72％。肿瘤大小、核分裂数与肿瘤破裂是独立的预后因素。根治性切除是最有效的治疗方法。伊马替尼可有效改善高复发风险患者的预后。

十二指肠间质瘤的螺旋CT表现

目的:探讨十二指肠间质瘤的CT表现特征。材料和方法:回顾性分析经手术和病理证实的17例十二指肠间质瘤患者的CT影像学资料。结果:肿瘤位于十二指肠降部7例,水平部5例,升部5例。17例中恶性9例,伴转移2例,低度恶性6例,良性2例。17例中腔外生长14例,腔内外生长3例,肿块最大径3～20cm,其中≥5cm者16例,<5cm者1例。肿物密度不均匀伴中心坏死13例,伴破溃5例,分叶状10例,增强动脉期周边强化15例,16例肿块边缘可见尖角征。结论:十二指肠间质瘤具有相对特征性的CT表现:腔外生长不均质肿块、动脉期周边强化、尖角征。掌握这些CT表现有利于提高诊断准确性。

1例老年十二指肠间质瘤破裂出血患者的诊治

十二指肠间质瘤在胃肠道间质瘤中相对少见,但由于其特殊、复杂的生理位置及解剖结构,给治疗带来了挑战。十二指肠间质瘤破裂出血进一步增加了治疗难度。本文报告了1例老年男性十二指肠间质瘤患者,主要表现为心悸、乏力伴黑便,影像学检查病变局部与胰头钩突、十二指肠降部、水平部分边界欠清,病灶穿刺活检提示十二指肠上皮细胞样肿瘤。入院后患者出血征象明显,行动脉血管栓塞及肿瘤切除治疗。病情稳定后,在全麻下行十二指肠间质瘤切除术,后经采取积极治疗,患者病情好转出院。