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.

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.