Duodenal Gastrointestinal Stromal Tumors Research Articles

Feasibility and efficacy of minimally invasive limited resection for primary duodenal gastrointestinal stromal tumors: a retrospective cohort study

BackgroundThe primary duodenal gastrointestinal stromal tumor (GIST) is a rare type of gastrointestinal tract tumor. Limited resection (LR) has been increasingly performed for duodenal GIST. However, only a few studies reported minimally invasive limited resection (MI-LR) for primary duodenal GIST.MethodsThe clinical data of 33 patients with primary duodenal GIST from December 2014 to February 2024 were retrospectively analyzed including 23 who received MI-LR and 10 who received laparoscopic or robotic pancreaticoduodenectomy (LPD/RPD).ResultsA total of 33 patients with primary duodenal GIST were enrolled and retrospectively reviewed. Patients received MI-LR exhibited less OT (280 vs. 388.5min, P=0.004), EBL (100 vs. 450ml, P<0.001), and lower morbidity of postoperative complications (52.2% vs. 100%, P=0.013) than LPD/RPD. Patients received LPD/RPD burdened more aggressive tumors with larger size (P=0.047), higher classification (P<0.001), and more mitotic count/50 HPF(P=0.005) compared with patients received MI-LR. The oncological outcomes were similar in MI-LR group and LPD/RPD group.All the patients underwent MI-LR with no conversion, including 12 cases of LLR and 11 cases of RLR. All of the clinicopathological data of the patients were similar in both groups. The median OT was 280(210-480) min and 257(180-450) min, and the median EBL was 100(20-1000) mL and 100(20-200) mL in the LLR and the RLR group separately. The postoperative complications mainly included DGE (LLR 4 cases, 33.4% and RLR 4 cases, 36.4%), intestinal fistula (LLR 2 cases, 16.7%, and RLR 0 case), gastrointestinal hemorrhage (LLR 0 case and RLR 1 case, 9.1%), and intra-abdominal infection (LLR 3 cases, 25.0% and RLR 1 case, 9.1%). The median postoperative length of hospitalization was 19.5(7-46) days in the LLR group and 19(9-38) days in the RLR group. No anastomotic stenosis, local recurrence or distant metastasis was observed during the follow-up period in the two groups.ConclusionsMinimally invasive limited resection is an optional treatment for primary duodenal GIST with satisfactory short-term and long-term oncological outcomes.

NTRK2 expression in gastrointestinal stromal tumors with a special emphasis on the clinicopathological and prognostic impacts

Gastrointestinal stromal tumors (GISTs) are typically characterized by activating mutations of the KIT proto-oncogene receptor tyrosine kinase (KIT) or platelet-derived growth factor receptor alpha (PDGFRA). Recently, the neurotrophic tyrosine receptor kinase (NTRK) fusion was reported in a small subset of wild-type GIST. We examined trk IHC and NTRK gene expressions in GIST. Pan-trk immunohistochemistry (IHC) was positive in 25 (all 16 duodenal and 9 out of 16 small intestinal GISTs) of 139 cases, and all pan-trk positive cases showed diffuse and strong expression of c-kit. Interestingly, all of these cases showed only trkB but not trkA/trkC expression. Cap analysis of gene expression (CAGE) analysis identified increased number of genes whose promoters were activated in pan-trk/trkB positive GISTs. Imbalanced expression of NTRK2, which suggests the presence of NTRK2 fusion, was not observed in any of trkB positive GISTs, despite higher mRNA expression. TrkB expression was found in duodenal GISTs and more than half of small intestinal GISTs, and this subset of cases showed poor prognosis. However, there was not clear difference in clinical outcomes according to the trkB expression status in small intestinal GISTs. These findings may provide a possible hypothesis for trkB overexpression contributing to the tumorigenesis and aggressive clinical outcome in GISTs of duodenal origin.

A Rare Case of Epithelioid Variant of Duodenal Gastrointestinal Tumour

Gastrointestinal stromal tumours (GISTs) are uncommon mesenchymal neoplasms of the digestive tract that develop from pluripotent mesenchymal stem cells. GISTs develop from interstitial cells of Cajal or their precursors that are distributed throughout the muscular wall of the gastrointestinal tract.&#x0D; Rare mesenchymal neoplasms of the gastrointestinal tract called gastrointestinal stromal tumours (GISTs) are derived from pluripotent mesenchymal stem cells. The interstitial cells of Cajal or their progenitors, which are dispersed throughout the muscular wall of the gastrointestinal system, give rise to gastrointestinal stromal tumours (GISTs). At a median age of 55–60 years old, they have an incidence of 10–20/million each year.[1-4] They develop mostly in the stomach (60%) and small intestine (35%) before developing in the rectum, oesophagus, omentum, and mesentery more than 5%. [2] Only less than 5% of GISTs are duodenal.[5] The majority of cases are sporadic, however 5% involve a family condition, such as neurofibromatosis type 1 or the Carney triad.[2] As a result of blockage, anaemia, or gastrointestinal bleeding from a core ulceration, they typically manifest with abdominal discomfort. The discovery of small duodenal GISTs during gastroscopy is possible.&#x0D; Within the GIST category, the epithelioid variant represents a distinct subtype that is less common than other variants, such as spindle cell or mixed cell types. The overall prevalence of epithelioid GISTs is relatively low compared to other subtypes. Large extragastric components may extend intraluminally or to the serosal side in larger tumours. GISTs have non-specific abdominal pain and distention as their clinical signs and symptoms; as a result, diagnosis and treatment are frequently delayed, which result in therapeutic failures and high morbidity and fatality rates. GISTs can exhibit a variety of histological subtypes under a microscope, including the spindle cell type (70%) and the epithelioid type (20–25%), as well as the combined spindle cell and epithelioid type. [6] The histopathological features of epithelioid GISTs have been extensively studied in the literature. One study by Pai et al. (2016) found that epithelioid GISTs had higher cellularity, higher mitotic counts, and more prominent nucleoli than other GIST subtypes. [7] Cytologically, the features of duodenal GIST resemble those of adenocarcinoma. Epithelioid Duodenal GIST must be differentiated from adenocarcinoma.&#x0D; We are reporting the case of a 68-year-old female who complained of pain abdomen, and constipation since 1 year. Pain was associated with nausea, vomiting, not able to digest food solid&gt;liquid and USG guided FNAC was advised. Cytological features confirmed the diagnosis of epithelioid variant of duodenal GIST.

PATHOLOGICAL HUMERAL FRACTURE FROM BONE METASTASIS OF A GASTROINTESTINAL STROMAL TUMOR: FIRST REPORTED CASE

Background: Gastrointestinal stromal tumor (GIST) is the most prevalent mesenchymal tumor of the GI tract. Metastases commonly occur in the liver and peritoneum, with very rare reported cases of bone metastases, hence, no therapeutic standard has been established for the management of bone metastases. Modern targeted therapy has improved patient survival, and although there are only a small number of reported GIST bone metastases, the incidence will likely continue to increase. Further understanding of GIST bone metastases is required for the implementation of an accurate and effective treatment plan. Case presentation: We report a 56-year-old patient who has a history of bleeding duodenal GIST resected with a Whipple operation. Post-operatively, Imatinib was started, but she developed liver metastasis 6 years later, requiring segmentectomy. She reported pain over the left humerus 2.5 years later and sustained a trivial injury to the left arm, resulting in a distal humerus shaft spiral fracture associated with a radial nerve palsy (Holstein-Lewis injury). Images showed a lytic lesion with cortical erosion and soft tissue extension at the fracture site. Biopsy confirmed GIST bone metastases. She underwent an open reduction and internal fixation with plating and curettage of the lytic lesion and made a good functional recovery afterward. Conclusion: This is the first reported case of a GIST bone metastases pathological Holstein–Lewis fracture. It highlights the potential for bone metastasis to present a long time after the diagnosis of a GIST. Although bone metastases are rare, they are now increasing due to the prolonged survival of patients and the introduction of targeted therapy. It is important to conduct long-term surveillance in specific patient demographics and future studies should be carried out to facilitate the development of a surveillance protocol in patients with GIST.

Survival outcome of local versus radical resection for jejunoileal gastrointestinal stromal tumors: a propensity score-matched population-based analysis

PurposeSurvival after local resection (LR) versus radical resection (RR) has been revealed comparable for patients with rectal and duodenal gastrointestinal stromal tumors (GISTs), but is unknown for jejunoileal (JI) GISTs. This study aimed to compare the long-term survival between patients with JI GISTs who underwent LR and RR, and to find out the prognostic factors for JI GISTs.MethodsPatients diagnosed with JI GISTs in 1975–2019 were identified from Surveillance, Epidemiology, and End Results (SEER) database and grouped according to surgical modality. Propensity score matching (PSM) was performed to balance the LR and RR groups. Overall survival (OS) and disease-specific survival (DSS) were compared in the full and matched cohorts using Kaplan–Meier (KM) analysis. Subgroup sensitivity analyses were also performed. Risk factors associated with DSS were analyzed in multivariate Cox analysis following model selection.Results1107 patients diagnosed with JI GISTs were included in the study cohort. After PSM, OS and DSS were comparable in LR and RR groups. Consistently, the two groups had similar DSS in all subgroup analyses. Moreover, multivariate Cox analysis identified lymphadenectomy, older age, larger tumor size, distant metastasis, high and unknown mitotic rate, but not LR, as independent prognostic risk factors for JI GISTs.ConclusionsWe conducted the first population-based comparison between the effect of different surgical modes on survival for patients with JI GISTs. LR can be carried out safely without compromising oncological outcome, and should be considered as a treatment option in selected patients with JI GISTs.

Duodenal neuroendocrine neoplasms on enhanced CT: establishing a diagnostic model with duodenal gastrointestinal stromal tumors in the non-ampullary area and analyzing the value of predicting prognosis

ObjectiveTo identify CT features and establish a diagnostic model for distinguishing non-ampullary duodenal neuroendocrine neoplasms (dNENs) from non-ampullary duodenal gastrointestinal stromal tumors (dGISTs) and to analyze overall survival outcomes of all dNENs patients.Materials and methodsThis retrospective study included 98 patients with pathologically confirmed dNENs (n = 44) and dGISTs (n = 54). Clinical data and CT characteristics were collected. Univariate analyses and binary logistic regression analyses were performed to identify independent factors and establish a diagnostic model between non-ampullary dNENs (n = 22) and dGISTs (n = 54). The ROC curve was created to determine diagnostic ability. Cox proportional hazards models were created and Kaplan–Meier survival analyses were performed for survival analysis of dNENs (n = 44).ResultsThree CT features were identified as independent predictors of non-ampullary dNENs, including intraluminal growth pattern (OR 0.450; 95% CI 0.206–0.983), absence of intratumoral vessels (OR 0.207; 95% CI 0.053–0.807) and unenhanced lesion > 40.76 HU (OR 5.720; 95% CI 1.575–20.774). The AUC was 0.866 (95% CI 0.765–0.968), with a sensitivity of 90.91% (95% CI 70.8–98.9%), specificity of 77.78% (95% CI 64.4–88.0%), and total accuracy rate of 81.58%. Lymph node metastases (HR: 21.60), obstructive biliary and/or pancreatic duct dilation (HR: 5.82) and portal lesion enhancement ≤ 99.79 HU (HR: 3.02) were independent prognostic factors related to poor outcomes.ConclusionWe established a diagnostic model to differentiate non-ampullary dNENs from dGISTs. Besides, we found that imaging features on enhanced CT can predict OS of patients with dNENs.

Giant gastrointestinal stromal tumor of the duodenum mimicking a pancreas head tumor: a case report

Duodenal gastrointestinal stromal tumor (GIST) is rarely observed in the gastrointestinal system. It can be confused with pancreas pathologies as it shows an extramural growth pattern. The case is here presented of a 65-year-old male who presented with the complaints of abdominal pain, nausea and vomiting. On contrast abdominal tomography, a centrally hypodense, necrotic mass, 140×115×100 mm in size, was observed in the pancreas head. With a preliminary diagnosis of neuroendocrine tumour/serous cystic neoplasia, a Whipple + partial vena cava resection + primary repair operation was performed. The pathology was reported as duodenal GIST. The patient was discharged with medication and referred to the oncology clinic.

Defect closure with endoscopic suturing improves endoscopic full-thickness resection of duodenal gastrointestinal stromal tumors.

Defect closure with endoscopic suturing improves endoscopic full-thickness resection of duodenal gastrointestinal stromal tumors.

Gastroduodenal gastrointestinal stromal tumour: a case series and review of literature

Gastrointestinal stromal tumour (GIST) is the most common non-epithelial mesenchymal tumour and comprises 0.1-3% of all GI tract tumours. They express tyrosine kinase and are potentially malignant. Therefore, early diagnosis and surgical resection is the key for good outcome. This is a retrospective analysis of medical records of five patients of gastroduodenal GIST who were managed in the department of surgery between 2014 and 2015. Demographic profile, clinical presentation, laboratory parameters, diagnostic imaging, treatment details, histopathology and long-term outcome was analysed. Patients were followed up regularly in surgery outpatient clinic. Last follow up was in December 2022. All were female; three of them presented with melena and two with lump abdomen. Patients with gastric GIST underwent sleeve resection in two and antrectomy in one patient. Patient with duodenal GIST underwent excision of tumour with primary repair of duodenum. Fifth patient had metastatic duodenal GIST; Imatinib was started in view of irresectable disease at presentation. However, there was tumour progression and she expired seven months after treatment initiation with Imatinib. Histopathology revealed low grade GIST in two, intermediate grade in one and malignant in one. Patient with malignant GIST received Imatinib for 2 years. All four patients are well on follow up with no sign of local and distant recurrence.

Large Locally Advanced Duodenal Gastrointestinal Stromal Tumor (GIST) Successfully Managed by Combined Use of Neoadjuvant Imatinib and Surgical Resection

Duodenal GISTs are rare mesenchymal neoplasms of the gastrointestinal tract. The usual presentation is gastrointestinal bleeding or abdominal pain. They can be asymptomatic until they reach a considerable size. Tyrosine kinase inhibitors (TKI) are important in high risk GISTs and in locally advanced disease. We report a 65-year-old man with abdominal discomfort, anemia and clinically palpable abdominal mass. A Computed Tomography (CT) scan of the abdomen and pelvis was done which showed a locally advanced duodenal GIST involving second and third part of duodenum. Neoadjuvant imatinib was given to this patient for 6 months. He underwent Whipple’s procedure and right hemicolectomy. The histopathological examination report revealed a high-risk duodenal GIST. Adjuvant Imatinib was continued for 1 month after the operation. He continued to do well with no evidence of disease recurrence based on post-operative CT abdomen and pelvis.

A rare case of pancreatic acinar cell carcinoma presenting a submucosal tumor.

A 66-year-old man, who underwent distal gastrectomy with Billroth I reconstruction for gastric cancer, regularly underwent upper endoscopy as a routine examination. Unlike 1 year earlier [Figure 1a], a submucosal tumor-like lesion was identified near the minor papilla [Figure 1b], but the opening of the minor papilla could not be confirmed. Computed tomography revealed a mass (26 mm × 10 mm) protruding from the duodenal wall into the duodenal lumen [Figure 2] without pancreatic duct dilation. EUS using a linear array echoendoscope showed that the hypoechoic and smooth-marginal mass adjacent to the pancreatic head [Figure 3a] and the accessory pancreatic duct could not be recognized. EUS using a miniature probe showed that the mass was mainly located in the muscularis propria of the duodenal wall [Figure 3b]. The initial diagnosis was a duodenal gastrointestinal stromal tumor; however, EUS-guided fine-needle biopsy of the mass revealed suspicious pancreatic acinar cell carcinoma (PACC). A pancreaticoduodenectomy was performed. Macroscopically, a gray-white mass with a 25-mm maximum diameter was found in the duodenal submucosa on the cut surface [Figure 4a]. The boundary between the mass and the pancreatic parenchyma was unclear. Predominant growth of the tumor was observed within the accessory pancreatic duct by loupe image [Figure 4b]. No invasive growth or cystic formation was found. The tumor cells having irregular, hyperchromatic nuclei and eosinophilic cytoplasm proliferated mainly in an acinar or tubular pattern [Figure 4c]. The neoplastic cells were diffusely positive for anti-trypsin [Figure 4d] and bcl-10, whereas they were negative for a neuroendocrine marker, chromogranin or synaptophysin. Finally, the pathological diagnosis was a PACC at stage TisN0M0.Figure 1: (a) Endoscopic image showing no abnormality of the duodenal wall and minor papilla 1 year ago. (b) Endoscopic image showing a submucosal tumor-like lesion near the original minor papillaFigure 2: Contrast-enhanced computed tomography showing a mass (arrow) protruding from the duodenal wall into the duodenal lumen located in contact with the pancreatic headFigure 3: (a) EUS using a linear array echoendoscope showing a hypoechoic and smooth-marginated mass outside the pancreatic head. (b) EUS using a miniature probe showing the mass mainly located in the muscularis propria of the duodenal wallFigure 4: (a) Gross examination of resected specimen revealed a gray-white, solid lesion mainly occupying the duodenal submucosa on the cut surface. (b) A tumor with intraductal growth was observed by loupe image of histologic specimen (H and E). Normal pancreatic parenchyma (arrow). (c) Tumor cells having irregular, hyperchromatic nuclei and eosinophilic cytoplasm proliferated resembling acini of the pancreas (H and E, × 200). (d) Immunohistochemically, the neoplastic cells were positive for anti-trypsin (×40)PACC is a rare pancreatic tumor,[1] which is typically a solid tumor with expansive growth.[2] A PACC that predominantly grows within the main pancreatic ducts is extremely rare.[3] There has not been any reported case of PACC growing in the accessory pancreatic duct and presenting a submucosal tumor. In this case, there are some hypotheses regarding the specific tumor appearance: PACC originating from (1) pancreatic parenchyma near the accessory pancreatic duct and (2) ectopic pancreas[4] or submucosal pancreatic parenchyma.[5] However, it is a limitation that it was difficult to prove the hypotheses. Authors’ contributions R.S. treated the patient and wrote the manuscript; H.K., H.N., S.H., T.M., K.S., T.Y., H.A., M.K., M.F., T.M., M.F., K.O., E.T., T.U., A.T., and A.I. treated the patient and contributed writing the manuscript; T.T. performed pathological diagnosis and contributed writing the manuscript; all authors approved the final manuscript. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest Masaki Kuwatani is an Editorial Board Member of the journal. This article was subject to the journal’s standard procedures, with peer review handled independently of the editor and his research group.

Synchronous Duodenal and Jejunal Gastrointestinal Stromal Tumors

BACKGROUND Gastrointestinal stromal tumor (GIST) constitutes up to 1% of all malignant neoplasms of the gastrointestinal tract, with the stomach and small intestine being the most frequently affected organs. The purpose of this report is to present the first published case of synchronous duodenal and jejunal GISTs. CASE REPORT A 57-years old male patient with type II diabetes complained of asthenia and vertigo, resulting from anemia. On upper digestive endoscopy, a friable lesion was found in the second portion of the duodenum. The biopsy diagnosed GIST and its removal was indicated. During the surgical procedure, a second tumor was found in the jejunum, which was also removed. Anatomopathological examination of this second lesion also revealed GIST with the same cytological features. Digestive reconstruction was performed in Roux-en-Y of the jejunum sectioned distally to the tumor with the open part of the duodenum. The patient evolved without complications, was discharged on the third postoperative day and has been followed up for eleven years without any other treatment and without neoplastic recurrence. Food transit occurs almost exclusively through the duodenum. CONCLUSION This is the first report of two synchronous GISTs of duodenum and jejunum. After removal of both tumors, the Roux-en-Y reconstruction adequately closed the opened duodenum, but food transit persisted physiological through the duodenum.

Application of the Falciform Ligament Patch for the Prevention of Duodenal Stump Leakage After Gastrectomy: Technical Report on a Case Series.

Background: Duodenal stump leakage (DSL) is a serious complication after gastrectomy. In this study, we developed a novel prevention technique using a falciform ligament patch (FLP) to prevent DSL among high-risk patients after gastrectomy. Materials and Methods: From January 2019 to July 2021, 14 patients who were judged to be at high risk for DSL during preoperative examinations or surgery were included in this retrospective study, and the FLP was applied to the duodenal stump. The falciform ligament was separated from the liver after duodenal transection during gastrectomy; the end part was used to cover the duodenal stump and was fixed using nonabsorbable polypropylene sutures. Results: In total, 14 patients who underwent FLP had one or two risk factors that were identified: 5 patients, gastric cancer duodenal invasion; 4 patients, gastric outlet obstruction (GOO); 1 patient, cancer involving the distal resection margin; 1 patient, duodenal gastrointestinal stromal tumor involving the distal resection margin; 1 patient, gastric cancer duodenal invasion and GOO; and 2 patients, cancer involving the distal resection margin and GOO. FLP construction was successful, and no patient developed complications of DSL. The average hospital stay was 11.9 days, and the patients were discharged without any morbidities after surgery. Conclusions: Therefore, the FLP can be used to prevent DSL among high-risk patients after gastrectomy.

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

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. To assess the effectiveness and safety of endoscopic resection for duodenal GISTs. 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. 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. Endoscopic resection for duodenal GISTs appears to be an effective and safe minimally invasive treatment when performed by an experienced endoscopist.

A duodenal gastrointestinal stromal tumor mimicking a pancreatic neuroendocrine tumor: a case report

BackgroundDuodenal gastrointestinal stromal tumors are rare. If tumor growth is extraluminal and involves the head of the pancreas, the diagnosis of a duodenal gastrointestinal stromal tumor is difficult. Case presentationA 44-year-old Japanese woman was referred to our hospital with anemia. An enhanced computed tomography scan showed a hypervascular mass 30 mm in diameter, but the origin of the tumor, either the duodenum or the head of the pancreas, was unclear. Upper gastrointestinal endoscopy revealed bulging accompanied by erosion and redness in part of the duodenal bulb. Mucosal biopsy was not diagnostic. Endoscopic ultrasound fine-needle aspiration was difficult to perform because a pulsating blood vessel was present in the region to be punctured. These findings led to a diagnosis of pancreatic neuroendocrine tumor invasion to the duodenum. The patient underwent pancreaticoduodenectomy. Histologically, the tumor was made up of spindle-shaped cells immunohistochemically positive for c-Kit and CD34. The tumor was ultimately diagnosed as a duodenal gastrointestinal stromal tumor.ConclusionExtraluminal duodenal gastrointestinal stromal tumors are rare and mimic pancreatic neuroendocrine tumors. Endoscopic ultrasound fine-needle aspiration is useful for preoperative diagnosis, but it is not possible in some cases. Intraoperative diagnosis based on a completely resected specimen of the tumor may be useful for modifying the surgical technique.

Gastrointestinal stromal tumors in the duodenum show increased contrast enhancement compared with those in the stomach on computed tomography.

Duodenal gastrointestinal stromal tumors (D-GISTs) are a rare and relatively small subset of GISTs whose imaging features are not well known. The present study aimed to evaluate the enhancement pattern of D-GISTs compared with that of gastric GISTs (G-GISTs) using dynamic computed tomography. This single-center, retrospective, clinicopathological analysis was conducted on 10 patients with D-GISTs who underwent surgery between June 2006 and October 2018. In the same period, 25 patients with G-GISTs underwent surgery and were enrolled. The contrast ratio was defined as the ratio between Hounsfield units in contrast enhanced and unenhanced images in different phases, and these ratios were compared between the D-GIST and G-GIST groups. Furthermore, microvessel density, analyzed by immunohistochemical staining for CD31, was compared between the D-GIST and G-GIST groups. The contrast ratio of D-GIST was significantly higher than that of G-GIST in the arterial, portal and delayed phases (P<0.01, P<0.01 and P=0.02, respectively). The microvessel density of the D-GISTs was significantly higher than that of the G-GISTs (P<0.0001). D-GISTs were more hypervascular than G-GISTs on both imaging and pathological analyses.

Surgical treatment and survival analysis of primary duodenal malignant tumor: a retrospective cohort study.

BackgroundA primary duodenal malignant tumor (PDMT) is an extremely uncommon malignancy that originates from a gastrointestinal tract tumor. Currently, there is no unified, effective surgical treatment for PDMTs. In this retrospective study, we sought to analyze and evaluate the surgical procedure for PDMTs including pancreaticoduodenectomy (PD) and limited resection (LR), expect to inform the management of PDMT.MethodsWe retrospectively reviewed patients with PDMT who underwent PD and LR in General Surgery Department of Tianjin Medical University General Hospital from January 2014 to December 2019. The clinical characteristics of the malignant tumors among the different segment of the duodenum were analyzed. We analyzed and compared the efficacy and safety of these two surgical treatments. Through survival result of the patients, we analyzed the survival factors affecting the PDMT.ResultsOf the 94 patients, 60 (63.8%) were diagnosed with duodenal adenocarcinomas (DAs), 32 (34.1%) with duodenal gastrointestinal stromal tumors (d-GISTs), and 2 (2.1%) with duodenal lymphomas. Of the duodenal malignancies localized in the descending (D2) segment, 72.6% were DAs, and the initial symptom was jaundice (27.4%). Comparing with D2, d-GISTs were more common in the non-D2 segment (50.0%), and 46.9% of these patients presented with anemia as a primary symptom. PDs (87.1%) were more commonly performed for malignancies localized in the D2 segment, and LRs (59.4%) were more commonly performed for malignancies localized in the non-D2 segment (P<0.05).ConclusionsIn this study, we found that PDMT is more likely to occur in the D2 segment than the other segments, and the most common pathological type is DA. Treatment decisions for PD and LR might depend on the tumor type, location, and whether invasion of the pancreas. PD might be the first choice of treatment for PDMTs located in the D2 segment; otherwise, LR would be preferred. Further studies, preferably large randomized clinical trials, are needed to confirm these results.

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

BACKGROUNDLiver 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 SUMMARYA 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.CONCLUSIONH-CEUS is useful for detecting microcirculation differences, wash-in patterns, and vascular morphogenesis and diagnosing liver metastasis of duodenal GIST.

Effects of endoscopic therapy and surgical resection on long-term survival outcomes in patients with duodenal gastrointestinal stromal tumors: a surveillance, epidemiology, and end result program analysis.

With the rapid development of endoscopic technology, endoscopic therapy (ET) has gradually become a new treatment choice for gastrointestinal stromal tumors (GISTs). However, due to the low incidence of duodenal GIST and the difficulty of ET, there is a lack of data to compare the long-term results of ET and surgical resection. Duodenal GIST patients from 2004 to 2015 were selected from the surveillance, epidemiology, and end result (SEER) database. We used the Kaplan-Meier method and log-rank test to describe the 5- and 10-year survival differences between the ET and the surgery groups. The multivariate Cox proportional hazard model was used for analyzing the risk factors influencing the prognosis of patients. We used a 1:1 propensity score-matched (PSM) to reduce confounding factors, and then we compared survival differences between the two groups again. A total of 294 patients with duodenal GIST were enrolled, including 41 (13.9%) patients with ET and 253 (86.1%) patients with surgical resection. Before PSM, the long-term survival of patients with duodenal GIST after ET and surgical resection was similar [5-year overall survival (OS) (79.7 vs. 79.3%, p = 0.876), 10-year OS (66.5 vs. 68.1%, p = 0.876)]. After adjusting the relevant variables using multivariate Cox analysis, we found that the ET and surgery groups were comparable in OS and cancer-specific survival (CSS). After PSM, there was also no significant difference between ET and surgical resection for long-term OS and CSS. Our study found no significant difference in long-term survival between ET and surgical resection in patients with duodenal GIST. However, to obtain high-quality evidence, more extensive sample size studies are needed in the future to evaluate the long-term effects of ET on patients.

Minimal change disease associated with gastrointestinal stromal tumor accompanied by significantly elevated serum IgE level: a case report

BackgroundMinimal change disease (MCD) is a common cause of the nephrotic syndrome. Several studies have shown an increased incidence of cancer in patients with MCD. However, there are no reports on the association between MCD and gastrointestinal stromal tumor (GIST).Case presentationWe report a case of a 66-year-old female with severe nephrotic syndrome and concomitant duodenal GIST. Immunoglobulin test showed a significant increase of IgE levels. The diagnosis of renal histopathology was MCD with subacute tubulointerstitial injury. The combination of preoperative Imatinib mesylate chemotherapy and tumor excision was accompanied by significant remission of proteinuria, and IgE level decreasing, without immunosuppressivetherapy.ConclusionsIt is the first case report that MCD was associated with GIST and elevated IgE level. Clinically, in patients with elevated IgE level associated with nephrotic syndrome, the possibility of tumor must be taken into account when allergic factors are excluded.