Duodenal Gastrointestinal Stromal Tümör: Nadir Bir Olgu

Öz

Gastrointestinal stromal tümörler (GİST), gastrointestinal sistemin en sık görülen mezenkimal kökenli tümörleridir ve genellikle mide ve ince bağırsakta yerleşim gösterirler. Ancak, duodenumda lokalize GİST’ler oldukça nadirdir ve cerrahi tedavileri özel teknikler gerektirir. Bu olgu sunumunda, 28 yaşında kadın hastada duodenumun ikinci segmentinde tespit edilen GİST nedeniyle uygulanan cerrahi tedavi ve postoperatif süreç ele alınmaktadır. Hasta, yaklaşık üç aydır süren iştahsızlık, karın ağrısı ve aralıklı bulantı şikayetleri ile başvurdu. Fizik muayenesinde belirgin bir patoloji saptanmamakla birlikte, üst gastrointestinal endoskopi ve kontrastlı batın bilgisayarlı tomografi (BT) incelemesinde duodenum ikinci segmentte ülsere bir kitle lezyonu tespit edildi ve cerrahi eksplorasyon kararı alındı. Laparotomi sırasında duodenumun ikinci kısmında, pankreas başına komşu, yaklaşık 4x5 cm boyutunda ülsere ve duodenal lümene protrüde, çevre dokulara belirgin invazyon gözlenmeyen tümör izlendi. Duodenum wedge rezeksiyon ve Roux-en-Y gastroenterostomi yapıldı. Ameliyat sonrası dönemde komplikasyon yaşanmayan hasta taburcu edildi. Histopatolojik incelemede, mitotik aktivitenin yüksek olduğu ve tümörün yüksek grade GİST olduğu rapor edildi. Hastaya adjuvan imatinib tedavisi amacıyla onkolojiye yönlendirildi. Sonuç olarak, duodenal GIST'ler nadirdir ancak erken tanı ve cerrahi müdahale ile etkili bir şekilde yönetilebilir. Tümörün yüksek dereceli doğası göz önüne alındığında cerrahi tedavi birincil yaklaşım olmaya devam etmekte olup, onkolojik takiplerin devamı sağ kalımını olumlu ölçüde iyileştirmektedir.

Anahtar Kelimeler

• Gastrointestinal tümör
• duodenal tümör
• mezenkimal tümör

Duodenal Gastrointestinal Stromal Tumor: A Rare Case

Öz

Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastrointestinal system and are usually located in the stomach and small intestine. However, GISTs localized in the duodenum are quite rare and require special techniques for surgical treatment. In this case report, the surgical treatment and postoperative process applied to a 28-year-old female patient due to GIST detected in the second segment of the duodenum is discussed. The patient applied with complaints of loss of appetite, abdominal pain and intermittent nausea lasting approximately three months. Although no obvious pathology was detected in the physical examination, an ulcerated mass lesion was detected in the second segment of the duodenum in the upper gastrointestinal endoscopy and contrast-enhanced abdominal computed tomography (CT) examination and a decision was made for surgical exploration. During laparotomy, an approximately 4x5 cm ulcerated tumor was observed in the second part of the duodenum, adjacent to the pancreatic head, protruding into the duodenal lumen, and no obvious invasion of the surrounding tissues. Duodenal wedge resection and Roux-en-Y gastroenterostomy were performed. The patient was discharged without any postoperative complications. Histopathological examination revealed high mitotic activity and the tumor was reported to be a high-grade GIST. The patient was referred to oncology for adjuvant imatinib therapy. In conclusion, duodenal GISTs are rare but can be effectively managed with early diagnosis and surgical intervention. Given the high-grade nature of the tumor, surgical treatment remains the primary approach, and continued oncological follow-up improves survival significantly.

Anahtar Kelimeler

• Gastrointestinal tumor
• duodenal tumor
• mesenchymal tumor

Kaynakça

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