Pankreas Başı Tümörü Gibi Davranan Duodenal Gastrointestinal Stromal Tümör

Öz

Bu yazı ile sadece ekstramural büyüme gösteren ve pankreas başı tümörü izlenimi veren duodenal gastrointestinal stromal tümörü olan (GIST) bir olgunun sunulması amaçlanmıştır. Ellialtı yaşındaki kadın hastada preoperatif dönemde tomografi ile batın orta kısmında 12x7x5 cm.lik heterojen bir kitle bulundu. Endoskopik muayenede duodenal lümen içinde mukozada bir anormallik saptanmadı. Ameliyatta pankreas başına uyan bölgede sert bir tümör saptandı. Peritoneal yayılım veya metastaz yoktu. İnce iğne aspirasyon biopsisinde tümör GIST olarak bildirildi. İatrojenik duodenal yaralanma oluşması nedeniyle hastaya pilor korucu pankreatikoduodektomi yapıldı. Histolojik inceleme ile tümöre pankreas dokusuna invaze duodenal GIST tanısı kondu. Bu şekilde ekstramural büyüme gösteren ve pankreas başı tümörü izlenimi veren tümör olgusu çok nadirdir. Anahtar kelimeler: Duodenum, Stromal, Tümör

Anahtar Kelimeler

• Duodenum, Stromal, Tümör

A Gastrointestinal Stromal Tumor of the Duodenum Mimicking a Pancreatic Head Tum

Abstract

We aimed to report a case with a gastrointestinal stromal tumor (GIST) of the duodenum that showed only extramural growth, mimicking a pancreatic head tumor. A 56-year-old woman. Computed tomography revealed a heterogen mass, 12x7x5 cm in diameter, in mid abdominal region preoperatively. Endoscopic examination showed no specific mucosal abnormalities in the duodenal lumen. A hard mass was detected intraoperatively in the pancreatic head region, and neither peritoneal dissemination nor metastasis was detected. The tumor was diagnosed peroperatively as a GIST in FNA biopsy, and the patient underwent pylorus-preserving pancreaticoduodenectomy because of iatrogenic duodenal injury. This neoplasm was finally diagnosed histologically as a duodenal GIST with the pancreatic tissue invasion. This is a rare case of a duodenal GIST with exclusively extramural growth mimicking a pancreatic head tumor. Key words: Duodenum, Stromal, Tumor

Keywords

• Duodenum, Stromal, Tumor

Kaynakça

1. Miettinen M, Majidi M, Lasota J. Pathology and diagnostic criteria of gastrointestinal stromal tumors (GISTs): a review. Eur J Cancer 2002;38:39-51.
2. Fletcher CD, Berman JJ, Corless C, et al. Diagnosis of gastrointestinal stromal tumors: A consensus approach. Hum Pathol 2002;33:459-65.
3. Sakamoto Y, Yamamoto J, Takahashi H, et al. Segmental resection of the third
4. portion of the duodenum for a gastrointestinal stromal tumor: a case report. Jpn J Oncol 2003;33:364-6.
5. Sturgeon C, Chejfec G, Espat NJ. Gastrointestinal stromal tumors: a spectrum of disease. I Surgical Oncology 2003;12:21-6.
6. Pidhorecky I, Cheney RT, Kraybill WG, Gibbs JF. Gastrointestinal stromal tumors: Current diagnosis, biologic behavior, and management. Ann Surg Oncol 2000;7:705- 12.
7. Takahashi Y, Noguchi T, Takeno S, et al. Gastrointestinal stromal tumor of the duodenal ampulla: Report of a case. Surg Today 2001;31:722-6.
8. Sawaki A, Ohashi K, Yamao K, et al. Effect of a tyrosine inhibitor ST1571 in a patient with hepatic metastases from a duodenal gastrointestinal stromal tumor. J Gastroenterol 2003;38:690-4.

9. Matsushita M, Kobayashi Y, Kobayashi H, Nagasawa M, Sato Y, Nakamura H. A case of gastrointestinal stromal tumour of the ampulla of Vater. Dig Liver Dis. 2005;4:275-7.
10. Goh BK, Chow PK, Ong HS, Wong WK. Gastrointestinal stromal tumor involving the second and third portion of the duodenum: Treatment by partial duodenectomy and Roux-en-Y duodenojejunostomy. J. Surg. Oncol 2005;4:273-5
11. Uchida H, Sasaki A, Iwaki K, et al. An extramural gastrointestinal stromal tumor of the duodenum mimicking a pancreatic head tumor. J Hepatobiliary Pancreat Surg. 2005;4:324-7.