Pinto MA1, Vieira FM1, Pereira PF1, Chedid MF1, Grezzana-Filho JMT1, Gressler JB1, Alves GV2, Juchem JF1, Leipnitz I1, Chedid AD1 and Kruel CR1*
1Division of Gastrointestinal Surgery and Liver and Pancreas Transplantation, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
2Division of Medical Oncology, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
Gastrointestinal stromal tumors (GISTs) represent less than 1% of all cases of abdominal neoplasms. The stomach (60%) and small intestine (35%) are the most common sites, the duodenum being affected in less than 5% of cases. A 53-year-old female patient presented to outpatient clinic with a 3-month history of diffuse abdominal pain and increased abdominal volume. CT scan revealed a giant (22.7 cm × 13.7 cm × 12.1 cm) tumor in the head and uncinate process of the pancreas and duodenum with several liver and several lung metastases. Regarding the presence of symptoms of abdominal compression, pancreatoduodenectomy was performed. Pathology report revealed GIST with extensive necrosis and moderate nuclear atypia, without pancreatic invasion. There were four mitoses per 50 large fields, Immunohistochemical staining was positive for CD117 and CD34. Ki67 was 10%. The patient was discharged on 22nd postoperative day and is being treated with Imatinib (400 mg/daily). She is free of symptoms and has gained 2 kg of weight over the first three postoperative months. There is no consensus on the ideal treatment for patients with metastatic GISTs along with unresectable metastastatic disease: palliative surgical resection versus therapy with tyrosine kinase inhibitors. The decision whether or not to resect the primary GIST in the context of metastatic disease should be performed on a case-by-case fashion, in which the severity of the symptoms or bleeding complications, tumor size and mitotic rate should be taken into account for establishing a tailored strategy.
Duodenum; Gastrointestinal stromal tumor; Metastases; Palliation; Pancreaticoduodenectomy
into MA, Vieira FM, Pereira PF, Chedid MF, Grezzana-Filho JMT, Gressler JB, et al. Palliative Pancreaticoduodenectomy for Giant Duodenal Gastrointestinal Stromal Tumor: Report of a Case. Surg Oncol Clin Pract J. 2017;2(1):1005.