A rare case report of locally recurrent hemorrhagic duodenal gastrointestinal stromal tumor: therapeutic challenges and review of prognostic indicators for recurrence

Abstract

Gastrointestinal stromal tumor is a rare neoplasm affecting gastrointestinal tract. Duodenal gastrointestinal stromal tumor originating from the fourth segment is considered an extremely rare disease. Surgical challenges arise when managing locally recurrent hemorrhagic duodenal gastrointestinal stromal tumor. A 58-year-old male presented with melena for the last 10 days. Thirty months previously, he had segmental resection of the fourth duodenal portion due to hemorrhagic gastrointestinal stromal tumor. No adjuvant imatinib therapy was administered (low risk for recurrence). The latest investigations showed actively bleeding tumor in the distal third portion of the duodenum, indicating a locally recurrent gastrointestinal stromal tumor. Uneventful emergent limited resection was performed. To the best of our knowledge, this is the first case report describing locally recurrent gastrointestinal stromal tumor in the distal duodenal portion. We will explain the therapeutic challenges and risk stratification and discuss gastrointestinal bleeding as a prognostic indicator for gastrointestinal stromal tumor recurrence.

Massive bleeding of a jejunal gastrointestinal stromal tumour: a rare case of a life-threatening presentation

“…To achieve curative treatment of a GIST, complete tumour excision with negative margins is required. Lymph node dissection is not required [ 2 , 6 ]. In spite of complete excision with clear margins, GISTs tend to recur in ~50% of cases [ 6 ].…”

“…However recent research demonstrates that GI bleeding is due to tumour perforation through the mucosa and therefore should be treated similarly to cases where there has been tumour rupture, which changes the risk to high. These studies suggest that GI bleeding could be an independent risk factor for recurrence and therefore these patients require adjuvant treatment with imatinib [ 2 , 7 , 8 ].…”

“…GISTs account for only 0.1—3% of all neoplasms in the GI tract [ 1 ]. The majority of GISTs are located in the stomach (60–70%), whereas 20–30% are found in the small intestine and rarely in the oesophagus, colon, rectum and retroperitoneum [ 2 ].…”

“…Abdominal pain (20%) and obstruction (10%) are other potential manifestations. In all, ~20% of GISTs are asymptomatic and are discovered incidentally during abdominal imaging or intraoperatively [ 2 ].…”

A Case Report of a Bleeding Duodenal Gastro-Intestinal Stromal Tumor and its Emergent Management

“…Imatinib is also effective in large primary tumors of the duodenum to enhance surgical resection [4]. If there is tumor regression a duodenal local resection, especially in the 2 nd part, becomes possible without the need for a and invasion of the submucosal blood vessels [6,7]. This is thought to contribute to tumor embolization and local recurrence or distant metastases.…”