Highlights • Duodenal GISTs are rare tumors of the digestive tract and although frequently symptomatic, they can also be diagnosed incidentally. • The management of GISTs should be conducted by a multidisciplinary team. • Surgery is the only potentially curative treatment for non-metastatic GISTs and the gold standard for local disease. • The recurrence of GISTs appears to have a stronger connection to the tumor biology rather than the kind of surgery performed. • High-risk GISTs have a formal indication for adjuvant therapy with a tyrosine kinase inhibitor.
Introduction Duodenal GISTs are rare mesenchymal tumors of the digestive tract. They usually present as gastrointestinal bleeding or non-specific abdominal pain, but they can also be asymptomatic. High-risk GISTs have malignant potential. Surgical resection is the only curative option and its extension depends on different factors. Tyrosine kinase inhibitors are of the utmost importance in high-risk and metastatic disease. Case description We herein report the case of a 75-year-old male, referred to our general surgery outpatient clinic, with an asymptomatic duodenal mass incidentally diagnosed during an abdominopelvic ultrasonography. Abdominal CT suggested GIST. Since no other lesions were found, a segmental duodenectomy was performed and the patient recovery was uneventful. Histologic exam confirmed the presence of a high-risk GIST, therefore adjuvant therapy with imatinib was initiated. Discussion Duodenal involvement by GISTs is rare, even more in its third/fourth portions. The widespread clinical use of radiological exams such as ultrasonography may lead to the diagnosis of asymptomatic masses. Surgical treatment is the gold-standard giving the malignant potential of these neoplasms. There are risk stratification scores that may be used to assess the need for adjuvant therapy. Conclusion Even large GISTs can by asymptomatic. Giving their malignant potential, early diagnosis and treatment are crucial. The histologic findings and genetic profile have an impact on the patient’s survival.