A CASE OF STROMAL TUMOR OF THE DUODENUM

Abstract

A 65-year-old man visited the hospital because of general fatigue and anemia. Hypotonic duodenography revealed a filling defect at the second portion of the duodenum. Endoscopic examination revealed a tumor with easy bleeding ulcer at the oral side of the Papilla Vater of the duodenum. Preoperative examinations showed that the tumor which was 5.5cm in diameter, solid, well-delineated, and hypervascular, and had developed extramurally from the second portion of the duodenum to the retroperitoneum. Under the diagnosis of duodenal tumor, a pylorus preserving pancreaticoduodenectomy was performed. At laparotomy, a mass with a smooth surface and located in the posterior wall of the duodenum was found. There was no metastasis. Histopathologically, this tumor was mainly composed of proliferated spindle cells that had mitotic figures by 6/10 high power field. Immunohistochemical study showed that the tumor was negative for smooth-muscle actin, desmin, neuron specific enolase and S-100 protein. Therefore, it was diagnosed as a duodenal stromal tumor that was suggestive of malignancy because of its 5.5cm diameter and frequent mitosis. There has been no signs of local recurrence and metastasis as of 4 months after the operation. However, the patient requires careful follow-up.