Jejunal GIST: An unusual cause of gastrointestinal bleeding

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Digestive and Liver Disease 42 (2010) 744

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ejunal GIST: An unusual cause of gastrointestinal bleeding

arco Bianchia,∗, Barbara De Pascalisb, Maurizio Kocha

Gastroenterology and Hepatology Unit, A.O.S. Filippo Neri, Rome, ItalyEmergency Department, S. Maria Goretti Hospital, Latina, Italy

r t i c l e i n f o

rticle history:

A 69-year-old man presented with maelena of 4-day durationnd anaemia. Oesophagogastroduodenoscopy and a colonoscopyoth resulted negative for causative lesions. Upper abdomen ultra-onography was normal. Tumour markers including CEA, AFP andA 19-9 were within normal values. A small bowel follow troughas therefore performed and showed a smooth, roundish, fillingefect in the jejunal lumen (Fig. 1). The subsequent abdominal com-uted tomography ascertained a 2.5 cm × 2 cm intramural massith disomogeneous enhancing within little necrotic areas. Endo-

copic ultrasonography demonstrated at the duodenal–jejunalransition (Treitz), an hypoechogen mass of 35 mm × 34 mm, orig-nating from the IV hypoechogen layer (muscularis propriae),isomogeneous, with some anechogenic and hyperechogenic focind irregular margins (Fig. 2) suggestive for GIST. The patient thus

∗ Corresponding author. Tel.: +39 03488293711.E-mail address: m.bianchi@sanfilipponeri.roma.it (M. Bianchi).

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590-8658/$36.00 © 2009 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevieroi:10.1016/j.dld.2009.06.008

underwent an elective segmental resection of the third and fourthportion of the duodenum after intestinal derotation (Valdoni –Strong’s procedure). Histology confirmed a spindle-cell GIST withstrong positive staining for c-kit (CD 117). Mitotic count was 2 for50 HPF and the proliferative index evaluated by Ki67 vas less than2%.

Obscure gastrointestinal bleeding represents approximately 5%of all gastrointestinal bleeds. GISTs are the most common mes-enchymal neoplasms of the gastrointestinal tract and in about 40%manifests with haemorrhage. Approximately 50–70% originatesin the stomach, whereas 20–30% of from the small bowel, withduodenum being the least common site [1].

Reference

1] Tran T, Davila JA, El-Serag HB. The epidemiology of malignant gastrointestinalstromal tumors: an analysis of 1,458 cases from 1992 to 2000. Am J Gastroenterol2005;100:162.

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