Digestive and Liver Disease 42 (2010) 744 Contents lists available at ScienceDirect Digestive and Liver Disease journal homepage: www.elsevier.com/locate/dld Image of the Month Jejunal GIST: An unusual cause of gastrointestinal bleeding Marco Bianchi a,∗ , Barbara De Pascalis b , Maurizio Koch a a Gastroenterology and Hepatology Unit, A.O.S. Filippo Neri, Rome, Italy b Emergency Department, S. Maria Goretti Hospital, Latina, Italy article info Article history: Received 3 June 2009 Accepted 8 June 2009 Available online 21 August 2009 A 69-year-old man presented with maelena of 4-day duration and anaemia. Oesophagogastroduodenoscopy and a colonoscopy both resulted negative for causative lesions. Upper abdomen ultrasonography was normal. Tumour markers including CEA, AFP and CA 19-9 were within normal values. A small bowel follow trough was therefore performed and showed a smooth, roundish, filling defect in the jejunal lumen (Fig. 1). The subsequent abdominal com- puted tomography ascertained a 2.5 cm × 2 cm intramural mass with disomogeneous enhancing within little necrotic areas. Endo- scopic ultrasonography demonstrated at the duodenal–jejunal transition (Treitz), an hypoechogen mass of 35 mm × 34 mm, orig- inating from the IV hypoechogen layer (muscularis propriae), disomogeneous, with some anechogenic and hyperechogenic foci and 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). underwent an elective segmental resection of the third and fourth portion of the duodenum after intestinal derotation (Valdoni – Strong’s procedure). Histology confirmed a spindle-cell GIST with strong positive staining for c-kit (CD 117). Mitotic count was 2 for 50 HPF and the proliferative index evaluated by Ki67 vas less than 2%. 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% originates in the stomach, whereas 20–30% of from the small bowel, with duodenum being the least common site [1]. Reference [1] Tran T, Davila JA, El-Serag HB. The epidemiology of malignant gastrointestinal stromal tumors: an analysis of 1,458 cases from 1992 to 2000. Am J Gastroenterol 2005;100:162. 1590-8658/$36.00 © 2009 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.dld.2009.06.008

Jejunal GIST: An unusual cause of gastrointestinal bleeding

Download PDF Report

Upload
marco-bianchi
View
215
Download
0

Embed Size (px)

Citation preview

Page 1: Jejunal GIST: An unusual cause of gastrointestinal bleeding

ARAA

absCwdpwstida

Digestive and Liver Disease 42 (2010) 744

Contents lists available at ScienceDirect

Digestive and Liver Disease

journa l homepage: www.e lsev ier .com/ locate /d ld

mage of the Month

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:

eceived 3 June 2009ccepted 8 June 2009vailable online 21 August 2009

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: [email protected] (M. Bianchi).

[

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.

dx.doi.org/10.1016/j.dld.2009.06.008

http://www.sciencedirect.com/science/journal/15908658

http://www.elsevier.com/locate/dld

mailto:[email protected]

dx.doi.org/10.1016/j.dld.2009.06.008