Research Information System
8. International Gastrointestinal Cancer Conference, İstanbul, Turkey, 7 - 09 December 2018
A 44 year old woman presented with signs of mild fever, epigastric pain and tenderness in April 2018. Her past medical history was uneventful except for a short duration of mild depression. She was using an antidepressant olanzapine and there was
no previous history of any kind of surgery and or allergy. Her
vital signs were normal and her physical examination revealed
mild abdominal tenderness. Her routine blood test were normal
except for mild to moderate elevation of c reactive protein (20
mg/dl) and slightly decreased hemoglobin Hmg 10.9 g/dl with
a hypochromic micrositer peripheral blood smear. An upper abdominal ultrasonography revealed a 8x7.5 cm thick walled mass
lesion located at the upper right quadrant extending inferiorly to
the level of umbilicus. An abdominal computerized tomography
revealed similar findings, but additionally CT depicted a connection of the mass with the lumen of 2nd part of the duodenum.
There was also appearance of air inside the lesion. An upper endoscopy showed a fistulous opening in the 2nd part of the duodenum on the lateral side with a purulent drainage coming from
this opening. A preliminary diagnosis was intra-abdominal abscess and or fistulizing eGIST (extraluminal gastrointestinal stromal tumor). Surgery was undertaken and nearly 8x7 cm tumoral
mass lesion was easily removed from the second part of the duodenum and the small defect in the duodenum wall was primarily
repaired. Pathology on macroscopy documented tumoral mass
with a necrotic core and on microscopy, the tumor was consisted of highly proliferative spindle cells with a mitotic index more
than 10. It was positive for vimentin and CD117 and negative for
S100 immunostains. Thus, a diagnosis of eGIST fistulising into
the duodenum was made and she was put on adjuvant imatinib
treatment during her uneventful follow up period.