A 76-year-old male patient with a history of chronic arterial hypertension, untreated old pulmonary tuberculosis and prostate adenocarcinoma operated in 2001 (radical prostatectomy), with subsequent controls without evidence of disease.
She had a history of four self-limiting episodes of upper gastrointestinal bleeding between 1964 and 1979.
During this period, he was evaluated by radiographic study, diagnosed with duodenal peptic disease, which was treated medically.
Between 1998 and 1999 she presented four other self-limiting episodes of upper gastrointestinal bleeding with inconclusive endoscopic studies managed medically.
A duodenography revealed an elevated hemispheric image with central ulceration, compatible with ulcerated leiomyoma in the third portion of the duodenum.
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Surgical treatment was decided, intervening in January 2000.
A bilateral subcostal laparotomy was performed, identifying between the third and fourth portion of the duodenum a 7 cm diameter lesion, encapsulated and without evidence of disseminated disease.
Tumor resection and primary duodenal suture were performed.
The report of the delayed biopsy described: gastrointestinal stromal tumor with differentiation to malignant muscles of low grade.
Tumor size of 7 x 4 x 4.5 cm, mitotic count of 7 to 12 per field with greater amplification (CMA) and negative surgical margins.
The case was presented to the oncology committee of the Hospital del Salvador in March 2000, sentinel behavior.
In the second half of 2003, the patient presented a new self-limiting episode of upper gastrointestinal bleeding, whose endoscopic study revealed an ulcerated soleuvant lesion, which compromised two thirds of the second portion of the duodenum, with a 3 x 3.5 cm nuclear biopsy.
Abdominal computed axial tomography showed no advanced disease.
The case was discussed in the oncology committee, its aggressive surgical treatment.
She underwent surgery in March 2004.
A bilateral subcostal laparotomy was performed, finding a 10 cm tumor in diameter attached to the head of the pancreas, with no other evidence of disseminated disease.
Distal gastrectomy, resection of distal bile duct, duodenum, head of pancreas and cholecystectomy were performed.
Transit was reconstituted with a gastro-jejunostomy, gastro-pancreato and common bile duct anastomosis.
The patient developed postoperative pneumonia and paroxysmal atrial fibrillation.
She was discharged 17 days after surgery in good condition.
Deferred biopsy was reported as: stromal tumor of the duodenum, malignant mucosal melanoma and subserosa.
Tumor size 7 x 5 x 5.5 cm, with less than 50% necrosis, with mitotic rate of 6 to 10 per CMA.
No angiolymphatic or perineural invasion was observed.
Surgical margins were tumor free.
No tumor involvement was observed in 13 lymph nodes examined.
A positive informed c-KIT (CD117) immunohistochemical study was performed.
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The oncologic committee started treatment with imatinib mesilate (Gleebec®) 800 mg daily orally on a permanent basis, as it was considered a patient at high risk of recurrence.
Currently the patient is kept under control by the digestive surgery team, 15 months after surgery.
He continued with pharmacological treatment, in good conditions, with good oral tolerance, stable weight and no clinical evidence of tumor recurrence.
