Case report
Atypical presentation of gastrointestinal stromal tumor masquerading as a large duodenal cyst: A case report

https://doi.org/10.1016/j.ijscr.2015.02.045Get rights and content
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Highlights

  • Gastrointestinal stromal tumors (GIST) are solid tumors.

  • Atypical presentations in form a cystic lesion have been rarely reported.

  • A duodenal GIST masquerading as a cystic lesion has never been reported.

  • First report a case of a large duodenal cyst that finally, turned out to be a GIST.

  • Successfully managed by local resection avoiding a pancreaticoduodenectomy.

Abstract

Introduction

Gastrointestinal stromal tumors (GIST) are solid tumors. A duodenal GIST masquerading as a cystic lesion has never been reported. We report a large duodenal cyst that finally turned out to be a GIST and was managed without a pancreaticoduodenectomy (PD).

Presentation of case

A 55 year old lady presented with painful lump in epigastrium. A CT scan revealed a large exophytic cystic lesion from the duodenum with a small solid component. An endoscopy showed a polypoid lesion in the second part of the duodenum adjacent to what looked like a diverticulum. A sleeve duodenal resection, duodeno-duodenostomy and pyloric exclusion was done. The histopathology was duodenal GIST.

Discussion

This case posed diagnostic difficulty as it was thought to be either a duplication cyst or a diverticulum of duodenum. The odd point was the small solid component in it. We considered the possibility of a malignancy arising in these settings, which is has been occasionally reported. To our surprise, it turned out to be a GIST. An extensive literature search yielded only four reports that have reported cystic GISTS, all arising from the stomach or pancreas where they have been mistaken for pseudocysts or even a mucinous cystadenocarcinoma of the pancreas. This is the first report of a cystic GIST arising from the duodenum.

Conclusion

GISTS can present as a predominantly cystic lesion and needs to be considered in the differential diagnosis of cystic lesions of the duodenum. Local resection is an attractive option in select cases and avoids a PD.

Keywords

Gastrointestinal tumor
Cystic degeneration
Duodenal cyst
Duodenal diverticulum
Pyloric exclusion

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