Gastrointestinal stromal tumour (GIST) mimicking polypoid process of the papilla of Vater

• Published in: Zeitschrift für Gastroenterologie
• Main Authors: Luigitsch, I, Simon, K, Pogány, P, László, F, Topa, L
• Format: Conference Proceeding
• Language: German
• Published: 19.05.2004
• ISSN: 0044-2771; 1439-7803
• DOI: 10.1055/s-2004-826987

GIST is of mesenchymal origin. The localization of GIST is mostly the stomach, duodenum, colon, and rarely the oesophagus and retroperitonium. Their size varies from 1–2mm to 40cm. GIST is mostly solitaire. The clinical characteristics of GIST are abdominal discomfort, pain, palpable tumour, bleeding and anaemia, and sometimes, obstructive jaundice, ileus or perforation. Case report: At her first observation, the 67 year-old women had gastroduodenoscopy, where a large tumour was found in the duodenum at the level of the papilla of Vater. Although, the patient had no cholestatic laboratory findings and abdominal ultrasonography didn't show dilated biliary ducts, we thought that the tumour is most likely to be originated from the papilla of Vater. At the first duodenoscopy, we performed pre-cutting and biopsy. The visualisation of choledochus was not successful. Histology found granulomatous tissue. At the second duodenoscopy, we could localise the polypoid tumour: it was situated in a juxtapapillar diverticulum and covered the orifitium of the papilla of Vater. The second histological sample also showed similar garnulomatous tissue as in the firs case. At the third duodenoscopy, we performed partial polypectomy. The third histology species was analysed immunohistochemically, and gave the final diagnosis: the tumour was GIST. The polyp was then surgically resected through duodenotomy. At her second observation, the patient had mild cholestasis among her laboratory findings. We performed ERCP, but we could not visualize the choledochus. The Wirsung duct was moderately dilated. The patient receives imatinibe (Glivec) treatment, and has no complaints and signs of tumour recidiva.