Endoscopic ultrasound-guided fine-needle aspiration for diagnosing a rare extraluminal duodenal gastrointestinal tumor

• 作者: Hajime Umezu Junji Kohisa Junji Yokoyama Kazunao Hayashi Kazunori Hosaka Kazuya Takahashi Kazuyasu Takizawa Kenichi Mizuno Kentaro Tominaga Kenya Kamimura Satoru Hashimoto Satoshi Ikarashi Satoshi Yamagiwa Shuji Terai Toshifumi Wakai
• 来源期刊: 世界胃肠内镜杂志：英文版（电子版）
• 学科: 医学
• 年，卷（期）: 2017,（12）
• 页码范围: 583-589
• 页数: 7页
• 分类号: R735

摘要

Duodenal gastrointestinal stromal tumors(GISTs) are extremely rare disease entities, and the extraluminal type is difficult to diagnose. These tumors have been misdiagnosed as pancreatic tumors; hence, pancreaticoduodenectomy has been performed, although partial duodenectomy can be performed if accurately diagnosed. Developing a diagnostic methodology including endoscopic ultrasonography(EUS) and fine-needle aspiration(FNA) has allowed us to diagnose the tumor directly through the duodenum. Here, we present a case of a 50-year-old woman with a 27-mm diameter tumor in the pancreatic uncus on computed tomography scan. EUS showed a well-defined hypoechoic mass in the pancreatic uncus that connected to the duodenal proper muscular layer and was followed by endoscopic ultrasoundguided fine-needle aspiration(EUS-FNA). Histological examination showed spindle-shaped tumor cells positively stained for c-kit. Based on these findings, the tumor was finally diagnosed as a duodenal GIST of the extraluminal type, and the patient underwent successful mass resection with partial resection of the duodenum. This case suggests that EUS and EUS-FNA are effective for diagnosing the extraluminal type of duodenal GISTs, which is difficult to differentiate from pancreatic head tumor, and for performing the correct surgical procedure.