Journal List > Korean J Gastroenterol > v.59(5) > 1006954

TOOLS
Seok, Shon, Seo, Choi, Chung, and Won: Gastroduodenal Intussusception Due to Pedunculated Polypoid Gastrointestinal Stromal Tumor
Case Report
The Korean Journal of Gastroenterology

The Korean Journal of Gastroenterology 2012; 59(5): 372-376.

Published online: 21 May 2012

DOI: https://doi.org/10.4166/kjg.2012.59.5.372

Gastroduodenal Intussusception Due to Pedunculated Polypoid Gastrointestinal Stromal Tumor

Hyo Sun Seok, Chong Il Shon, Hyun Il Seo, Young Ghil Choi, Won Gil Chung, Hyun Sun Won

Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, Seoul, Korea.

Correspondence to: Chong Il Shon, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul 110-746, Korea. Tel: +82-2-2001-2050, Fax: +82-2-2001-2049, Chongil.sohn@samsung.com

Received 4 January 2011       Revised 27 January 2011       Accepted 18 February 2011

Copyright © 2012 The Korean Society of Gastroenterology

(open-access):

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The gastrointestinal stromal tumor (GIST) is a mesenchymal tumor of the digestive tract showing differentiation along the line of interstitial cell of Cajal. The most GISTs in the stomach generally show the appearance of submucosal tumors. It is rare for GISTs to appear as a pedunculated polypoid lesion on endoscopy. We experienced a case of a 51-year-old man who had a pedunculated polypoid GIST. He was admitted to our hospital for nausea, vomiting, melena and severe anemia (hemoglobin 3.4 g/dL, hematocrit 10.8%). An upper endoscopy showed gastroduodenal intussusception due to a pedunculated polypoid mass. This report presents a rare case of endoscopically proven gastroduodenal intussusceptions due to pedunculated polypoid GIST in the stomach.

Keywords: Gastrointestinal stromal tumors, Polyps, Intussusception

Figures and Tables

Fig. 1
An endoscopic finding. (A) Endoscopy showed abnormal convergence of the gastric folds from antrum toward the pylorus, suggesting intussuception in the duodenum. (B) The surface of mass was hemorrhagic and showed uneven granular appearance on the retroflexed view in the duodenal 2nd portion.
kjg-59-372-g001
Fig. 2
Abdominal CT finding. (A) Abdominal CT scan showed full thickeness invagination of the proximal antrum with the omentum in the duodenum. pA, proximal antrum; dA, distal antrum; O, omentum; P, pyloric ring; D, duodenum. (B) It showed intussuscepted heterogenous low density mass into the 2nd portion of the duodenum and no regional lymph node enlargement.
kjg-59-372-g002
Fig. 3
Gross findings of resected specimen. The resected tumor was 5.5×4.2×1.7 cm in size. The mass showed brownish granular apperance with hemorrhage.
kjg-59-372-g003
Fig. 4
Histopathologic findings (×400). (A) The tumor cells was composed of epithelioid cells with mitosis (H&E). The tumor cells was positive for CD 117 (B) and CD34 (C).
kjg-59-372-g004
Table 1
Reports of the Cases of the Pedunculated Polypoid Gastrointestinal Stromal Tumors
kjg-59-372-i001

M, male; F, female; Hg, hemoglobin; HPF, high-power field; NM, not mentioned.

Notes

Financial support: None.

Conflict of interest: None.

References

1. Nowain A, Bhakta H, Pais S, Kanel G, Verma S. Gastrointestinal stromal tumors: clinical profile, pathogenesis, treatment strategies and prognosis. J Gastroenterol Hepatol. 2005. 20:818–824.
2. Hirota S, Isozaki K, Moriyama Y, et al. Gain-of-function mutations of c-kit in human gastrointestinal stromal tumors. Science. 1998. 279:577–580.
3. Choi SH, Han JK, Kim SH, et al. Intussusception in adults: from stomach to rectum. AJR Am J Roentgenol. 2004. 183:691–698.
4. Casali PG, Blay JY. Esmo/conticanet/eurobonet Consensus Panel of Experts. conticanet/eurobonet Consensus Panel of Experts. Gastrointestinal stromal tumours: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2010. 21:Suppl 5. v98–v102.
5. Lanza FL, Graham DY, Nelson RS, Godines R, McKechnie JC. Endoscopic upper gastrointestinal polypectomy. Report of 73 polypectomies in 63 patients. Am J Gastroenterol. 1981. 75:345–348.
6. Goenka MK, Bhasin DK, Singh V, et al. Gastric stromal tumor: treatment by snare polypectomy. Trop Gastroenterol. 1996. 17:43–46.
7. Kim IH, Kim PS, Lee DH, et al. Gastric malignant stromal tumor with long stalk impacted into duodenum. Yonsei Med J. 1999. 40:510–513.
8. Crowther KS, Wyld L, Yamani Q, Jacob G. Case report: gastroduodenal intussusception of a gastrointestinal stromal tumour. Br J Radiol. 2002. 75:987–989.
9. Adjepong SE, Parameswaran R, Perry A, et al. Gastroduodenal intussusception due to gastrointestinal stromal tumor (GIST) treated by laparoscopic billroth II distal gastrectomy. Surg Laparosc Endosc Percutan Tech. 2006. 16:245–247.
10. Tahara T, Shibata T, Nakamura M, et al. Gastrointestinal stromal tumor of the stomach with narrow stalk-like based, uneven protruding appearance presenting with severe acute anemia despite small size. Case Rep Gastroenterol. 2010. 4:111–117.
11. Gupta P, Tewari M, Shukla HS. Gastrointestinal stromal tumor. Surg Oncol. 2008. 17:129–138.
12. Lin F, Setya V, Signor W. Gastroduodenal intussusception secondary to a gastric lipoma: a case report and review of the literature. Am Surg. 1992. 58:772–774.
13. Ha HK, Shinn KS, Kim IC, Bahk YW. Gastroduodenal intussusception due to a prolapsed gastric adenoma. AJR Am J Roentgenol. 1992. 159:432.
14. Son JI, Lee JH, Lee SI, et al. A case of gastroduodenal intussusception secondary to gastric carcinoid tumor. Korean J Gastroenterol. 2001. 38:288–291.
15. Lin JT. Endoscopic diagnosis of gastroduodenal intussusception. Endoscopy. 1996. 28:324.
16. Miettinen M, Lasota J. Gastrointestinal stromal tumors: review on morphology, molecular pathology, prognosis, and differential diagnosis. Arch Pathol Lab Med. 2006. 130:1466–1478.
17. Kang YK, Kim KM, Sohn T, et al. Korean GIST Study Group. Clinical practice guideline for accurate diagnosis and effective treatment of gastrointestinal stromal tumor in Korea. J Korean Med Sci. 2010. 25:1543–1552.
18. Demetri GD, von Mehren M, Blanke CD, et al. Efficacy and safety of imatinib mesylate in advanced gastrointestinal stromal tumors. N Engl J Med. 2002. 347:472–480.
19. Ho MY, Blanke CD. Gastrointestinal stromal tumors: disease and treatment update. Gastroenterology. 2011. 140:1372–1376.
20. Dematteo RP, Ballman KV, Antonescu CR, et al. American College of Surgeons Oncology Group (ACOSOG) Intergroup Adjuvant GIST Study Team. Adjuvant imatinib mesylate after resection of localised, primary gastrointestinal stromal tumour: a randomised, double-blind, placebo-controlled trial. Lancet. 2009. 373:1097–1104.
TOOLS
ORCID iDs

Hyun Il Seo
https://orcid.org/http://orcid.org/0000-0002-0339-5031

Similar articles