Case Report
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Dec 16, 2017; 9(12): 583-589
Published online Dec 16, 2017. doi: 10.4253/wjge.v9.i12.583
Endoscopic ultrasound-guided fine-needle aspiration for diagnosing a rare extraluminal duodenal gastrointestinal tumor
Kazunao Hayashi, Kenya Kamimura, Kazunori Hosaka, Satoshi Ikarashi, Junji Kohisa, Kazuya Takahashi, Kentaro Tominaga, Kenichi Mizuno, Satoru Hashimoto, Junji Yokoyama, Satoshi Yamagiwa, Kazuyasu Takizawa, Toshifumi Wakai, Hajime Umezu, Shuji Terai
Kazunao Hayashi, Kenya Kamimura, Kazunori Hosaka, Satoshi Ikarashi, Junji Kohisa, Kazuya Takahashi, Kentaro Tominaga, Kenichi Mizuno, Satoru Hashimoto, Junji Yokoyama, Satoshi Yamagiwa, Shuji Terai, Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
Kazuyasu Takizawa, Toshifumi Wakai, Division of Digestive and General Surgery, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
Hajime Umezu, Department of Pathology, Niigata University Medical and Dental Hospital, Niigata 951-8510, Japan
Author contributions: Hayashi K and Kamimura K wrote the manuscript; Hosaka K, Ikarashi S, Kohisa J, Takahashi K, Tominaga K, Mizuno K, Hashimoto S, Yokoyama J, Yamagiwa S, Terai S, Takizawa K and Wakai T diagnosed and treated the patient; Umezu H performed histological analysis; all authors read and approved the final version of the manuscript.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Niigata University.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report and accompanying images.
Conflict-of-interest statement: The authors declare that they have no current financial arrangement or affiliation with any organization that may have a direct influence on their work.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Kenya Kamimura, MD, PhD, Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachido-ri, Chuo-ku, Niigata, 951-8510, Japan. kenya-k@med.niigata-u.ac.jp
Telephone: +81-25-2272207 Fax: +81-25-2270776
Received: August 1, 2017
Peer-review started: August 4, 2017
First decision: September 1, 2017
Revised: September 4, 2017
Accepted: October 16, 2017
Article in press: October 17, 2017
Published online: December 16, 2017
Abstract

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 ultrasound-guided 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.

Keywords: Gastrointestinal stromal tumor, Duodenum, Extraluminal type, Pancreatic head tumor, Endoscopic ultrasonography, Endoscopic ultrasound-guided fine-needle aspiration, Partial resection

Core tip: Duodenal gastrointestinal stromal tumors are extremely rare disease entities, and the extraluminal type is difficult to diagnose. Therefore, these tumors have been misdiagnosed as pancreatic tumors; hence, pancreaticoduodenectomy has been performed, although partial duodenectomy can be performed if accurately diagnosed. Recent advances in developing endoscopic ultrasonography and endoscopic ultrasound-guided fine-needle aspiration are helpful for accurate diagnosis of the tumors located in the area and effective for performing the correct surgical procedure.