Presentation
Hematemesis.
Patient Data
Large, well-defined exophytic, highly vascularized solid mass lesion of the submucosal/mucosal extension seen in the hepatoduodenal area. It shows homogeneous enhancement with an internal hypoattenuating area, without internal calcifications or a hemorrhagic component.
The lesion exerts a mass effect upon adjacent organs.
No bowel obstruction.
Case Discussion
Findings are suggestive of a duodenal gastrointestinal stromal tumor (GIST).
GISTs are the most common mesenchymal tumor of the GI tract, rarely occurring before the age of 40. They mostly appear large, often reaching sizes of >10 cm, with central necrosis. However, lymph node enlargement is uncommon.
Although the tumor originates in the submucosa, it can be difficult to determine the site of origin of large tumors as they may become very large and exophytic and may ulcerate into the mucosa. GIST rarely causes bowel obstruction, even with large tumors and it is associated with Carney’s triad and NF-1.
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