Introducere: Tumorile stromale gastrointestinale (GIST) sunt rare si, desi sunt cele mai frecvente neoplasme mezenchimale (care provin din celulele Cajal) ale tractului digestiv, reprezinta <1% din toate tumorile maligne gastrointestinale. GIST-urile care provin din duoden sunt relativ rare, reprezentand <5% din toate GIST-urile. Rareori au fost raportate GIST-uri duodenale gigante (>15 cm). Materiale și metode: O femeie de 70 de ani a fost spitalizata cu dureri abdominale superioare și disconfort. Pacienta a avut antecedente de rezectie anterioara pentru cancer rectal (adenocarcinom, G2, T3N0M0) cu radioterapie preoperatorie si chimioterapie adjuvanta (patru cure). La examenul fizic, in cadranul superior drept al abdomenului s-a palpat o masa dura. CA 19-9 – 2,5 U/ml si CEA – 2 ng/ml. Tomografia computerizata a abdomenului a evidentiat o formatiune lobulata (16x12x7cm, +50 HU) cu zone de necroza in cadranul superior drept. Nu s-a vizualizat invazie evidenta a organelor adiacente. Originea acestei leziuni a fost incerta in baza aspectului imagistic. Rezultate: Laparotomia a fost efectuata pentru diagnosticul si tratamentul formatiunii abdominale. La explorarea cavitatii abdominale s-a depistat o masa solida uriasa, cu originea din peretele anterior al duodenului (D1). Tumora a fost excizata cu rezectie in pana si inchiderea primara a duodenului. Examenul histopatologic: tumora a fost compusa din celule fusiforme, cu zone de necroza si hemoragie, mitoze-21/50HPF. Analiza imunohistochimica a evidentiat colorare pozitiva pentru CD117 (KIT) și DOG1 si colorare negativa pentru CD34, S-100 si actina α-muschilor netezi (SMA). Evolutia postoperatorie a fost fara evenimente. A inceput sa ia imatinib ca terapie tintita adjuvanta. Supravegherea pe parcursul a doi ani a demonstrat ca nu exista recidive si progresie a bolii. Concluzii: GIST-urile gigante care provin din duoden sunt rare. Rezectia R0 cu terapie tintita adjuvanta este metoda de electie.

Introduction: Gastrointestinal stromal tumors (GISTs) are rare and, although they are the most common mesenchymal neoplasms (originating from Cajal cells) of gastrointestinal tract, they account for <1% of all gastrointestinal malignancies. GISTs arising from the duodenum are relatively rare, accounting for <5% of all GISTs. Giant duodenal GISTs (>15 cm) have rarely been reported. Materials and Methods: A 70-year-old woman was referred with upper abdominal pain and discomfort. The patient had a past history of anterior resection for rectal cancer (adenocarcinoma, G2, T3N0M0) with preoperative radiotherapy and adjuvant chemotherapy (four courses). On physical examination, a hard mass was palpable in the right upper quadrant. CA 19-9 – 2.5 U/ml and CEA – 2 ng/ml. Abdominal computed tomography revealed a lobulated mass (16x12x7 cm, +50 HU) with areas of necrosis in the right upper quadrant. There was no obvious invasion to adjacent organs. The origin of this lesion was uncertain based on its appearance on imaging. Results: Laparotomy was performed for diagnosis and treatment of the abdominal mass. On exploration of the abdominal cavity, a huge solid mass was originating from the anterior wall of duodenum (D1). Tumor was removed with wedge resection and primary closure of the duodenum. Histopathological examination: tumor was composed of spindle cells, with areas of necrosis and bleeding, mitosis-21/50HPF. Immunohistochemistry analysis revealed positive staining for CD117 (KIT) and DOG1, and negative staining for CD34, S-100, and α-smooth muscle actin (SMA). Her postoperative course was uneventful. She begun imatinib as adjuvant chemotherapy. Follow-up during two years demonstrated no recurrence and progression of disease. Conclusions: Giant GISTs arising from the duodenum are rare. R0 resection with adjuvant target therapy is the method of choice.