Importance of preoperative imaging of duodenal gastrointestinal stromal tumors for the choice of a surgical procedure

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. Almost 95% of GISTs express a specific stem cell growth factor receptor (c-kit; protein, CD117), as shown by an immunohistochemical analysis. About 70% of GISTs appear in the stomach, 20% in the small intestine and 10% in the colon, rectum and other sites of the GI tract and peritoneal cavity. Duodenal GISTs account for nearly 0.1% of all GI tumors. Two cases presented in the report demonstrate the critical importance of preoperative imaging for the choice of a surgical procedure for a duodenal GIST. In the case of a big decaying tumor of the second portion of the duodenum penetrating into the pancreatic head, the Whipple procedure was performed, whereas a pancreas-preserving duodenumectomy, type 1b, was done for a relatively small tumor of the third part of the duodenum without adventitia and lymphatic node involvement.