Resected duodenal gastrointestinal stromal tumour with an affected margin and exon 9 mutation:  adjuvant therapy.
We report on a 44-year-old female patient complaining of epigastric pain with an initial diagnosis of acute pancreatitis. Three months later, the symptoms reappeared and an abdomen computed tomography scan showed a mass in the third portion of the duodenum. After surgical resection, the pathologist confirmed malignant mesenchymal proliferation with a mitotic index of 2 mitoses/50 HPF. There was no tumour necrosis. The proliferation index (Ki 67) was 2%. A mutational analysis was carried out, which identified a mutation in c-KIT exon 9, with duplication of codons 502 and 503. A radical surgery was rejected by the patient and adjuvant therapy with imatinib at an initial dose of 400 mg/day was considered, with the intention of increasing the dose to 800 mg/day because of the presence of mutation in c-KIT exon 9 related to a poor response to imatinib. However, because of the adverse effects, the increase in the dose was ruled out, and the patient completed 1 year of adjuvant therapy with no evidence of disease relapse.
Medical Oncology Unit, La Paz Hospital bCIOCC, Madrid, Spain. nuria.rodriguez@salud.madrid.org
Nuria Rodríguez
NR
Salas
Antonio
A
Cubillo
D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001549:Benzamides; D017024:Chemotherapy, Adjuvant; D004252:DNA Mutational Analysis; D004305:Dose-Response Relationship, Drug; D004379:Duodenal Neoplasms / Q000188:drug therapy / Q000235:genetics / Q000473:pathology / Q000601:surgery*; D005091:Exons; D005260:Female; D046152:Gastrointestinal Stromal Tumors / Q000188:drug therapy / Q000235:genetics / Q000473:pathology / Q000601:surgery*; D006801:Humans; D000068877:Imatinib Mesylate; D064847:Multimodal Imaging; D009154:Mutation; D010879:Piperazines / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D049268:Positron-Emission Tomography; D019009:Proto-Oncogene Proteins c-kit / Q000235:genetics*; D011743:Pyrimidines / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed
D000970:Antineoplastic Agents; D001549:Benzamides; D010879:Piperazines; D011743:Pyrimidines; D000068877:Imatinib Mesylate; D019009:Proto-Oncogene Proteins c-kit