title: Duodenal gastrointestinal stromal tumor: From clinicopathological features to surgical outcomes.
abstract: Duodenal gastrointestinal tumors represent an extremely rare subset of stromal tumors arising from interstitial cells of Cajal. In the last 30 years the comprehension of the pathophysiology and natural history of this previously misunderstood clinical entity, in association with developments in endoscopy, imaging technology, and immunohistochemistry has resulted in novel diagnostic and treatment approaches. This is a comprehensive review of the current data of the literature on the various aspects of the diagnosis and treatment of these tumors. The duodenum is the less commonly involved site for these tumors in the digestive tract. Endoscopy and computed tomography can usually establish the diagnosis, confirmed by immunohistochemical staining and occasionally molecular genetic analysis. Endoscopic ultrasound with fine needle aspiration has been recently found to be the gold diagnostic standard with high sensitivity and specificity rates, diagnosing GIST in up to 80% of patients. Due to the complex anatomy of the pancreatico-duodenal region optimal therapeutic strategy of duodenal GISTs are challenging. Nevertheless surgical resection with microscopically clear resection margins seems to be the only potentially curative treatment for non-metastatic primary GISTs of the duodenum. Imatinib mesylate plays a key role in the management of GISTs both as neoadjuvant therapy and in patients with recurrent and metastatic disease. Meanwhile, the advances in the comprehension of the pathophysiology and natural history of this previously misunderstood clinical entity as well as the treatment of these tumors may render feasible, in the near future, the advent of newer and more effective treatment options.
authors.affiliation: Unit of General and Minimally Invasive Surgery, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100, Siena, Italy. Electronic address: marano.luigi@email.it.
authors.forename: L
authors.initials: L
authors.lastname: Marano
authors.affiliation: Unit of General and Minimally Invasive Surgery, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100, Siena, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Boccardi
authors.affiliation: Unit of General and Minimally Invasive Surgery, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100, Siena, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Marrelli
authors.affiliation: Unit of General and Minimally Invasive Surgery, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100, Siena, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Roviello
mesh_terms: D017677:Age Distribution; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001549:Benzamides / Q000627:therapeutic use*; D044963:Biopsy, Fine-Needle; D016099:Endoscopy, Gastrointestinal; D019160:Endosonography; D005060:Europe / Q000453:epidemiology; D005770:Gastrointestinal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology / Q000628:therapy*; D046152:Gastrointestinal Stromal Tumors / Q000175:diagnosis* / Q000453:epidemiology / Q000556:secondary / Q000628:therapy*; D006801:Humans; D000068877:Imatinib Mesylate; D007150:Immunohistochemistry; D007211:Indoles / Q000627:therapeutic use; D009154:Mutation; D016577:Pancreaticoduodenectomy; D010671:Phenylurea Compounds / Q000627:therapeutic use; D010879:Piperazines / Q000627:therapeutic use*; D015995:Prevalence; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use*; D019009:Proto-Oncogene Proteins c-kit / Q000235:genetics*; D011725:Pyridines / Q000627:therapeutic use; D011743:Pyrimidines / Q000627:therapeutic use*; D011758:Pyrroles / Q000627:therapeutic use; D017678:Sex Distribution; D000077210:Sunitinib; D014481:United States / Q000453:epidemiology
chemical_list: D000970:Antineoplastic Agents; D001549:Benzamides; D007211:Indoles; D010671:Phenylurea Compounds; D010879:Piperazines; D047428:Protein Kinase Inhibitors; D011725:Pyridines; D011743:Pyrimidines; D011758:Pyrroles; C559147:regorafenib; D000068877:Imatinib Mesylate; D019009:Proto-Oncogene Proteins c-kit; D000077210:Sunitinib
keywords: Duodenal tumors; Gastrointestinal stromal tumors; Imatinib; Pancreaticoduodenectomy; Tyrosine kinase inhibitors