Whipple procedure for duodenal gastrointestinal stromal tumors: A report of two cases

Gastrointestinal stromal tumors (GIST) are rare neoplasms that can grow anywhere along the GI tract. They comprise only 0.1 % to 3 % of all gastrointestinal tumors, and approximately 30 % of GISTs are malignant. They exhibit variable clinical presentations, ranging from incidental findings to symptomatic presentations such as gastrointestinal bleeding, abdominal pain, abdominal mass, or obstruction. Duodenal gastrointestinal stromal tumors are among the rarest subtypes, accounting for less than 4 % of all GISTs but up to 21 % of the resected ones.

We report two cases of duodenal GIST (dGIST) treated with the Whipple procedure. The first patient, a 73- year old woman, presented with dizziness, and lightheadedness. The patient had severe anemia requiring blood transfusions. Imaging revealed a mass with fistula formation. Subsequent endoscopy with biopsy confirmed the diagnosis of GIST. The second patient, a 48-year-old woman, presented with lightheadedness, melena and epigastric abdominal pain. Laboratory investigations revealed severe anemia. Urgent upper endoscopy revealed an ulcerated submucosal duodenal mass. Imaging demonstrated mass near the junction of the second and third part of the duodenum.

The surgical approach for GIST is usually influenced by tumor size, site, histopathological findings and overall risk assessment. Nevertheless, unlike other subtypes of GISTs, surgical management of duodenal GISTs poses unique challenges due to ongoing controversies regarding the most appropriate surgical approach.

Diagnosis of GIST can be challenging and is usually influenced by the presenting symptoms. The cornerstone of management in GIST is complete tumor resection with negative margins.