Gastroduodenal intussusception and pylorus obstruction induced by a c-KIT-negative gastric gastrointestinal stromal tumor: case report and review of the literature

Abstract

Introduction Gastrointestinal stromal tumors (GISTs) are infrequently reported to cause gastroduodenal intussusception, especially in the cases with complete pylorus obstruction. GISTs comprise only 1 – 3 % of all gastrointestinal tract tumors, and most of them strongly express the c-KIT protein. Approximately 5 % of GISTs show negative staining of c-KIT.

Case presentation A 69-year-old man complained of acute abdominal pain accompanied with nausea and vomiting for 6 hours. Emergency endoscopic examination, upper gastroenterography, and computed tomography scan suggested gastroduodenal intussusception and pylorus obstruction induced by a gastric GIST. Laparoscopic exploration and wedge resection of the tumor were performed in the patient. Postoperative histological examination showed a gastric GIST with c-KIT-negative expression.

Conclusion Herein, we report the unique findings of a c-KIT-negative gastric GIST presenting with gastroduodenal intussusception and pylorus obstruction. We also reviewed the English language literature of gastroduodenal intussusception induced by GISTs and put our case in the context of the previously reported cases.

Zusammenfassung

Einleitung Gastrointestinale Stromatumoren (GIST) können gelegentlich eine gastroduodenale Invagination verursachen, insbesondere bei Patienten mit vollständiger Pylorusstenose. GIST stellen nur 1 % bis 3 % aller gastrointestinalen Tumoren dar, und die meisten zeigen eine starke Expression des c-KIT Proteins. Ungefähr 5 % aller GIST zeigen eine negative Färbung für c-KIT.

Fallbericht Ein 69-jähriger Patient klagte über akute Unterbauchschmerzen mit seit sechs Stunden anhaltender Übelkeit und Erbrechen. Die notfallmäßig durchgeführte endoskopische Untersuchung, Gastrografie und Computertomografie ließen auf eine gastroduodenale Invagination und Pylorusstenose schließen, hervorgerufen durch ein Magen-GIST. Es wurden eine laparoskopische Untersuchung und eine Wedge-Resektion des Tumors durchgeführt. Die postoperative histologische Untersuchung ergab einen Magen-GIST mit c-KIT-negativer Expression.

Schlussfolgerung Wir berichten hier über den außergewöhnlichen Befund eines c-KIT-negativen Magen-GIST mit gastroduodenaler Invagination und Pylorusstenose. Zudem haben wir die englischsprachige Literatur zu GIST-induzierter gastroduodenaler Invagination analysiert und unseren Fall mit bereits dokumentierten Fällen verglichen.

Key words

GIST - c-KIT-negative - gastroduodenal intussusception - pylorus obstruction

Schlüsselwörter

GIST - c-KIT-negativ - gastroduodenale Invagination - pylorusstenose

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