Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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A Case of Duodenal Gastrointestinal Stromal Tumor Mimicking a Vascular Neoplasm

점막하 혈관 종양으로 오인된 십이지장 위장관 기질종양 1예

  • Yang, Jung-Kyung (Department of Internal Medicine, Konyang University College of Medicine) ;
  • Kim, Yong-Seok (Department of Internal Medicine, Konyang University College of Medicine) ;
  • Koo, Hoon-Sup (Department of Internal Medicine, Konyang University College of Medicine) ;
  • Kim, Kwang-Il (Department of Internal Medicine, Konyang University College of Medicine) ;
  • Kim, Sun-Moon (Department of Internal Medicine, Konyang University College of Medicine) ;
  • Im, Euyi-Hyeog (Department of Internal Medicine, Konyang University College of Medicine) ;
  • Huh, Kyu-Chan (Department of Internal Medicine, Konyang University College of Medicine) ;
  • Lee, Sang-Eok (Department of General Surgery, Konyang University College of Medicine)
  • 양정경 (건양대학교 의과대학 내과학교실) ;
  • 김용석 (건양대학교 의과대학 내과학교실) ;
  • 구훈섭 (건양대학교 의과대학 내과학교실) ;
  • 김광일 (건양대학교 의과대학 내과학교실) ;
  • 김선문 (건양대학교 의과대학 내과학교실) ;
  • 임의혁 (건양대학교 의과대학 내과학교실) ;
  • 허규찬 (건양대학교 의과대학 내과학교실) ;
  • 이상억 (건양대학교 의과대학 외과학교실)
  • Received : 2009.10.28
  • Accepted : 2010.06.10
  • Published : 2010.07.30
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Abstract

Gastrointestinal stromal tumors (GIST) are the most common mesenchymal neoplasm of the gastrointestinal tract. They are preferentially located in the stomach and small intestine. However, the duodenum is an unusual location for GIST. Here we present a case of a 67-year-old woman with a GIST of the 3rd portion of duodenum mimicking vascular neoplasm as an obscure acute gastrointestinal bleeding. The upper gastrointestinal endoscopy and colonoscopy failed to find the lesion. Finally, a large protruded lesion with ulcer was found at the 3rd portion of duodenum using a colonoscope through the oral approach. A spurting bleeding was developed during hypertonic saline epinephrine injection for treatment of oozing bleeding at the margin of the ulcer. Abdominal 3D CT-angiography showed a round and hypervascular structure at the posterior wall of duodenum. A wedge resection of the third portion of the duodenum was performed. Microscopic findings revealed GIST.

위장관 기질종양은 위장관에서 가장 흔하게 관찰되는 비 상피성 종양으로 위장관 종양의 1%를 차지하며 십이지장에서 4.5%가량 나타나고 십이지장 중에서는 제2부에서 가장 흔한 것으로 알려져 있다. 저자들은 흑색변을 주소로 내원하여 상부위장관 내시경과 대장내시경검사로 원인을 찾지 못하여 대장내시경 기기를 이용한 구강접근으로 십이지장 제3부의 출혈 병변을 찾고 내시경과 혈관 조영 3차원 입체 복부 전산화단층촬영에서 점막하 혈관 종양 혹은 후복강 혈관종양을 의심하였지만 수술 후 십이지장 제3부의 위장관 기질종양으로 확진된 증례를 경험하였기에 보고한다.

Keywords

References

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