CONTEXT: @entity674 (GISTs) are uncommon and constitute a relatively small subset of GISTs which presents a unique dilemma having various surgical options. A case of a large ulcerating duodenal @entity677 arising from the second and third parts of the duodenum and involving the pancreas which was managed by a Whipple resection is presented. The literature is also reviewed to present the current status on surgical options, outcome, prognostic indicators and the role of @entity2213 mesylate in its management. CASE REPORT: A 58-year-old @entity1 presented with @entity360 which was diagnosed to be due to a duodenal @entity677 following CT scan and endoscopic biopsy. The mass which measured about 10x9 cm originated from the 2nd part and extended into the 3rd part of the duodenum. He underwent a Whipple resection, and histopathology confirmed a duodenal @entity677 having a greater than 10 mitotic count per fifty high power field and areas of @entity39 . Postoperatively, he received @entity2213 400 mg bid; however, 4 months later, he presented with multiple disseminated peritoneal metastases and succumbed to the disease 2 months later. CONCLUSION: GISTs of the duodenum which are small in size and do not involve the papilla of Vater are better resolved using a limited resection of the duodenum since the outcome in terms of operative risk or disease recurrence is not influenced in these cases. However, large @entity5 with more extensive involvement would require a pancreaticoduodenectomy to achieve adequate @entity5 clearance. Even though duodenal GISTs have a relatively better prognosis as compared to GISTs at other sites, their @entity146 ranges from small indolent @entity5 to @entity146 . Following @entity5 resection, a recurrence rate of about 40% has been reported. A more favorable prognosis in duodenal GISTs is attributed to a lower prevalence of @entity876 loss, the duodenal location of the @entity5 , a smaller size of the lesion and a low mitotic count. @entity2213 is reported to play a role in neoadjuvant therapy as well as in the management of metastatic and recurrent disease, although some of these @entity5 may fail to respond.

Large duodenal XXXX presenting with acute bleeding managed by a whipple resection. A review of surgical options and the prognostic indicators of outcome.

@entity1 :: ('9606', 'Species') :: ['patient'] @entity677 :: ('MESH:C564650', 'Disease') :: ['GIST'] @entity39 :: ('MESH:D009336', 'Disease') :: ['necrosis'] @entity5 :: ('MESH:D009369', 'Disease') :: ['tumor', 'tumors'] @entity146 :: ('MESH:D001523', 'Disease') :: ['aggressive sarcomas', 'aggressiveness'] @entity876 :: ('7157', 'Gene') :: ['P53'] @entity674 :: ('MESH:D046152', 'Disease') :: ['Duodenal gastrointestinal stromal tumors'] @entity360 :: ('MESH:D006471', 'Disease') :: ['acute gastrointestinal bleeding'] @entity2213 :: ('MESH:C097613', 'Chemical') :: ['imatinib', 'Imatinib mesylate', 'imatinib mesylate']
@entity674 :: (MESH:D046152,Disease) :: ['gastrointestinal stromal tumor']
