Stromal Tumor with Lymph Node Metastases of the Duodenum -Report of a Case-

Shizuhiro Hirata, Masahiko Kawamoto¹⁾, Hiroshi Nakashima, Toru Yamasaki, Kazumitsu Nagafuchi, Hideki Kishikawa, Hirotoshi Yonemasu²⁾

Department of Surgery, Wakamatsu City Hospital
¹⁾Department of Surgery, Harasanshin Hospital
²⁾Second Department of Pathology, Kyushu University Faculty of Medicine

Primary malignant tumors rarely arise from the duodenum. We report a case of a duodenal stromal tumor with lymph node metastases, and discuss this case in relation to the literature. A 45-year-old woman was hospitalized with complaints of anemia and fatigue. We detected a submucosal tumor (5.3×3.5×2.5 cm) in the post-bulbar portion of the duodenum. Histological findings of the biopsy specimen suggested leiomyoma or leiomyosarcoma. Local resection of the tumor and sampling of regional lymph nodes were performed. In the resected specimen, the tumor cells were immunohistochemically positive for Vimentin, α smooth muscle actin and S-100 protein, It was diagnosed as a stromal tumor (combined smooth muscle neural type). Histological examination revealed low-grade malignancy, but two of four lymph nodes examined showed metastasis. Therefore pylorus-preserving pancreaticodudenectomy (PpPD) was carried out to complete the lymph adenectomy 3 weeks later. One of the dissected lymph nodes showed metastasis. A stromal tumor with lymph node metastasis is reported to be rare and it is still controversial whether lymph adenectomy improves the prognosis. But this case suggest that concurrent regional lymph adenectomy may be beneficial for a large stromal tumor with evident lymph adenopathy.

Key words
stromal tumor of the duodenum, combined smooth muscle neural type, lymph node metastasis

Reprint requests
Shizuhiro Hirata Department of Surgery, Wakamatsu City Hospital
1-8-3 Hakusan, Wakamatsu-ku, Fukuoka, 808-0035 JAPAN

Accepted
June 10, 1998

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