PMC3619631_01
(a) shows intraoperative photograph of haemorrhagic exophytic anterior wall duodenal GIST. (b) demonstrates a clamp across the base of the tumour for intraoperative evaluation of bleeding cessation with the use of endoscopy. Local limited wedge resection was subsequently performed with clear margins. Surrounding bowel can be seen to be healthy allowing for a primary anastomosis.
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fig1
Emergency laparotomy identified a mass lesion on the anterior duodenal wall between the 3rd and 4th part of the duodenum (D3 and D4, resp.) (Figure 1). Continued haemorrhage was evident from the nasogastric tube, and a bowel clamp applied under the mass with an on-table OGD confirming haemostasis (Figure 1(b)).
Immunohistochemistry at microscopic level of GIST neoplasm. (a) demonstrates the 10x image with hematoxylin and eosin staining. The tumour had a mitotic index of 2/50 high power fields (HPF). (b) shows positive staining for CD117 (c-kit) which is characteristic of GIST tumours and (c) shows the tumour also staining positive for CD34.
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fig2
Microscopically (Figure 2), it showed strong positive staining for both CD117 (c-kit) and CD34, all being consistent with a gastrointestinal stromal tumour (GIST). 