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Background and objective: Gastrointestinal stromal tumors (GISTs) are rare mesenchymal neoplasms of the gastrointestinal tract, most commonly affecting middle-aged and elderly patients. They arise from the interstitial cells of Cajal and are frequently associated with mutations in the c-KIT or PDGFRA genes. We present a case of a young adult with a massive abdominal GIST and omental metastases, successfully treated with complete surgical resection. This case highlights that even extremely large tumors in complex anatomical regions may be amenable to curative surgery with careful planning and adherence to oncological principles.

Method: A 24-year-old man presented with vague abdominal discomfort and a sensation of pressure when bending forward. He had no relevant medical or family history. Physical examination revealed a large, painless abdominal mass occupying most of the upper abdomen. CT imaging demonstrated a giant intra-abdominal tumor compressing adjacent organs.At laparotomy, a well-circumscribed, irregular spherical tumor measuring approximately 20 × 20 cm was identified, with multiple diverticular extensions, areas of necrosis and hemorrhage, and abundant pathological vascularization. The tumor was adherent but not invasive to surrounding structures. Two omental metastases measuring about 8 × 5 cm were also found. Complete oncological (R0) resection was achieved, including partial duodenal D4 resection, followed by primary interrupted duodenal suturing.

Result: The postoperative course was uneventful, and the patient was discharged on postoperative day five. Histopathological analysis confirmed GIST with features consistent with high-risk disease. The multidisciplinary oncology board recommended adjuvant therapy with imatinib. At eight months of follow-up, the patient remained free of recurrence and in good general condition. The case demonstrates that large GISTs with limited metastases can be safely resected with curative intent when appropriate surgical strategy is applied.

Summary: Giant duodenal GISTs in young patients are rare and may present with minimal symptoms despite significant tumor size. Careful surgical planning and radical oncological resection can enable complete R0 removal even in cases that initially appear inoperable. Combined surgical and targeted therapy offers favorable outcomes and should be considered in selected patients with advanced but potentially resectable disease.