Duodenal stromal tumor in a high-risk pregnancy: a case report and literature review.

backgroundGastrointestinal stromal tumor (GIST) is an extremely rare occurrence in pregnancy and, it can be challenging to manage. There is currently no consensus on the management of GIST during pregnancy. CASE PRESENTATION: A 36-year-old woman with a scarred uterus presented with melena and vomiting at 17 weeks of gestation. She was profoundly anemic, with a hemoglobin of 58.0 g/L. Gastroduodenoscopy revealed an ulcerated, 20 mm mass capped with fresh blood in the descending duodenum. Endoscopic ultrasonography revealed a heterogeneous hypoechoic mass with a clear boundary and rich blood flow originating from the muscularis propria. A week later and after multidisciplinary discussion, the patient underwent duodenectomy. Postoperative pathology confirmed a diagnosis of duodenal stromal tumor of mixed spindle/epithelioid cell type, with a low risk of recurrence. A full-term healthy baby was delivered by cesarean section, and there were no signs of recurrence three years later.

conclusionsA review of 20 reported cases of GIST in pregnancy reveals that surgical intervention is feasible during gestation, particularly in the second trimester, and that delivery outcomes are generally favorable. In this case, multidisciplinary collaboration enabled successful duodenal tumor resection at 18 weeks of gestation, followed by term delivery and sustained recurrence-free survival at three years. These findings underscore the importance of individualized surgical timing, multidisciplinary teamwork, and shared decision-making in managing GIST during high-risk pregnancy.