Laparoscopic Resection of Incidentally Detected Early-Stage Synchronous Duodenal and Jejunal Gastrointestinal Stromal Tumors in a Patient with Neurofibromatosis Type 1.

introductionAlthough gastrointestinal stromal tumors (GISTs) are more common in neurofibromatosis type 1 (NF1) than in sporadic disease, the role of screening has not been well established. This case report details the successful laparoscopic resection for duodenal and jejunal GISTs detected during a general health check-up in an asymptomatic early-stage patient. CASE PRESENTATION: A 47-year-old female was diagnosed with NF1 during childhood. Abdominal ultrasonography performed during a general health check-up revealed a mass near the liver, in the region extending from the duodenal bulb to the hepatoduodenal ligament. Contrast-enhanced CT revealed the presence of a second mass in the jejunum. No clinical symptoms or findings, such as anemia or obstruction, were observed. Laparoscopic surgery was performed for both diagnostic and therapeutic purposes. Based on intraoperative findings, enucleation was selected for the periduodenal tumor partially attached to the duodenal wall, and partial intestinal resection was performed for the jejunal lesion. Capsule rupture did not occur in either tumor. Histopathology confirmed a 2.5-cm duodenal GIST and a 3.5-cm jejunal GIST. Both tumors showed a mitotic count of <1 per 50 high-power fields and were classified as belonging to the low-risk group according to established recurrence risk systems. The patient is currently under surveillance with no recurrence observed 2 years and 7 months postoperatively.

conclusionsThis case report describes an asymptomatic, early-stage duodenal and jejunal GISTs associated with NF1 that was successfully treated by minimally invasive laparoscopic surgery. Although routine screening is not currently recommended and a single case cannot establish its benefit, this case suggests a potential role for risk-based early detection strategies in selected patients.