scholarly journals Laparoscopic Transgastric Resection of a Large Gastric GIST: A Case Report and Review of Literature

2021 ◽  
Vol 07 (04) ◽  
pp. e337-e341
Author(s):  
Eham Arora ◽  
Jaini Gala ◽  
Aditya Nanavati ◽  
Arun Patil ◽  
Ajay Bhandarwar
Keyword(s):  
Case Report ◽  
Wedge Resection ◽  
Laparoscopic Approach ◽  
Posterior Wall ◽  
Needle Aspiration ◽  
Primary Treatment ◽  
Resected Specimen ◽  
Gastric Gist ◽  
Mesenchymal Tumors ◽  
Transgastric Approach

Abstract Introduction Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastrointestinal (GI) tract. Their primary treatment is surgical. Case Report Here we report a case of a 36-year-old male patient who was being evaluated for weakness, anemia, and melena. Upper GI endoscopy showed a mass projecting into the lumen and an abdominal computed tomography (CT) confirmed a well-defined mass close to the lesser curvature on the posterior wall. An endoscopic ultrasound-guided fine needle aspiration suggested a diagnosis of GIST. After optimization, the patient was taken up for a laparoscopic transgastric resection of the GIST. The resected specimen measured 9.5 × 8.5 × 7.5 cm. Postoperatively, the patient recovered well and was discharged by the fifth postoperative day. Discussion While traditionally, open surgery has been advocated for GISTs, for fear of spillage and peritoneal seeding, the role of minimal access surgery has been growing in recent years. The use of a transgastric approach avoids the potential complication of luminal stenosis following a wedge resection of a tumor close to the cardia. Because lymphadenectomies are rarely required and local invasion is uncommon, a wide local resection is usually curative. Thus, a laparoscopic approach can be considered as the first line in uncomplicated GISTs, irrespective of tumor size.

scholarly journals Gastrointestinal Stromal Tumor of the Stomach with an Abscess Excised by Laparoscopic Surgery

2016 ◽  
Vol 10 (2) ◽  
pp. 399-405 ◽  
Author(s):  
Yoshiaki Maeda ◽  
Toshiki Shinohara ◽  
Tomonari Katayama ◽  
Akihisa Nagatsu ◽  
Noriaki Futakawa ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Ct Scan ◽  
Wedge Resection ◽  
Gastric Wall ◽  
Laboratory Data ◽  
Needle Aspiration ◽  
Gastric Gist ◽  
Abdominal Abscess ◽  
En Bloc ◽  
Lesser Curvature

Gastrointestinal stromal tumors (GISTs) of the stomach presenting as an intra-abdominal abscess are extremely rare. We herein report a case that underwent successful laparoscopic resection of gastric GIST presenting with an intra-abdominal abscess. A 70-year-old man presented with a 3-day history of acute upper abdominal pain with a fever. Laboratory data showed an elevated white blood cell count and C-reactive protein level. A CT scan revealed a mass of mixed solid and fluid components, measuring 5.5 cm, in the adjacent lesser curvature of the stomach. He was diagnosed as having an intra-abdominal abscess, and antibiotic therapy was administered. Consequently, his symptoms were relieved and a CT scan on the 7th day showed that the mass reduced and became homogenous. According to the results of a fine-needle aspiration biopsy, the tumor was suspected to be a GIST. Laparoscopic surgery with the 5-port approach was performed. The tumor existed in the lesser curvature of the stomach, and was excised en bloc with the omentum and gastric wall by wedge resection. The tumor measured 3.0 cm in diameter and originated from the serosal layer of the stomach. Histological findings showed spindle cells with a stromal growth pattern that was positive for c-kit (CD 117) and CD 34. The postoperative course was uneventful, and no recurrence has been noted in the 2 years since the operation. This is the first report of a case with gastric GIST with an intra-abdominal abscess that was successfully treated by laparoscopic surgery.

scholarly journals A137 LAPAROSCOPIC ENDOSCOPIC COOPERATIVE SURGERY FOR GASTROINTESTINAL STROMAL TUMOURS: EARLY EXPERIENCE IN A CANADIAN ACADEMIC CENTRE

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 122-123
Author(s):  
D J Low ◽  
A Fecso ◽  
T Chesney ◽  
J Mosko
Keyword(s):  
Case Report ◽  
Wedge Resection ◽  
Gastric Gist ◽  
Full Thickness ◽  
Review Of The Literature ◽  
Gastrointestinal Stromal Tumours ◽  
Canadian Experience ◽  
Endoscopic Guidance ◽  
Subepithelial Lesions ◽  
Laparoscopic Endoscopic Cooperative Surgery

Abstract Background Surgical resection with laparoscopic gastric wedge resection is commonly conducted for local management of gastrointestinal stromal tumours (GIST). However, resection margins are often difficult to appreciate for lesions with larger endophytic components. As a result, tumour margins may be compromised or excess tissue resected. Laparoscopic endoscopic cooperative surgery (LECS) was developed in Japan to overcome these technical challenges in the resection of subepithelial lesions, including GISTs. Here, we present a case report of an early Canadian experience utilizing LECS in the management of gastric GIST. Aims To describe a case report of an early Canadian experience of LECS for the resection of a gastric GIST. Methods We performed a review of the literature and describe a case of LECS. Results We present a 70-year-old female referred to our centre for endoscopic resection of a 2.5x2.5cm histologically confirmed gastric GIST (low mitotic index and no known metastases). Repeat endoscopic evaluation at our centre confirmed a 25-30mm subepithelial lesion with both exophytic (small) and endophytic (large) components. After tumour board review, we opted for a LECS approach. In the OR, the lesion was identified endoscopically and marked with a Dual J-Knife (Olympus). The margins were injected with a combination of Voluven, methylene blue, and dilute epinephrine. A circumferential incision was then completed using standard ESD technique. The lesion was subsequently identified laparoscopically, with endoscopic guidance, along the lesser curvature. The lesser omentum was mobilized for clear visualization of the serosa around the lesion. A full thickness incision was made endoscopically along the distal aspect of lesion. Full thickness resection was continued endoscopically for one third of the circumference of the lesion until gastric insufflation became compromised. Full thickness resection was completed laparoscopically under endoscopic guidance with grossly negative margins. The defect was closed with running laparoscopic sutures. Endoscopic leak test was performed which was negative. The specimen was retrieved and follow up pathology demonstrated a GIST with low mitotic index and negative margins without tumour rupture. Conclusions In a review of the literature, LECS appears to minimize tissue resection while maintaining R0 resection rates. This technique is especially useful for subepithelial lesions with larger endophytic and transmural components. It has an excellent safety profile with a less than 5% anastomotic leak rate. As such, the literature supports LECS as a suitable procedure for gastric subepithelial lesions <50 mm. However, further studies are needed to compare it systematically to conventional laparoscopic wedge resection in addition to other innovative endoscopic techniques such as STER and EFTR. Funding Agencies None

scholarly journals Laparoscopic gastric wedge resection as the method of choice in the treatment of gastrointestinal stromal tumors: A case report

2016 ◽  
Vol 144 (3-4) ◽  
pp. 211-214
Author(s):  
Dejan Stevanovic ◽  
Dragos Stojanovic ◽  
Damir Jasarovic ◽  
Nebojsa Mitrovic ◽  
Zorana Bokun-Vukasinovic
Keyword(s):  
Gastrointestinal Tract ◽  
Gastrointestinal Stromal Tumors ◽  
Histological Grade ◽  
Wedge Resection ◽  
Gastric Gist ◽  
Histopathological Analysis ◽  
Primary Therapy ◽  
Mesenchymal Tumors ◽  
Stromal Tumors ◽  
Common Group

Introduction. The gastrointestinal stromal tumors (GIST) are the most frequent mesenchymal tumors of the gastrointestinal tract. The surgery of resectable gastric GIST is the primary therapy for these tumors, but the decision regarding the surgical radicality of the procedures is still a point of discussion among surgeons and oncologists. Case Outline. A 74-year-old patient was admitted to hospital with signs of bleeding from the upper parts of the gastrointestinal tract. Urgent gastroscopy was performed and a subepithelial gastric lesion with bleeding ulceration was noted in the region of the fornix. A computed tomography scan of the abdomen showed a tumor in the fornix region with the dimensions of 48 ? 32 mm, which was growing mostly intraluminally. After an adequate preoperative preparation the patient underwent a laparoscopic wedge resection of gastric fornix with intramural tumor lesion. The histopathological analysis of the specimen showed a well differentiated GIST (histological grade G1), of the spindle cell type. Based on the immunohistochemical analysis of the specimen it was concluded that the patient was in the IA stage of the disease with a low risk of malignant progression. In the population of patients with GIST, this is the most common group (43%), with low malignant potential, and relapses present in only 3.6% of cases. The patient started with oral food intake on the first postoperative day, the first bowel movement occurred 36 hours after surgery, and the patient was released from hospital on the fourth postoperative day. Conclusion. Based on the aforementioned, we consider that the laparoscopic gastric wedge resection is a safe and efficient surgical procedure. This is primary therapy for most common group of patients with resectable gastric GIST.

scholarly journals A gastrointestinal stromal tumor: Case report

2006 ◽  
Vol 59 (9-10) ◽  
pp. 487-489
Author(s):  
Milivoje Vukovic ◽  
Nebojsa Moljevic ◽  
Dragan Krivokuca
Keyword(s):  
Small Intestine ◽  
Case Report ◽  
Surgical Resection ◽  
Kinase Inhibitor ◽  
Iliac Fossa ◽  
Primary Treatment ◽  
Clinical Findings ◽  
Mesenchymal Tumors ◽  
The Right ◽  
Surgery Department

Introduction. Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastrointestinal tract. They frequently occur in the stomach and small intestine, but they rarely occur in the colon and rectum. Case report. This is a case report of a patient with a GIST involving the cecum, and acute obstruction of the small intestine. A 47-year- old male patient was admitted to the emergency surgery department with abdominal pain and distension lasting for a few days. Clinical examination revealed tenderness in the right iliac fossa. Routine hematologic testing revealed anemia, and abdominal x-ray multiple air-fluid levels in the small intestine. Based on the clinical findings, we decided to perform an explorative laparotomy. A large cecal tumor was detected. The proximal parts of the small intestine were severely distended. Discussion and Conclusion. GISTs are more common in the stomach (60-70%) and the small intestine (25-35%), than in the colon, rectum and esophagus. The most frequent complications associated with GISTs are obstructions and hemorrhages. Surgical resection is the primary treatment of GISTs. Radiotherapy and chemotherapy are generally ineffective. Continuous postoperative follow-up is necessary, because most recurrences occur within the first 2 years after complete surgical resection. In the past few years, surgical resection was followed by adjuvant tyrosine kinase inhibitor therapy. .

scholarly journals Subclinical Needle Tract Seeding by Endoscopic Ultrasound-Guided Fine-Needle Aspiration for Pancreatic Cancer

2021 ◽  
pp. 977-982
Author(s):  
Nozomi Uozumi ◽  
Shoji Oura ◽  
Shinichiro Makimoto
Keyword(s):  
Pancreatic Cancer ◽  
Fine Needle Aspiration ◽  
Posterior Wall ◽  
Needle Aspiration ◽  
Pathological Examination ◽  
Resected Specimen ◽  
Fine Needle ◽  
Needle Tract ◽  
Needle Tract Seeding ◽  
Atypical Cells

A 77-year-old woman with epigastralgia was referred to our hospital. Abdominal computed tomography showed a hypointense mass in the pancreatic tail. Abdominal and endoscopic ultrasonography (EUS) showed a hypo-echoic mass, 25 × 25 mm in size, with pancreatic duct dilatation. EUS-guided fine-needle aspiration (EUS-FNA) was performed to the mass through gastric posterior wall. Pathological examination showed atypical cells growing papillary or tubular fashion, leading to the diagnosis of adenocarcinoma. Under the preoperative diagnosis of T2N0M0 pancreatic cancer, the patient underwent distal pancreatectomy and splenectomy. Macroscopic view of the resected specimen showed a presumed puncture-induced pancreatic pseudocyst adjacent to the pancreas. Pathological examination showed well-differentiated adenocarcinoma and a pseudocyst with presumed migrated atypical cells in the pseudocyst wall. The patient recovered uneventfully and has been on outpatient follow-up with adjuvant TS-1 therapy. Optimal treatment of pancreatic cancer naturally needs preoperative definitive diagnosis more strictly than other solid malignancies due to its much higher operative harm to the patients. EUS-FNA is a safe and effective diagnostic method but needs careful attention to the needle tract seeding.

A Band Lifting Assisted Method for Laparoscopic Resection of Gastrointestinal Stromal Tumors on the Posterior Wall of the Stomach

2010 ◽  
Vol 76 (1) ◽  
pp. 25-27
Author(s):  
Zhen-Ling Ji ◽  
Jun-Sheng Li ◽  
Wei Zhang
Keyword(s):  
Gastrointestinal Stromal Tumors ◽  
Wedge Resection ◽  
Surgical Techniques ◽  
Posterior Wall ◽  
Rubber Band ◽  
Surgical Margins ◽  
Laparoscopic Technique ◽  
Resected Specimen ◽  
Stromal Tumors ◽  
Linear Cutter

Laparoscopic surgical techniques are beneficial for the wedge resection of gastrointestinal stromal tumors (GISTs). We have developed a new technique of laparoscopic transgastric resection for GISTs of the posterior wall of the stomach, a band lifting wedge resection method that has been confirmed to ensure sufficient surgical margins around the resected specimen in 21 cases. GISTs located at the posterior wall of the stomach were collected for this study. Laparoscopic anterior gastrotomy was performed and a 9-Fr rubber band was looped around the base of the tumor, allowing it to be lifted up through the anterior gastrotomy. The lesion was transected using a laparoscopic linear cutter and the gastrotomy was then closed by sequential application of the linear cutter. Surgical specimens were examined immunohistochemically All GISTs were successfully and completely resected using the laparoscopic technique. The resected tumors were ellipse-shaped or round. Macroscopic examination of the resected specimens showed complete tumor excision with negative surgical margins in all patients. A band lifting method for transection of GISTs on the posterior wall of the stomach easily allows for sufficient surgical margins of GISTs. The technique is reliable and feasible for laparoscopic treatment of GISTs in the stomach.

scholarly journals Coexistence of Primary GEJ Adenocarcinoma and Pedunculated Gastric Gastrointestinal Stromal Tumor

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Aroub Alkaaki ◽  
Basma Abdulhadi ◽  
Murad Aljiffry ◽  
Mohammed Nassif ◽  
Haneen Al-Maghrabi ◽  
...  
Keyword(s):  
Digestive System ◽  
Wedge Resection ◽  
Gastroesophageal Junction ◽  
Pathological Examination ◽  
Gastric Gist ◽  
Gi Tract ◽  
Mesenchymal Tumors ◽  
Gastric Mass ◽  
Greater Curvature ◽  
Submucosal Resection

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the digestive system, although they account for only 0.1–3% of all gastrointestinal (GI) malignancies. They can arise anywhere along the GI tract with gastric predominance. Concurrent occurrence of GIST and gastroesophageal junction (GEJ) neoplasm is rare. We report a 55-year-old gentleman presenting with a polyp at the GEJ and a synchronous, large, and pedunculated gastric mass at the greater curvature. Those were treated with a wedge resection of the gastric pedunculated mass with negative margins along with transgastric submucosal resection of the GEJ polyp. Pathological examination confirmed synchronous invasive GEJ adenocarcinoma and a high-grade gastric GIST.

Premalignant and Malignant Lesions of the Heterotopic Pancreas in the Esophagus: a Case Report and Review of the Literature

2015 ◽  
Vol 24 (2) ◽  
pp. 235-239 ◽  
Author(s):  
Jan Ulrych ◽  
Vladimir Fryba ◽  
Helena Skalova ◽  
Zdenek Krska ◽  
Tomas Krechler ◽  
...  
Keyword(s):  
Case Report ◽  
Gastrointestinal Tract ◽  
Unusual Case ◽  
Accurate Diagnosis ◽  
Heterotopic Pancreas ◽  
Premalignant Lesions ◽  
Resected Specimen ◽  
Review Of The Literature ◽  
Severe Dysphagia ◽  
Malignant Lesions

Heterotopic pancreas is a congenital pathology of the gastrointestinal tract, particularly rare in the esophagus. Both symptomatology and findings during preoperative examinations are non-specific and therefore do not often lead to an accurate diagnosis, which is usually revealed only by histopathological assessment of a resected specimen. We report an unusual case of a patient suffering from severe dysphagia caused by heterotopic pancreas in the distal esophagus with chronic inflammation and foci of premalignant changes. This article also reviews 14 adult cases of heterotopic pancreas in the esophagus previously reported in the literature, with the aim of determining the clinical features of this disease and possible complications including rare premalignant lesions and malignant transformation. Especially with regard to those complications, we suggest that both symptomatic and incidentally found asymptomatic lesions should be resected.

Sign in / Sign up

Export Citation Format

Share Document