scholarly journals Single Surgical Approach for Gastric Gastrointestinal Stromal Tumor and Cholecystolitiasis by Laparoscopic Procedure

2021 ◽  
Vol 15 (4) ◽  
pp. 216
Author(s):  
Abdul Mughni ◽  
Vito Mahendra Ekasaputra ◽  
Siti Amarwati
Keyword(s):  
Gastrointestinal Stromal Tumor ◽  
Wedge Resection ◽  
Tumor Resection ◽  
Partial Gastrectomy ◽  
Early Mobilization ◽  
Gastric Fundus ◽  
Minimal Invasive ◽  
Stromal Tumor ◽  
Gastrointestinal Neoplasms ◽  
The Right

Introduction: Gastrointestinal stromal tumor (GIST) is a rare neoplasm representing 80% of gastrointestinal neoplasms. Laparoscopic resection is only recommended for GIST less than 2 cm and 5 cm for laparoscopic wedge resection. Thus, a large GIST is recommended to complete resection through laparotomy. A large GIST of the gastric fundus can be found in patients, which coincides with an upper right abdominal quadrant pain caused by cholecystolithiasis. A suggested laparotomy for tumor resection and cholecystectomy may result in poor recovery in the postoperative period. Therefore, one approach surgery with minimally invasive laparoscopic partial gastrectomy using Endoflex stapler and cholecystectomy was performed to achieve the optimal outcome.Case Presentation: A 43-year-old male had a major complaint of hematemesis and melena for one month and colicky pain in the right upper quadrant of the abdomen with increased intensity in the last two months. Contrast-enhanced abdominal MSCT revealed a solid 4.6 x 4 x 5.6 cm exophytic mass on the gastric fundus, added with 0.5 cm gall bladder stone. Laparoscopic partial gastrectomy and cholecystectomy were performed in a single minimal invasive surgical procedure. The post-operative period was uneventful. The patient experienced minimum pain, early mobilization, and better diet tolerance. He was discharged on day four after the surgery. Besides, the histopathologic result revealed a malignant mesenchymal tumor according to GIST with a tumor-free margin of resection.Conclusions: Single approach surgery with minimal laparoscopic partial gastrectomy and cholecystectomy has provided optimal outcomes for patients with large GIST and cholecystolithiasis.

scholarly journals Gastrointestinal Stromal Tumor Mimicking an Adrenal Incidentaloma: A Case Report

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A997-A997
Author(s):  
Sarah Hamidi ◽  
Frédéric Mercier ◽  
Isabelle Bourdeau ◽  
Agnes Rakel
Keyword(s):  
Differential Diagnosis ◽  
Case Report ◽  
Gastrointestinal Stromal Tumor ◽  
Tumor Resection ◽  
Partial Gastrectomy ◽  
Adrenal Incidentaloma ◽  
Stromal Tumor ◽  
Gastric Gist ◽  
Plasma Free Metanephrines ◽  
The Right

Abstract Background: The differential diagnosis of adrenal incidentalomas is broad and includes benign or malignant primary adrenal lesions, metastases, myelolipomas, infections or hemorrhage. We present here a patient with a gastrointestinal stromal tumor (GIST) presenting as an adrenal incidentaloma. Clinical Case: A 64-year-old man was referred to Endocrinology for the work-up of a left adrenal incidentaloma discovered on an abdominal CT scan performed for left upper quadrant abdominal pain. His past medical history included well-controlled type 2 diabetes and hypertension. On subsequent imaging, the mass was described as a solid homogenous nodule with a density of 31 HU and an absolute contrast washout of 22%. Between 2017 and 2020, the mass’ size increased from 14 x 13 to 24 x 19 millimeters. Further functional imaging revealed no 131I-MIBG uptake but moderate hypermetabolism on FDG PET-CT with a SUVmax of 4.5. There was discordance regarding the mass’ localization between the various imaging modalities used preoperatively: some showed a left adrenal lesion whereas others suggested that it was adjacent to, but distinct from, the adrenal gland. Biochemical workup included normal 1-mg dexamethasone suppression test, serum potassium levels, 24-hour urine fractionated catecholamines, as well as plasma free metanephrines and normetanephrines. Chromogranin A levels were also normal. In light of these findings, laparoscopic tumor resection, with or without left adrenalectomy, was scheduled. During surgery, it was discovered that the tumor was intraperitoneal, located next to the splenic hilum and originating from the greater curvature of the stomach; a partial gastrectomy was therefore performed, without left adrenalectomy. Pathological evaluation revealed that the mass was a small spindle cell-type GIST. Genetic analysis of the tumoral DNA showed a somatic mutation in exon 11 of the KIT gene (c.1658_1669del, p.Tyr553_Gln556del). Conclusion: We report a rare case of gastric GIST initially mimicking a left adrenal incidentaloma. Localization of GISTs in the adrenal area is rare, with very few cases reported to date in the literature. Unlike other cases described previously, our patient underwent the right procedure thanks to adequate tumor localization during surgery. However, as some patients have experienced unnecessary adrenalectomy for similar clinical presentations, gastric GISTs should be kept in mind in the differential diagnosis of non-functional atypical adrenal masses, especially in the presence of suspicious PET scan imaging. References: 1. Hexi Du, Jun Zhou, Cheng Yang, Li Zhang, Chaozhao Liang: Gastrointestinal stromal tumor masquerading as an adrenal tumor: a case report with literature review. Int J Clin Exp Med 2017;10(10):14883-14887.

scholarly journals A Giant Gastrointestinal Stromal Tumor of the Stomach with Extramural Growth

2016 ◽  
Vol 10 (2) ◽  
pp. 344-351 ◽  
Author(s):  
Ryosuke Miyazaki ◽  
Seiji Arihiro ◽  
Eri Hayashi ◽  
Takuya Kitahara ◽  
Sayumi Oki ◽  
...  
Keyword(s):  
Gastrointestinal Stromal Tumor ◽  
Tumor Resection ◽  
Partial Gastrectomy ◽  
Major Axis ◽  
Anterior Wall ◽  
Stromal Tumor ◽  
Gastric Body ◽  
Abdominal Organs ◽  
Loss Of Appetite ◽  
Upper Abdominal

A 76-year-old man presented to our hospital with abdominal distention and loss of appetite. The 10% of weight lost relative to this patient in 1 month. Abdominal computed tomography and magnetic resonance imaging revealed a giant mass, with a major axis of 23 cm, containing solid components, not involving the upper abdominal organs. Esophagogastroduodenoscopy showed extramural compression from the middle gastric body to the antrum, as well as a normal mucosal surface. These findings were suggestive of a gastrointestinal stromal tumor attached to the anterior wall of the stomach without metastasis or invasion. Partial gastrectomy was performed for tumor resection, and the patient was subsequently treated with adjuvant imatinib. We report a rare case of a large extramural gastrointestinal stromal tumor of the stomach that was larger than 20 cm in diameter and present a pertinent literature review.

scholarly journals DISSEMINATED GASTROINTESTINAL STROMAL TUMOR IN PREGNANCY. A CASE REPORT

2020 ◽  
Vol 19 (6) ◽  
pp. 148-154
Author(s):  
A. G. Abdullaev ◽  
A. A. Kurbanov
Keyword(s):  
Gastrointestinal Stromal Tumor ◽  
Ultrasound Examination ◽  
Tumor Resection ◽  
Pregnant Patient ◽  
Anticancer Therapy ◽  
Stromal Tumor ◽  
Gastrointestinal Neoplasms ◽  
Optimal Timing ◽  
Sporadic Tumors ◽  
Made In

Background. Gastrointestinal stromal tumor (GIST ) is a rare neoplasm with an incidence of only 10–20 cases per million population. All gastrointestinal neoplasms may have malignant potential and most of them are sporadic tumors. GIST occurring during pregnancy is extremely rare, therefore, surgeons face challenging ethical, surgical and oncological issues. Case. We describe a clinical cause of GIST found at the 16–17-th week of pregnancy in a 31-year-old woman. The patient was under the supervision of obstetricians-gynecologists, radiologists and oncologists, and a weekly ultrasound examination was performed. Caesarean delivery was performed at the 26th week of pregnancy due to disease progression and in order to start anticancer therapy as soon as possible. Conclusion. We described the first reported case of a successful treatment in a 31-yearold pregnant patient with GIST of the small intestine complicated by peritoneal carcinomatosis and ascites. We compared our case with other reported cases of GIST during pregnancy and discussed the problems faced by both patients and surgeons. There are no recommendations on the optimal timing of tumor resection during pregnancy, and therefore key decisions must be made in a multidisciplinary team (MDT ), taking into account the wishes of the patient. Our clinical case demonstrates the feasibility of changing the approaches to the management and treatment of patients with intraperitoneal dissemination, as well as emphasizes the importance of interdisciplinary team including oncologists, obstetricians, gynecologists, neonatologists and other specialists.

scholarly journals TOMOGRAPHIC FINDINGS OF GASTRIC GASTROINTESTINAL STROMAL TUMOR AND CORRELATION WITH THE MITOTIC INDEX

2013 ◽  
Vol 50 (4) ◽  
pp. 244-250 ◽  
Author(s):  
Gustavo Lemos PELANDRÉ ◽  
Maria Célia DJAHJAH ◽  
Emerson Leandro GASPARETTO ◽  
Marcelo Souto NACIF ◽  
Edson MARCHIORI ◽  
...  
Keyword(s):  
Gastrointestinal Stromal Tumor ◽  
Mitotic Index ◽  
Statistical Correlation ◽  
Gastric Fundus ◽  
The Body ◽  
Stromal Tumor ◽  
Gastric Body ◽  
Dense Area ◽  
Stromal Tumors ◽  
Mesenteric Fat

ContextGastrointestinal stromal tumors are uncommon abdominal neoplasms and can affect any portion of the gastrointestinal tract.ObjectivesDescribe the tomographic findings of the gastrointestinal stromal tumor of gastric origin, correlating it with the mitotic index.MethodsTwenty-one patients were selected within the period of January 2000 and 2008, with histopathological and immunohistochemical diagnosis of gastric gastrointestinal stromal tumors, who presented computed tomography done before the treatment. The tomographic variables analyzed were lesion topography, dimensions, contours, morphology, pattern and intensity enhancement through venous contrast, growth pattern, invasion of adjacent organs, presence of ulceration, fistula, calcifications, infiltration of mesenteric fat, lymphadenopathy and metastasis. The mitotic index was determined through optic microscopy, counting the number of mitosis figures in 50 high power fields.ResultsThe tumors were located in the body (66.7%) or gastric fundus (33.3%), with dimensions varying between 4.2 and 21.2 cm (average of 10.5 cm). The growth was predominantly extraluminal (47.6%) or intra/extra luminal (28.6%). The enhancement by venous contrast was heterogeneous in 66.7%. The statistical analysis showed that irregular morphology (P = 0.027) and infiltration of mesenteric fat (P = 0.012) presented correlation with the high mitotic index.ConclusionsIn the present study, most part of the tumors were located in the gastric body, with average size of 10.5 cm, presenting central hypo dense area, heterogeneous enhancement through contrast and predominantly extra luminal growth. Irregular morphology and infiltration of mesenteric fat present statistical correlation with high mitotic level.

Fulminant Hepatic Failure Caused by Diffuse Liver Metastases following Gastrointestinal Stromal Tumor Resection

2009 ◽  
Vol 2 ◽  
pp. CGast.S3221
Author(s):  
Abdel-Rauf Zeina ◽  
Alicia Nachtigal ◽  
Eugene Vlodavsky ◽  
Jochanan E. Naschitz
Keyword(s):  
Liver Metastases ◽  
Gastrointestinal Stromal Tumor ◽  
Fulminant Hepatic Failure ◽  
Hepatic Failure ◽  
Tumor Resection ◽  
Stromal Tumor ◽  
Prognostic Features ◽  
Elevated Liver Enzymes ◽  
Complete Tumor

Metastatic tumors to the liver resulting in fulminant hepatic failure are a rare occurrence and have not been previously described in patients with gastrointestinal stromal tumor (GIST). A 70 year-old man was referred to hospital with postprandial discomfort. On examination a 19.5 cm large epithelioid GIST of the stomach was diagnosed. The mass exhibited unfavorable prognostic features: mitotic index 18/50 high-power fields, large primary tumor size and male sex. Complete tumor resection with negative margins was achieved and metastases were not detected. The patient presented six months later with jaundice, asterixis and elevated liver enzymes. Computerized tomography showed multiple liver hypodense lesions representing metastases. Treatment with imatinib mesylate was of no avail and the patient died 3 days later as the result of hepatic failure. Massive liver metastases can, even though rarely, be responsible for fulminant hepatic failure. Clinical and radiological follow-up are crucial in patients with GIST even after surgical resection.

scholarly journals Hybrid NOTES: Complete Endoscopic Resection of the Gastric Wall Assisted by Laparoscopy in a Gastric Fundus Gastrointestinal Stromal Tumor

2018 ◽  
Vol 26 (3) ◽  
pp. 215-217
Author(s):  
João Fernandes ◽  
Diogo Libânio ◽  
Sílvia Giestas ◽  
Tarcísio Araújo ◽  
José Ramada ◽  
...  
Keyword(s):  
Gastrointestinal Stromal Tumor ◽  
Endoscopic Resection ◽  
Gastric Wall ◽  
Gastric Fundus ◽  
Stromal Tumor ◽  
Hybrid Notes

scholarly journals An Intra-Abdominal Desmoid Tumor, Embedded in the Pancreas, Preoperatively Diagnosed as an Extragastric Growing Gastrointestinal Stromal Tumor

2017 ◽  
Vol 10 (1) ◽  
pp. 301-307 ◽  
Author(s):  
Mari Mizuno ◽  
Yoshiaki Kawaguchi ◽  
Aya Kawanishi ◽  
Yohei Kawashima ◽  
Atsuko Maruno ◽  
...  
Keyword(s):  
Gastrointestinal Stromal Tumor ◽  
Desmoid Tumor ◽  
Abdominal Cavity ◽  
Partial Gastrectomy ◽  
Abdominal Ultrasound ◽  
Needle Aspiration ◽  
Stromal Tumor ◽  
Conversion To Open Surgery ◽  
Enhanced Computed Tomography ◽  
Abdominal Desmoid Tumor

A 45-year-old woman was found to have a pancreatic tumor by abdominal ultrasound performed for a medical check-up. Abdominal contrast-enhanced computed tomography showed a hypovascular tumor measuring 30 mm in diameter in the pancreatic tail. Endoscopic ultrasound-guided fine needle aspiration was performed. An extragastric growing gastrointestinal stromal tumor was thereby diagnosed preoperatively, and surgical resection was planned. Laparoscopic surgery was attempted but conversion to open surgery was necessitated by extensive adhesions, and distal pancreatectomy, splenectomy, and partial gastrectomy were performed. The histological diagnosis was an intra-abdominal desmoid tumor. A desmoid tumor is a fibrous soft tissue tumor arising in the fascia and musculoaponeurotic tissues. It usually occurs in the extremities and abdominal wall, and only rarely in the abdominal cavity. We experienced a case with an intra-abdominal desmoid tumor that was histologically diagnosed after laparotomy, which had been preoperatively diagnosed as an extragastric growing gastrointestinal stromal tumor. Although rare, desmoid tumors should be considered in the differential diagnosis of intra-abdominal tumors. Herein, we report this case with a literature review.

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