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Harhar M, Harouachi A, Akouh N, Atmani A, Aabdi H, Bouhout T, Bennani A, Serji B, EL Harroudi T. Gastrointestinal stromal tumor in the fourth portion of the duodenum does not express the CD117: A case report. Ann Med Surg (Lond) 2022; 77:103560. [PMID: 35637997 PMCID: PMC9142376 DOI: 10.1016/j.amsu.2022.103560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/27/2022] [Accepted: 03/27/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the digestive tract. Presentation of case 54-year-old woman with a history of phyllodes tumor of the left breast he patient was admitted to our hospital for management of retroperitoneal soft tissue tumor, attached to the fourth portion of the duodenum, opposite the head of the pancreas. The patient underwent a large excision of the tumor, the duodenojejunal flexure, and the third and fourth portions of the duodenum along with the head of the pancreas. The histopathological examination confirmed the presence of a spindlecell mesenchymal proliferation. These cells do not express CD117, but they express DOG1. A PDGFRA mutation was identified later. The final diagnosis was duodenal GIST. Discussion few cases of GIST in the fourth portion of the duodenum had been reported in the literature. PDGFRA mutation is identified as GISTs tumorigenesis to 15% of cases, and the diagnosis of GISTs is not based solely on the expression of the protein Kit. Conclusion the molecular biology examinations are very helpful in the direction of the correct diagnosis in case of negative staining for CD117.
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Affiliation(s)
- Marouane Harhar
- Surgical Oncology Department, Regional Oncology Center, Mohammed VI University Hospital, Oujda, Morocco
- Mohammed First University Oujda, Faculty of Medicine and Pharmacy Oujda, Oujda, Morocco
| | - Abdelhakim Harouachi
- Surgical Oncology Department, Regional Oncology Center, Mohammed VI University Hospital, Oujda, Morocco
- Mohammed First University Oujda, Faculty of Medicine and Pharmacy Oujda, Oujda, Morocco
| | - Nada Akouh
- Mohammed First University Oujda, Faculty of Medicine and Pharmacy Oujda, Oujda, Morocco
- Department of Pathology, Mohammed VI University Hospital, Oujda, Morocco
| | - Abderrahmane Atmani
- Surgical Oncology Department, Regional Oncology Center, Mohammed VI University Hospital, Oujda, Morocco
- Mohammed First University Oujda, Faculty of Medicine and Pharmacy Oujda, Oujda, Morocco
| | - Houssam Aabdi
- Surgical Oncology Department, Regional Oncology Center, Mohammed VI University Hospital, Oujda, Morocco
- Mohammed First University Oujda, Faculty of Medicine and Pharmacy Oujda, Oujda, Morocco
| | - Tariq Bouhout
- Surgical Oncology Department, Regional Oncology Center, Mohammed VI University Hospital, Oujda, Morocco
- Mohammed First University Oujda, Faculty of Medicine and Pharmacy Oujda, Oujda, Morocco
| | - Amal Bennani
- Mohammed First University Oujda, Faculty of Medicine and Pharmacy Oujda, Oujda, Morocco
- Department of Pathology, Mohammed VI University Hospital, Oujda, Morocco
| | - Badr Serji
- Surgical Oncology Department, Regional Oncology Center, Mohammed VI University Hospital, Oujda, Morocco
- Mohammed First University Oujda, Faculty of Medicine and Pharmacy Oujda, Oujda, Morocco
| | - Tijani EL Harroudi
- Surgical Oncology Department, Regional Oncology Center, Mohammed VI University Hospital, Oujda, Morocco
- Mohammed First University Oujda, Faculty of Medicine and Pharmacy Oujda, Oujda, Morocco
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Piachas A, Tooulias A, Tsoulfas G. Primary gastrointestinal stromal tumor of the left hepatic lobe: a case report and a review of the literature. J Surg Case Rep 2021; 2021:rjab572. [PMID: 34987760 PMCID: PMC8702343 DOI: 10.1093/jscr/rjab572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/22/2021] [Indexed: 11/24/2022] Open
Abstract
Gastrointestinal stromal tumors (GISTs) can arise from any site of the gastrointestinal tract. These tumors are known to originate from the interstitial cells of Cajal, located in the gastrointestinal mesenchyme. In the case presented, a 37-year-old Caucasian male was admitted to our Surgery department with 2-month history of mild abdominal pain, early satiety and flatulence. The computed tomography revealed a huge mass in the left hepatic lobe consisting of both spindle and epithelial cells. Immunohistochemistry revealed strong CD117 positivity expression. Only a few other cases of liver GIST have been reported in the literature.
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Affiliation(s)
- Athanasios Piachas
- Division of Transplant Surgery, Aristotle University of Thessaloniki, Ippokratio General Hospital, Thessaloniki, Greece
| | - Andreas Tooulias
- Department of Surgery, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Georgios Tsoulfas
- Division of Transplant Surgery, Aristotle University of Thessaloniki, Ippokratio General Hospital, Thessaloniki, Greece
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Ding P, Guo H, Yang P, Sun C, Tian Y, Liu Y, Li Y, Zhao Q. Association Between the Nutritional Risk and the Survival Rate in Newly Diagnosed GIST Patients. Front Nutr 2021; 8:743475. [PMID: 34778339 PMCID: PMC8581449 DOI: 10.3389/fnut.2021.743475] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 10/07/2021] [Indexed: 01/27/2023] Open
Abstract
Background: Currently, the incidence of gastrointestinal stromal tumors (GIST) is increasing rapidly worldwide. Malnutrition may increase the risk of perioperative complications and affect the prognosis of patients. However, previous studies on the nutritional status of GIST patients and its impact on prognosis are limited. Therefore, this study aims to explore the incidence of malnutrition in newly diagnosed GIST patients, the proportion of participants in need of nutritional intervention, and the relationship between nutritional status and overall survival (OS). Methods: We retrospectively analyzed the clinical data of GIST patients treated in our hospital from January 2014 to January 2018. Nutritional Risk Screening 2002 (NRS2002) and Patient-Generated Subjective Global Assessment (PG-SGA) were used to assess the nutritional status of all patients. This study was to investigate the clinical significance of PG-SGA by analyzing the relationship between PG-SGA score and OS. Results: A total of 1,268 newly diagnosed GIST patients were included in this study, of which 77.76% were at risk of malnutrition (NRS2002 score ≥ 3), and the incidence of malnutrition was 10.09% (PG-SGA score ≥ 4). Meanwhile, we found 2.29% of the patients required urgent nutritional support (PG-SGA score ≥ 9). Multivariate analysis showed that age (p = 0.013), BMI (p = 0.001), weight loss (p = 0.001), anemia (p = 0.005), pre-albumin (p = 0.010), albumin (p = 0.002), tumor location (p = 0.001), tumor size (p = 0.002), and NIH classification (p = 0.001) were risk factors for nutritional status. The prognosis was significantly in GIST patients with different PG-SGA score at admission (p < 0.05). Conclusion: This study suggested that malnutrition is common in newly diagnosed GIST patients, and the higher the PG-SGA score, the worse the clinical outcome.
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Affiliation(s)
- Ping'an Ding
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Honghai Guo
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Peigang Yang
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Chenyu Sun
- Internal Medicine, AMITA Health Saint Joseph Hospital Chicago, Chicago, IL, United States
| | - Yuan Tian
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yang Liu
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yong Li
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Qun Zhao
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
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Moin K, Alneyadi M, Shantour S, Alao DO. Life-threatening haematochezia in a man with two gastrointestinal stromal tumours. BMJ Case Rep 2021; 14:14/6/e243357. [PMID: 34108158 DOI: 10.1136/bcr-2021-243357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A man in his 30s was brought by ambulance to the emergency department with a complaint of frank bright red rectal bleeding and dizziness. His blood pressure was 60/18 mm Hg. He was resuscitated with intravenous normal saline and an emergency blood transfusion. Following a negative emergency oesophagogastroduodenoscopy and colonoscopy, an angiographic CT of the abdomen revealed a large tumour in the ileum. After failing to stabilise him with multiple blood transfusions, he had an emergent laparotomy and surgical resection of the tumour, which was confirmed by histocytology as gastrointestinal stromal tumour (GIST). He made full recovery and was discharged home after 10 days. We discussed the challenges of managing significant lower gastrointestinal bleeding and reviewed the current management of GIST.
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Affiliation(s)
- Kinza Moin
- Emergency Medicine, Tawam Hospital, Al Ain, UAE
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Ahmed M. Recent advances in the management of gastrointestinal stromal tumor. World J Clin Cases 2020; 8:3142-3155. [PMID: 32874969 PMCID: PMC7441252 DOI: 10.12998/wjcc.v8.i15.3142] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/26/2020] [Accepted: 07/14/2020] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal stromal tumor (GIST) is a rare but an important clinical entity seen in our clinical practice. It is the most common mesenchymal tumor of the gastrointestinal tract and most common malignancy of the small intestine. Although the exact prevalence of GIST is not known, the incidence of GIST has been increasing. GISTs arise from interstitial cells of Cajal. Most of the GISTs occur due to mutation in c-kit gene or platelet derived growth factor receptor alpha gene. 15% of GISTs do not have these mutations and they are called wild-type GISTs. Almost all GISTs express KIT receptor tyrosine kinase. Histologically, GISTs look like spindle cell tumors most of the time but they can be epitheloid or mixed type. The median size of GISTs varies from 2.7 cm to 8.9 cm. Clinically, patients with small GISTs remain asymptomatic but as the GIST size increases, patients present with various symptoms depending on the location of the GIST. Most of GISTs are located in the stomach or small bowel. Diagnosis is suspected on imaging and endoscopic studies, and confirmed by tissue acquisition with immunohistochemical staining. The aggressiveness of GISTs depends on the size, mitotic index and location. Surgical resection is the treatment of choice. But various endoscopic modalities of resection are increasingly being tried. Tyrosine kinase inhibitors are extremely useful in the management of large GISTs, unresectable GISTs and metastatic GISTs. Treatment options for metastatic GISTs also include radiotherapy, chemotherapy, hepatic artery embolization, chemoembolization and radiofrequency ablation.
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Affiliation(s)
- Monjur Ahmed
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Thomas Jefferson University, Philadelphia, PA 19107, United States
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Wang X, Kou H, He H, Lu M, Zhou L, Wang L. Difference in Perfusion Parameters Between Gastric Cancer and Gastric Stromal Tumors: Evaluation With Oral Contrast Plus Contrast-Enhanced Ultrasonography. Front Oncol 2020; 10:532. [PMID: 32432030 PMCID: PMC7214801 DOI: 10.3389/fonc.2020.00532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 03/25/2020] [Indexed: 12/31/2022] Open
Abstract
Objective: To explore the difference of perfusion parameters between gastric cancer (GC) and gastric stromal tumors (GSTs) by using oral contrast plus contrast-enhanced ultrasonography (OC+CEUS). Methods: We retrospectively reviewed 149 patients with histologically confirmed gastric lesions (80 patients with GC and 69 patients with GST). OC+CEUS was performed in all patients in the GC group and the GST group before surgery. The cine loops of OC+CEUS of all cases were analyzed. The perfusion parameters including arrival time (AT), time to peak (TTP), basal intensity (BI), and peak intensity (PI) were obtained via a program designed for autotracking contrast quantification (ACQ). The between-group differences in these parameters were compared. Results: According to time-intensity curve (TIC) analysis, high-risk GST had higher PI than low-risk GST (P < 0.05). GC had faster AT and higher PI than normal gastric wall (P < 0.05); GST had higher PI than normal gastric wall (P < 0.05). Furthermore, the GC group had faster AT and higher PI than the GST group (P < 0.05). In contrast, the difference in BI and peak time (TTP) between the groups was not significant (P > 0.05). Conclusion: AT and PI differ significantly between the GC group and the GST group. As a new method, OC+CEUS has value for the differential diagnosis of GC and GST.
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Affiliation(s)
- Xiaohua Wang
- Department of Ultrasound, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hongju Kou
- Department of Ultrasound, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Huiliao He
- Department of Ultrasound, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Mingdong Lu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Lingling Zhou
- Department of Pathology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Liang Wang
- Department of Ultrasound, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
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Li LY, Li BW, Mekaroonkamol P, Chen HM, Shen SS, Luo H, Dacha S, Xue Y, Cristofaro S, Keilin S, Willingham F, Cai Q. Mucosectomy device-assisted endoscopic resection of gastric subepithelial lesions. J Dig Dis 2020; 21:215-221. [PMID: 32129564 DOI: 10.1111/1751-2980.12856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 02/24/2020] [Accepted: 03/02/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Some gastrointestinal subepithelial tumors (SETs) have malignant potential and complete resection may be required. However, endoscopic submucosal dissection (ESD) can be a tedious procedure and requires a long and extensive training to master. Devices for endoscopic full-thickness resection (EFTR) are limited and are not widely available. We report here a simpler endoscopic method to resect small SETs using a commercially available endoscopic mucosal resection (EMR) kit and enucleation technique. METHODS All patients with SET who underwent device-assisted resection at our tertiary care hospital from April 2015 to November 2016 were enrolled in this retrospective study. All procedures were performed by a single expert endoscopist with an advanced endoscopy trainee. A mucosectomy and a limited dissection under mucosa were performed to preserve the mucosa before a device-assisted enucleation of the tumor to facilitate endoscopic closure of the defect closure in all cases. RESULTS A total of 12 patients aged 38-70 y, of whom six were males, were included. Most of the tumors originated from the muscularis propria and were located at the proximal gastric body. The mean procedural duration was 53 minutes (range 23-91 min). The average size of the lesions was 13 mm (range 9-21 mm). The mean duration of hospitalization was 1.3 days. Bleeding and intentional perforation were all successfully managed during the procedure and did not result in any clinically significant adverse event. CONCLUSION A device-assisted EFTR using a commercially available EMR kit is a safe and feasible method for the endoscopic resection of small gastric extrovert SETs.
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Affiliation(s)
- Lian Yong Li
- Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA.,Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bai Wen Li
- Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA.,Department of Gastroenterology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Parit Mekaroonkamol
- Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA
| | - Hui Min Chen
- Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA.,Division of Gastroenterology and Hepatology, Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shan Shan Shen
- Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA.,Department of Gastroenterology, Drum Tower Hospital affiliated to the Medical School of Nanjing University, Nanjing, Jiangsu Province, China
| | - Hui Luo
- Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA.,Department of Gastroenterology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Sunil Dacha
- Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA
| | - Yue Xue
- Department of Pathology, Emory University School of Medicine, Atlanta, GA
| | - Sarah Cristofaro
- Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA
| | - Steven Keilin
- Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA
| | - Field Willingham
- Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA
| | - Qiang Cai
- Department of Medicine, Division of Digestive Diseases, Emory University School of Medicine, Atlanta, GA
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Aoe Y, Sugihara T, Ogawa A, Nagahara R, Miyoshi K, Matono T, Nagahara T, Isomoto H, Kuroda H, Hirooka Y. Natural History of Exophytic Type Gastrointestinal Stromal Tumor: A Case Report. Yonago Acta Med 2019. [DOI: 10.33160/yam.2019.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Yasutaka Aoe
- *Department of Pathobiological Science and Technology, School of Health Science, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
| | - Takaaki Sugihara
- †Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
| | - Ayame Ogawa
- *Department of Pathobiological Science and Technology, School of Health Science, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
| | - Ran Nagahara
- †Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
| | - Kenichi Miyoshi
- †Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
| | - Tomomitsu Matono
- †Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
| | - Takakazu Nagahara
- †Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
| | - Hajime Isomoto
- †Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
| | - Hirohiko Kuroda
- ‡Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
| | - Yasuaki Hirooka
- *Department of Pathobiological Science and Technology, School of Health Science, Tottori University Faculty of Medicine, Yonago 683-8503, Japan
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Sugihara T, Koda M, Tanimura T, Yoshida M, Murawaki Y. A report of three cases of exophytic gastrointestinal stromal tumor detected by transabdominal ultrasound. J Med Ultrason (2001) 2015; 43:107-11. [PMID: 26703175 DOI: 10.1007/s10396-015-0661-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 07/22/2015] [Indexed: 01/11/2023]
Abstract
Gastrointestinal stromal tumors (GISTs) are the most common submucosal tumors of the stomach. GISTs are often detected by esophagogastroduodenal endoscopy (EGD). However, the exophytic GIST type is relatively rare and difficult to detect by EGD. Most exophytic GISTs found are large and symptomatic. We present three cases with exophytic GISTs less than 5 cm in diameter detected by transabdominal ultrasound (TUS). All patients were asymptomatic and TUS revealed hypoechoic solid masses 2-3 cm in diameter between the stomach and left lobe of the liver. In contrast, no tumor in the stomach was detected by esophagogastroduodenal endoscopy. Endoscopic ultrasound and enhanced CT showed gastric tumors protruding outward. All three cases underwent partial gastrectomy, and the excised tumor was diagnosed as low-grade GIST. In conclusion, TUS can be a starting point for diagnosing exophytic GISTs of the stomach.
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Affiliation(s)
- Takaaki Sugihara
- Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, Tottori University Faculty of Medicine, 36-1 Nishimachi, Yonago, Tottori, 683-8504, Japan.
| | - Masahiko Koda
- Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, Tottori University Faculty of Medicine, 36-1 Nishimachi, Yonago, Tottori, 683-8504, Japan
| | - Takashi Tanimura
- Department of Gastroenterology, Matsue Municipal Hospital, 32-1 Noshirachyo, Matsue, Shimane, 690-8509, Japan
| | - Manabu Yoshida
- Department of Clinical Laboratory, Matsue Municipal Hospital, 32-1 Noshirachyo, Matsue, Shimane, 690-8509, Japan
| | - Yoshikazu Murawaki
- Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, Tottori University Faculty of Medicine, 36-1 Nishimachi, Yonago, Tottori, 683-8504, Japan
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Chen X, Lv H, Zhang W, Cao J. Large cystic-based gastrointestinal stromal tumor: A case report. Oncol Lett 2014; 7:846-848. [PMID: 24527092 PMCID: PMC3919916 DOI: 10.3892/ol.2014.1798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 11/19/2013] [Indexed: 11/21/2022] Open
Abstract
A 60-year-old male with increasing abdominal distension was admitted to The Fifth Affiliated Hospital of Guangzhou Medical University (Guangzhou, China). The abdominal sonogram exhibited a huge abdominal cystic-based mass with solid components in the left upper quadrant. A contrast-enhanced computed tomography scan of the abdomen revealed a large heterogeneous cystic solid tumor, but the source of the tumor could not be determined. The laparotomy demonstrated a huge cystic-based tumor with an integrated cystic wall, arising from the posterior wall of the gastric body. Multiple septa and ~3,500 ml of yellowish fluid were found in the cystic cavity. Pathological analysis showed that the tumor contained a mixture of polygonal and spindle cells. Immunohistochemical study indicated that the tumor cells were positive for CD117 and CD34. The final diagnosis was gastric gastrointestinal stromal tumor. The patient recovered well and no recurrence or metastasis was identified following a 12-month follow-up.
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Affiliation(s)
- Xinqi Chen
- Department of Digestive Surgery, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510700, P.R. China
| | - Huizeng Lv
- Department of Digestive Surgery, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510700, P.R. China
| | - Wenhai Zhang
- Department of Digestive Surgery, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510700, P.R. China
| | - Jie Cao
- Department of Gastrointestinal Surgery, Affiliated Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong 510180, P.R. China
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Schwameis K, Fochtmann A, Schwameis M, Asari R, Schur S, Köstler W, Birner P, Ba-Ssalamah A, Zacherl J, Wrba F, Brodowicz T, Schoppmann SF. Surgical treatment of GIST--an institutional experience of a high-volume center. Int J Surg 2013; 11:801-6. [PMID: 23999064 DOI: 10.1016/j.ijsu.2013.08.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Revised: 07/26/2013] [Accepted: 08/22/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND Discovery of the molecular pathogenesis of Gastrointestinal stromal tumors led to the development of targeted therapies, revolutionizing their treatment. However, surgery is still the mainstay of GIST therapy and the only chance for cure. AIM Here we present a single institutional consecutive case series of 159 GIST-patients. METHODS AND PATIENTS A total of 159 GIST-patients who underwent resection between 1994 and 2011 were reviewed for clinicopathohistological data, informations on surgical and medical therapy and further follow-up, outcome and survival data. RESULTS Laparoscopic (25.2%) and open (71.1%) GIST surgery achieved complete resection rates of 97.5% and 85.2%, whereas 44.4% of incomplete and 6.6% of complete resected patients died from GIST. Compared to open surgery laparoscopy significantly reduced duration of operation (183.4 vs. 130.6 min), length of hospitalization (16.1 vs. 8.3 d) and morbidity (23% vs. 7.5%). Mean survival time was 3.7 ± 2.7 years (R0: 5.1 a and R1: 2.6 a) and the mean overall survival was 4.5 ± 3.8 years. CONCLUSION Complete surgical resection is the primary goal and laparoscopy can be performed safely in a subset of GIST-patients with potential perioperative advantages. Although not proven by the present study the authors assume that multimodal GIST-treatment, as performed in reference-centers, is required for advanced or high risk disease. Our data suggest the potential for minimally invasive GIST resection to achieving comparable oncological outcomes as after open surgery while providing low morbidity rates.
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Affiliation(s)
- Katrin Schwameis
- Department of Surgery, Medical University of Vienna, Austria; Comprehensive Cancer Center Vienna, Austria.
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Zhou B, Zhang M, Wu J, Yan S, Zhou J, Zheng S. Pancreaticoduodenectomy versus local resection in the treatment of gastrointestinal stromal tumors of the duodenum. World J Surg Oncol 2013; 11:196. [PMID: 23945012 PMCID: PMC3751193 DOI: 10.1186/1477-7819-11-196] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Accepted: 08/04/2013] [Indexed: 02/07/2023] Open
Abstract
Background Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms. However, duodenal GISTs compromise a small and rare subset and few studies have focused on them. We evaluated the surgical management of patients with duodenal GISTs treated by pancreaticoduodenectomy (PD) versus local resection (LR) in our institution and analyzed the postoperative outcomes. Methods This was a retrospective review of patients with duodenal GISTs managed in our institution from January 2006 to January 2012. Clinicopathologic findings and disease-free survival (DFS) of duodenal GIST patients were analyzed. Results A total of 48 patients were selected. The most common presentation was bleeding (60.4%), and the second portion of the duodenum (35.4%) was the most common dominant site. Of the patients, 34 (70.8%) underwent LR while 14 (29.2%) underwent PD. The surgical margins for all studied patients were free. Patients who ultimately underwent PD were more likely to present with a larger tumor (median size: PD, 6.3 cm vs LR, 4.0 cm; P = 0.02) and more commonly presented with a tumor in the second portion of the duodenum (second portion: PD, 64.3% vs LR, 23.5%; P = 0.007). The tumors treated by PD had a higher grade of risk compared with LR as defined by National Institutes of Health (NIH) criteria (P = 0.019). PD was significantly associated with a longer operation time and a longer hospital stay compared to LR (P < 0.001 and P = 0.001, respectively). In our study, the median follow-up period was 36 months (range: 0 to 81 months). The 1- and 3-year DFS was 100% and 88%, respectively. From multivariable analysis, the only significant factor associated with a worse DFS was an NIH high risk classification (hazard ratio = 4.24). Conclusions The recurrence of duodenal GIST was correlated to tumor biology rather than type of operation. PD was associated with a longer hospital stay and longer operation time. Therefore, LR with clear surgical margins should be considered a reliable and curative option for duodenal GIST and PD should be reserved for lesions not amenable to LR.
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Zhou B, Zhang M, Yan S, Zheng S. Primary gastrointestinal stromal tumor of the liver: report of a case. Surg Today 2013; 44:1142-6. [PMID: 23681598 DOI: 10.1007/s00595-013-0521-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 11/05/2012] [Indexed: 12/23/2022]
Abstract
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. They can occur anywhere in the gastrointestinal tract, and rarely outside the digestive tract. We herein report a case of primary gastrointestinal stromal tumor that was resected from the liver of a 56-year-old male, which is the sixth description of a primary hepatic gastrointestinal stromal tumor. The tumor was shown to be completely limited within the liver by radiological, intraoperative and pathological examinations. The pathological results demonstrated an intermediate risk gastrointestinal stromal tumor, and immunohistochemical expression of CD117 was positive. Although rare, we suggested that GISTs should be considered in the differential diagnosis of hepatic nodules, and that not all hepatic gastrointestinal stromal tumors should automatically be considered to be metastases from a primary gastrointestinal site.
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Affiliation(s)
- Bo Zhou
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, Key Laboratory of Organ Transplantation, Zhejiang Province, Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, China,
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Izawa N, Sawada T, Abiko R, Kumon D, Hirakawa M, Kobayashi M, Obinata N, Nomoto M, Maehata T, Yamauchi SI, Kouro T, Tsuda T, Kitajima S, Yasuda H, Tanaka K, Tanaka I, Hoshikawa M, Takagi M, Itoh F. Gastrointestinal stromal tumor presenting with prominent calcification. World J Gastroenterol 2012; 18:5645-8. [PMID: 23112561 PMCID: PMC3482655 DOI: 10.3748/wjg.v18.i39.5645] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Revised: 04/06/2012] [Accepted: 04/12/2012] [Indexed: 02/06/2023] Open
Abstract
We present a rare case of a gastrointestinal stromal tumor (GIST) in the stomach with prominent calcification at presentation. A 61-year-old woman visited our hospital because of epigastric discomfort. A spherical calcified lesion with a diameter of about 30 mm was incidentally shown in the left upper quadrant on an abdominal X-ray. Computed tomography demonstrated that the tumor was growing from the upper gastric body, with calcification in the peripheral ring area. A laparoscopic partial gastrectomy was performed, and the resected specimen revealed a well-circumscribed tumor with exophytic growth from the gastric muscularis propria. Microscopic examination revealed spindle-shaped tumor cells with calcification and hemorrhage. Additionally, positive immunoreactivity of the tumor to KIT and CD34 and a low mitotic index resulted in the diagnosis of very low risk GIST. There are a few case reports of heavily calcified GIST, although solitary or punctate calcification of primary GIST has been reported in several case series. Dystrophic calcification of necrotic or degenerative tissue is the supposed cause of primary calcified GISTs. In contrast, appearance of calcification after administration of imatinib mesylate, which may be one indicator of disease response, is possibly caused by a different mechanism.
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Bean SM, Baker A, Eloubeidi M, Eltoum I, Jhala N, Crowe R, Jhala D, Chhieng DC. Endoscopic ultrasound-guided fine-needle aspiration of intrathoracic and intra-abdominal spindle cell and mesenchymal lesions. Cancer Cytopathol 2010; 119:37-48. [DOI: 10.1002/cncy.20120] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Revised: 09/16/2010] [Accepted: 09/17/2010] [Indexed: 12/13/2022]
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