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Nishiyama R, Ogasawara T, Mamuro N, Kamei Y, Yamada M, Furukawa D, Suzuki T, Nishi T, Shimada H. Coexistence of gastric cancer and gastric GIST with intra-tumor bleeding: successful embolization with subsequent total gastrectomy. Surg Case Rep 2021; 7:160. [PMID: 34241722 PMCID: PMC8271045 DOI: 10.1186/s40792-021-01244-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 07/03/2021] [Indexed: 12/31/2022] Open
Abstract
Background Gastrointestinal stromal tumor (GIST) is a rare tumor, however, simultaneous development of gastric cancer and gastric GIST has been documented more frequently in recent years. Rupture of gastric GIST is even more rare and occurred in 7% of all GISTs. Although ruptured GIST might be occasionally difficult to be managed by endoscopy, transcatheter arterial embolization (TAE) was reported to control bleeding from GIST effectively. We report herein a case of coexistence of gastric cancer and gastric GIST with progressing intra-tumor bleeding managed successfully by TAE and review the clinicopathological characteristics of this rare condition reported previously in the Japanese literature. Case presentation A 75-year-old woman with dyspnea and systemic edema was diagnosed as simultaneous occurrence of gastric cancer (histopathologically detected tubular adenocarcinoma pT2N1M0 fStageIIA) and gastric GIST (65 × 92 mm in diameter at the anterior wall of the fornix) with intra-tumor hemorrhage. Perceiving the progress of bleeding from tumor growth and exacerbating anemia, TAE of left gastric artery was performed. Then remission of anemia has been obtained, the patient underwent an elective radical surgery. Conclusions Simultaneous occurrence of gastric cancer and gastric GIST was speculated to be more common. TAE for ruptured GIST may be effective for hemostasis and reduction of tumor burden, which could facilitate minimal invasive surgery.
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Affiliation(s)
- Raisuke Nishiyama
- Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, Oiso Hospital, 21-1 Gakkyo, Oiso, Naka-Gun Kanagawa, 259-1198, Japan.
| | - Toshihito Ogasawara
- Department of Surgery, Tokai University School of Medicine, Oiso Hospital, 21-1 Gakkyo, Oiso, Naka-Gun Kanagawa, 259-1198, Japan
| | - Nana Mamuro
- Department of Surgery, Tokai University School of Medicine, Oiso Hospital, 21-1 Gakkyo, Oiso, Naka-Gun Kanagawa, 259-1198, Japan
| | - Yutarou Kamei
- Department of Surgery, Tokai University School of Medicine, Oiso Hospital, 21-1 Gakkyo, Oiso, Naka-Gun Kanagawa, 259-1198, Japan
| | - Misuzu Yamada
- Department of Surgery, Tokai University School of Medicine, Oiso Hospital, 21-1 Gakkyo, Oiso, Naka-Gun Kanagawa, 259-1198, Japan
| | - Daisuke Furukawa
- Department of Surgery, Tokai University School of Medicine, Oiso Hospital, 21-1 Gakkyo, Oiso, Naka-Gun Kanagawa, 259-1198, Japan
| | - Toshiyuki Suzuki
- Department of Surgery, Tokai University School of Medicine, Oiso Hospital, 21-1 Gakkyo, Oiso, Naka-Gun Kanagawa, 259-1198, Japan
| | - Takayuki Nishi
- Department of Surgery, Tokai University School of Medicine, Oiso Hospital, 21-1 Gakkyo, Oiso, Naka-Gun Kanagawa, 259-1198, Japan
| | - Hideo Shimada
- Department of Surgery, Tokai University School of Medicine, Oiso Hospital, 21-1 Gakkyo, Oiso, Naka-Gun Kanagawa, 259-1198, Japan
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Huang Y, Shih K, Yang C, Chen Y, Yen H. Bleeding gastrointestinal stromal tumor mimicking ectopic variceal bleeding and treated successfully with endoscopic sclerotherapy. ADVANCES IN DIGESTIVE MEDICINE 2020. [DOI: 10.1002/aid2.13245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Yen‐Pin Huang
- Endoscopy Center, Division of Gastroenterology Changhua Christian Hospital Changhua Taiwan
| | - Kai‐Lun Shih
- Endoscopy Center, Division of Gastroenterology Changhua Christian Hospital Changhua Taiwan
| | - Chia‐Wei Yang
- Endoscopy Center, Division of Gastroenterology Changhua Christian Hospital Changhua Taiwan
| | - Yang‐Yuan Chen
- Endoscopy Center, Division of Gastroenterology Changhua Christian Hospital Changhua Taiwan
| | - Hsu‐Heng Yen
- Endoscopy Center, Division of Gastroenterology Changhua Christian Hospital Changhua Taiwan
- School of Medicine, Chung Shan Medical University Taichung Taiwan
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Clinical outcomes of upper gastrointestinal bleeding in patients with gastric gastrointestinal stromal tumor. Surg Endosc 2019; 34:696-706. [PMID: 31062158 DOI: 10.1007/s00464-019-06816-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 04/29/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Upper gastrointestinal bleeding (UGIB) is one of the major manifestations of gastrointestinal stromal tumor (GIST) of the stomach. Several studies have reported that GIST bleeding is associated with poor prognosis. However, only case reports have reported hemostasis modalities for treating hemorrhagic gastric GIST. To identify clinical outcome of gastric GIST bleeding, we analyzed risk factors and prognosis of hemorrhagic GIST evaluating hemostasis methods. METHODS Total 697 patients histopathologically diagnosed with primary gastric GIST between January 1998 and May 2015 were enrolled to the study, retrospectively. RESULTS Of 697 total patients, 46 (6.6%) patients had UGIB. Endoscopic intervention, transarterial embolization, or surgical intervention was performed for initial hemostasis in 15, 2, and 1, respectively. Over a median of 68 months of follow-up, 16 patients in bleeding group and 88 patients in non-bleeding group died; the 5-year survival rate was 79.4% in bleeding group and 91.8% in non-bleeding group (p = 0.004). Multivariate analysis showed that significant risk factors for gastric GIST bleeding included the maximal tumor diameter > 5 cm and Ki-67 positivity. Age ≥ 60 [hazard ratio (HR) = 8.124, p = 0.048], necrosis (HR = 5.093, p = 0.027), and bleeding (HR 5.743, p = 0.034) were significant factors for overall survival of gastric GIST patients. CONCLUSIONS Bleeding risk of gastric GIST was higher when tumor had diameter > 5 cm or Ki-67 positivity. In addition, tumor bleeding, necrosis, and age ≥ 60 years were associated with poor overall survival. Endoscopic intervention can be considered as an effective method for initial hemostasis of hemorrhagic gastric GIST.
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Razik A, Madhusudhan KS, Aggarwal A, Panwar R, Srivastava DN. Gastrointestinal Stromal Tumor of the Jejunum With Active Bleeding Demonstrated on Dual-Energy MDCT Angiography: A Case Report. Curr Probl Diagn Radiol 2017; 48:298-301. [PMID: 29169676 DOI: 10.1067/j.cpradiol.2017.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 10/23/2017] [Indexed: 01/15/2023]
Abstract
Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of the gastrointestinal tract and may occasionally present with acute gastrointestinal bleed (GIB). Multidetector computed tomography (MDCT) angiography is extremely useful in demonstrating the tumor as well as the presence of active hemorrhage, thereby guiding subsequent interventional or surgical management. We report a case of a 38-year-old man who presented with acute-onset melena and compensated shock, whose source of bleed remained elusive on endoscopy. MDCT angiography performed on a dual-energy scanner showed a jejunal tumor with active intraluminal contrast extravasation. The tumor was subsequently resected and the patient did well on follow-up. This was one of the few instances when MDCT angiography demonstrated active bleeding in a GIST and the first such case demonstrated on a dual-energy scanner.
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Affiliation(s)
- Abdul Razik
- Department of Radio-diagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Kumble S Madhusudhan
- Department of Radio-diagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
| | - Abhishek Aggarwal
- Department of Gastrointestinal Surgery and Liver Transplantation, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Rajesh Panwar
- Department of Gastrointestinal Surgery and Liver Transplantation, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Deep N Srivastava
- Department of Radio-diagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Siao FY, Yen HH. Unusual Upper Gastrointestinal Bleeding. Gastroenterology 2015; 149:1691-2. [PMID: 26484890 DOI: 10.1053/j.gastro.2015.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 08/10/2015] [Indexed: 12/02/2022]
Affiliation(s)
- Fu-Yuan Siao
- Department of Emergency Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Hsu-Heng Yen
- Department of Gastroenterology, Chung Shan Medical University, Taichung, Taiwan; College of Medicine, Chung Shan Medical University, Taichung, Taiwan
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Koo HJ, Shin JH, Shin S, Yoon HK, Ko GY, Gwon DI. Efficacy and Clinical Outcomes of Transcatheter Arterial Embolization for Gastrointestinal Bleeding from Gastrointestinal Stromal Tumor. J Vasc Interv Radiol 2015; 26:1297-304.e1. [PMID: 26190186 DOI: 10.1016/j.jvir.2015.06.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 05/29/2015] [Accepted: 06/01/2015] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To evaluate the efficacy and clinical outcomes of transcatheter arterial embolization (TAE) for gastrointestinal (GI) bleeding from gastrointestinal stromal tumor (GIST). MATERIALS AND METHODS TAE was performed in 20 referred patients (male:female = 13:7; median age, 56.3 y) for GI bleeding from GISTs. The locations of GISTs were assessed using contrast-enhanced computed tomography (CT) and catheter angiography. The technical and clinical success of TAE and clinical outcomes including procedure-related complications, recurrent bleeding, 30-day and overall mortality, and cumulative survival were evaluated. RESULTS The sites of GIST-related bleeding or tumor staining were the jejunum (n = 9), stomach (n = 5), ileum (n = 3), duodenum (n = 2), and jejunum and colon (n = 1). Angiography showed bleeding from GIST in 5 patients, and tumor staining was noted in only 15 patients. TAE was performed for patients with and without contrast medium extravasation on angiography. Technical and clinical success rates of TAE were 95% (19 of 20 patients) and 90% (18 of 20 patients), respectively. Recurrent bleeding was noted in 1 patient. There were no procedure-related complications. In 15 patients, surgical resection of the tumors was performed after TAE. The 30-day and overall mortality rates were 10% (2 of 20 patients) and 30% (6 of 20 patients), respectively. CONCLUSIONS TAE is a safe and effective method for controlling GI bleeding from the GIST.
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Affiliation(s)
- Hyun Jung Koo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Olymphic-ro 43 gil 88, Songpa-Gu, Seoul 138-736, Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Olymphic-ro 43 gil 88, Songpa-Gu, Seoul 138-736, Korea.
| | - Sooyoung Shin
- Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hyun-Ki Yoon
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Olymphic-ro 43 gil 88, Songpa-Gu, Seoul 138-736, Korea
| | - Gi-Young Ko
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Olymphic-ro 43 gil 88, Songpa-Gu, Seoul 138-736, Korea
| | - Dong Il Gwon
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Olymphic-ro 43 gil 88, Songpa-Gu, Seoul 138-736, Korea
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