1
|
Tarallo M, Carruezzo C, Dentice Di Accadia FM, Del Gaudio A, Caruso D, Polici M, Crocetti D, Costi U, Polistena A, Panzuto F, Laghi A, Cavallaro G, Fiori E. A Case Report of Multiple Gastrointestinal Stromal Tumors: Imaging Findings, Surgical Approach, and Review of the Literature. Front Surg 2022; 9:886135. [PMID: 36017517 PMCID: PMC9396543 DOI: 10.3389/fsurg.2022.886135] [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: 02/28/2022] [Accepted: 04/25/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction Multiple gastrointestinal stromal tumors (GISTs) are rare tumors. Differential diagnosis between metastatic and multiple GISTs represents a challenge for a proper workup, prediction prognosis, and therapeutic strategy. Case presentation We present the case of 67-year-old man with computed tomography (CT) evidence of multiple exophytic lesions in the abdomen, reaching diameters ranging from 1 to 9 cm, without any signs of organs infiltration, and resulting positive at 18F-FDG-PET/CT. Laparoscopic biopsy revealed multiple GISTs, and surgical resection by using an open approach was performed to achieve radicality. Moreover, an extensive review of the current literature was performed. Results Small GISTs (<5 cm) can be treated by the laparoscopic approach, while in the case of large GISTs (>5 cm), tumor location and size should be taken into account to reach the stage of radical surgery avoiding tumor rupture. For metastatic GISTs, Imatinib represents the first choice of treatment, and surgery should be considered only in a few selected cases when all lesions are resectable. Conclusion Sporadic multiple GISTs are a rare event, imaging findings are not specific for GISTs, and biopsy requires a secure diagnosis and proper management. In the case of large lesions, with a high risk of vessels injury, laparotomy excision should be considered to achieve radicality and to avoid tumor rupture.
Collapse
Affiliation(s)
- Mariarita Tarallo
- Department of Surgery Pietro Valdoni, University of Rome Sapienza, Rome, Italy
- Correspondence: Mariarita Tarallo
| | - Cristina Carruezzo
- Department of Surgery Pietro Valdoni, University of Rome Sapienza, Rome, Italy
| | | | - Antonella Del Gaudio
- Department of Medical Surgical Sciences and Translational Medicine, Radiology Unit, Sant’Andrea University Hospital, University of Rome Sapienza, Rome, Italy
| | - Damiano Caruso
- Department of Medical Surgical Sciences and Translational Medicine, Radiology Unit, Sant’Andrea University Hospital, University of Rome Sapienza, Rome, Italy
| | - Michela Polici
- Department of Medical Surgical Sciences and Translational Medicine, Radiology Unit, Sant’Andrea University Hospital, University of Rome Sapienza, Rome, Italy
| | - Daniele Crocetti
- Department of Surgery Pietro Valdoni, University of Rome Sapienza, Rome, Italy
| | - Umberto Costi
- Department of Surgery Pietro Valdoni, University of Rome Sapienza, Rome, Italy
| | - Andrea Polistena
- Department of Surgery Pietro Valdoni, University of Rome Sapienza, Rome, Italy
| | - Francesco Panzuto
- Department of Medical Surgical Sciences and Translational Medicine, Radiology Unit, Sant’Andrea University Hospital, University of Rome Sapienza, Rome, Italy
- Department of Medical Surgical Sciences and Translational Medicine, Digestive Disease Unit, Sant'Andrea University Hospital, University of Rome Sapienza, Rome, Italy
| | - Andrea Laghi
- Department of Medical Surgical Sciences and Translational Medicine, Radiology Unit, Sant’Andrea University Hospital, University of Rome Sapienza, Rome, Italy
| | - Giuseppe Cavallaro
- Department of Surgery Pietro Valdoni, University of Rome Sapienza, Rome, Italy
| | - Enrico Fiori
- Department of Surgery Pietro Valdoni, University of Rome Sapienza, Rome, Italy
| |
Collapse
|
2
|
Kim JH, Ryu MH, Park YS, Kim HJ, Park H, Kang YK. Intra-abdominal desmoid tumors mimicking gastrointestinal stromal tumors - 8 cases: A case report. World J Gastroenterol 2019; 25:2010-2018. [PMID: 31086468 PMCID: PMC6487383 DOI: 10.3748/wjg.v25.i16.2010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 02/22/2019] [Accepted: 03/01/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Intra-abdominal desmoid tumors (DTs) can mimic recurrence or progression of gastrointestinal stromal tumors (GISTs). Differential diagnosis is important to avoid unnecessary or inappropriate treatment. CASE SUMMARY All 8 patients experienced surgical resection of GIST, and median time to diagnosis of DT was 1.8 years after surgical resection. All sites of DT were in the peritoneum around the surgical sites of GIST. The following clinical suspicion coupled with radiological findings contributed to the suspicion of intra-abdominal DTs: (1) Occurrence of a new single lesion in the peritoneum around the surgical sites of GIST; (2) uncontrolled lesion with imatinib while other lesions being controlled with imatinib; (3) well-defined ovoid shaped lesion with delayed or mild enhancement and absence of necrosis, hemorrhage, and cystic change on computed tomography; and (4) a lesion showing mild or no hypermetabolic activity on 18fluorodeoxyglucose-positron emission tomography, contrary to initially hyperactive lesion of GIST. All DTs were surgically removed except for one unresectable DT and only one DT recurred at another site of peritoneum, which was also surgically removed. CONCLUSION Intra-abdominal DT should be a differential diagnosis for a new single lesion in patients with GIST.
Collapse
Affiliation(s)
- Jwa Hoon Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
| | - Min-Hee Ryu
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
| | - Young Soo Park
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
| | - Hyun Jin Kim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
| | - Hyojung Park
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
| | - Yoon-Koo Kang
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
| |
Collapse
|