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Mirovic M, Stojanovic MD, Jovanovic M, Stankovic V, Milosev D, Zdravkovic N, Milosevic B, Cvetkovic A, Spasic M, Vekic B, Jovanovic I, Stojanovic BS, Petrovic M, Bogut A, Peulic M, Stojanovic B. Exploring Perforated Jejunal GIST: A Rare Case Report and Review of Molecular and Clinical Literature. Curr Issues Mol Biol 2024; 46:1192-1207. [PMID: 38392194 PMCID: PMC10887764 DOI: 10.3390/cimb46020076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/13/2024] [Accepted: 01/24/2024] [Indexed: 02/24/2024] Open
Abstract
This case report details a rare instance of a perforated jejunal gastrointestinal stromal tumor (GIST) in a 76-year-old female patient. The patient presented with acute abdominal pain and distension without any changes in bowel habits or episodes of nausea and vomiting. Initial diagnostics, including abdominal plain radiography and ultrasonography, were inconclusive; however, a computed tomography (CT) scan revealed pneumoperitoneum and an irregular fluid collection suggestive of small intestine perforations. Surgical intervention uncovered a 35 mm jejunal GIST with a 10 mm perforation. Histopathological examination confirmed a mixed cell type GIST with high malignancy potential, further substantiated by immunohistochemistry markers CD117, DOG1, and vimentin. Molecular analysis illuminated the role of key oncogenes, primarily KIT and PDGFRA mutations, emphasizing the importance of molecular diagnostics in GIST management. Despite the severity of the presentation, the patient's postoperative recovery was favorable, highlighting the effectiveness of prompt surgical and multidisciplinary approaches in managing complex GIST cases.
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Affiliation(s)
- Milos Mirovic
- Department of General Surgery, Clinical Hospital Center Kotor, 85330 Kotor, Montenegro
| | - Milica Dimitrijevic Stojanovic
- Department of Pathology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
- Department of Pathology, University Clinical Center Kragujevac, 34000 Kragujevac, Serbia
| | - Marina Jovanovic
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Vesna Stankovic
- Department of Pathology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
- Department of Pathology, University Clinical Center Kragujevac, 34000 Kragujevac, Serbia
| | - Danijela Milosev
- Department of Pathology, University Clinical Center Kragujevac, 34000 Kragujevac, Serbia
| | - Natasa Zdravkovic
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Bojan Milosevic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Aleksandar Cvetkovic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Marko Spasic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Berislav Vekic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Ivan Jovanovic
- Center for Molecular Medicine and Stem Cell Research, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Bojana S Stojanovic
- Department of Pathophysiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Marko Petrovic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Ana Bogut
- City Medical Emergency Department, 11000 Belgrade, Serbia
| | - Miodrag Peulic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Bojan Stojanovic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
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Aldosari S, Ayman A, Almaiman L, Alzaid T, Alhossaini R, Amin T. Acute abdomen secondary to perforated jejunal gastrointestinal stromal tumor and imatinib-related isolated pericardial effusion in a 50-year-old female patient: A case report and review of literature. Int J Surg Case Rep 2023; 106:108197. [PMID: 37071957 PMCID: PMC10130195 DOI: 10.1016/j.ijscr.2023.108197] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 04/08/2023] [Accepted: 04/10/2023] [Indexed: 04/20/2023] Open
Abstract
INTRODUCTION Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastrointestinal tract; occurring most often in the stomach and to a lesser extent in the jejunum. The majority of the tumors express activating mutations in either c-KIT or PDGFRA tyrosine kinases, which respond to tyrosine kinase inhibitors (TKI). Jejunal GIST is considered to be extremely rare and challenging to diagnose due to its non-specific presentation. As a result, patients usually present at an advance stage of the disease, making the prognosis poor and difficult to manage. CASE PRESENTATION In the present study, we report a 50-year-old female who was diagnosed with metastatic jejunal GIST. She was commenced on Imatinib (TKI) and shortly after she presented to the emergency department with an acute abdomen. A CT scan of the abdomen revealed ischemic changes in the jejunal loops and pneumoperitoneum. The patient required emergency laparotomy due to perforated GIST, and creation of pericardial window due to hemodynamic instability possibly secondary TKI-related isolated pericardial effusion. CONCLUSION Jejunal GIST is rare and usually presents as emergency due to obstruction, hemorrhage or rarely perforation. Although, systemic therapy with TKI is the principal treatment for advance disease, Jejunal GIST should be removed surgically. It is surgically challenging due to the anatomical complexity of the tumor. Surgeons treating such patients must be cautious for TKI side effects.
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Affiliation(s)
- Sarah Aldosari
- Department of Surgery, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
| | - Azzam Ayman
- Department of Surgical Oncology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia; Department of General Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | | | - Tariq Alzaid
- Department of Pathology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Rana Alhossaini
- Department of Surgery, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Tarek Amin
- Department of Surgical Oncology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
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Abdelgawad M, Kamel OM, Issa PP, Omar M, Barghuthi L, Davis T, Ismael H. Ruptured gastro-intestinal stromal tumor as a surgical emergency: A case report and literature review. J Surg Case Rep 2022; 2022:rjac434. [PMID: 36452287 PMCID: PMC9699728 DOI: 10.1093/jscr/rjac434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 08/29/2022] [Indexed: 02/02/2024] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. GISTs of the small bowel are rare, and often present with an abdominal mass and/or bleeding. Chemotherapy and surgery are the mainstay of therapy. Here, we discuss an unusual case of a ruptured jejunal GIST with hemoperitoneum and recurrence despite surgical excision followed by Imatinib treatment. Forty-five cases of ruptured small intestinal GISTs were identified in the literature. Most cases were in males and were found to be at the site of the jejunum.
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Affiliation(s)
- Mohamed Abdelgawad
- Department of Surgery, University of Texas Health Science Center, UT Health East Texas, Tyler, TX, USA
| | - Omar M Kamel
- Department of Surgery, School of Medicine, Tulane University, New Orleans, LA, USA
| | - Peter P Issa
- School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Mahmoud Omar
- Department of Surgery, School of Medicine, Tulane University, New Orleans, LA, USA
| | - Lutfi Barghuthi
- Department of Surgery, University of Texas Health Science Center, UT Health East Texas, Tyler, TX, USA
| | - Tyler Davis
- Department of Surgery, University of Texas Health Science Center, UT Health East Texas, Tyler, TX, USA
| | - Hishaam Ismael
- Department of Surgery, University of Texas Health Science Center, UT Health East Texas, Tyler, TX, USA
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Bairwa B. Gastrointestinal stromal tumor of jejunum presenting as a pelvic mass: A rare case report and review of literature. ARCHIVES OF MEDICINE AND HEALTH SCIENCES 2022. [DOI: 10.4103/amhs.amhs_306_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Liu T, Lin G, Peng H, Huang L, Jiang X, Li H, Cai K, Jiang J, Guo L, Du X, Tang J, Zhang W, Chen J, Ye Y. Clinicopathological characteristics and prognosis of gastrointestinal stromal tumors containing air-fluid levels. PLoS One 2021; 16:e0261566. [PMID: 34919581 PMCID: PMC8682903 DOI: 10.1371/journal.pone.0261566] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 12/04/2021] [Indexed: 11/18/2022] Open
Abstract
An air-fluid level within a gastrointestinal stromal tumor (GIST) is unusual and indicates the presence of a fistula within the lumen of the GI tract. Until recently, the optimal management of such patients was not clear-cut. This retrospective study investigated the clinicopathological characteristics, surgical procedures, pre-and post-operative management, and prognosis of patients with GIST containing an air-fluid level. Data of GIST patients, spanning 5 years, including 17 GIST patients with air-fluid levels in the experimental group and 34 GIST patients without air-fluid levels in the control group, were retrieved from two hospitals in China. The clinicopathological characteristics, types of surgery, management, and clinical outcomes of GIST patients were compared between the two groups. GISTs containing air-fluid levels were significantly different from GISTs without air-fluid levels regarding tumor morphology, NIH risk category, invasion of adjacent organs, and necrosis or ulceration. Most GIST patients with air-fluid levels (14/17, 82.4%) received open surgery, significantly higher than the 20.6% in the control group. Targeted therapy with Imatinib mesylate (IM) was implemented in all GIST patients in the experimental group (17/17, 100%); markedly higher than those (3/34, 8.8%) in the control group. During follow-up, recurrence and death rates (5.9% and 5.9%) in the experimental group were higher than those (2.9% and 0%) in the control group. Open surgery is commonly performed in GIST patients with air-fluid levels who also require targeted therapy with IM. The Torricelli-Bernoulli sign could be a risk factor, adversely affecting the patient’s prognosis.
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Affiliation(s)
- Tianzhu Liu
- Department of Radiology, Guangdong Hospital of Traditional Chinese Medicine, Zhuhai, China
| | - Gao Lin
- Department of General Surgery, Guangdong Hospital of Traditional Chinese Medicine, Zhuhai, Guangdong, China
| | - Hui Peng
- Department of Pathology, Guangdong Hospital of Traditional Chinese Medicine, Zhuhai, Guangdong, China
| | - Lesheng Huang
- Department of Radiology, Guangdong Hospital of Traditional Chinese Medicine, Zhuhai, China
| | - Xiaosong Jiang
- Department of General Surgery, Guangdong Hospital of Traditional Chinese Medicine, Zhuhai, Guangdong, China
| | - Hongyi Li
- Department of Radiology, Guangdong Hospital of Traditional Chinese Medicine, Zhuhai, China
| | - Kaili Cai
- Department of Radiology, Guangdong Hospital of Traditional Chinese Medicine, Zhuhai, China
| | - Jinghua Jiang
- Department of Radiology, Guangdong Hospital of Traditional Chinese Medicine, Zhuhai, China
| | - Lei Guo
- Department of Radiology, Guangdong Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong, China
| | - Xiaohua Du
- Department of Pathology, Guangdong Hospital of Traditional Chinese Medicine, Zhuhai, Guangdong, China
| | - Jiahui Tang
- Department of Radiology, Guangdong Hospital of Traditional Chinese Medicine, Zhuhai, China
| | - Wanchun Zhang
- Department of Radiology, Guangdong Hospital of Traditional Chinese Medicine, Zhuhai, China
| | - Jun Chen
- Department of Radiology, Guangdong Hospital of Traditional Chinese Medicine, Zhuhai, China
- * E-mail: (YY); (JC)
| | - Yongsong Ye
- Department of Radiology, Guangdong Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong, China
- * E-mail: (YY); (JC)
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