Small bowel gastrointestinal stromal tumor presenting with gastrointestinal bleeding in patient with type 1 Neurofibromatosis: Management and laparoscopic treatment. Case report and review of the literature

Life-threatening gastrointestinal bleeding in a case of neurofibromatosis 1 and gastrointestinal stromal tumour managed with surgical intervention as a case report

A 63-year-old patient with skin neurofibromas since birth was brought to emergency in a critical state due to massive bleeding per rectum. After stabilization and massive transfusion, the patient underwent Gastro-Intestinal (GI) endoscopy and abdominal computed tomography. A mass was identified in the jejunum. On laparotomy, multiple neurofibromas were seen in the jejunum. The segment with bleeding tumour was resected. Histopathology revealed benign spindle cell neoplasm, a gastrointestinal stromal tumour. The patient recovered and was discharged on day 15.

Neurofibromatosis type 1 with multiple gastrointestinal stromal tumors: A case report

BACKGROUND

Neurofibromatosis type 1 (NF1) is characterized by café-au-lait patches on the skin and the presence of neurofibromas. Gastrointestinal stromal tumor (GIST) is the most common non-neurological tumor in NF1 patients. In NF1-associated GIST, KIT and PDGFRA mutations are frequently absent and imatinib is ineffective. Surgical resection is first-line treatment.

CASE SUMMARY

A 56-year-old woman with NF1 was hospitalized because of an incidental pelvic mass. Physical examination was notable for multiple café-au-lait patches and numerous subcutaneous soft nodular masses of the skin of the head, face, trunk, and limbs. Her abdomen was soft and nontender. No masses were palpated. Digital rectal examination was unremarkable. Abdominal computed tomography was suspicious for GIST or solitary fibrous tumor. Laparoscopy was performed, which identified eight well-demarcated masses in the jejunum. All were resected and pathologically diagnosed as GISTs. The patient was discharged on day 7 after surgery without complications. No tumor recurrence was evident at the 6-mo follow-up.

CONCLUSION

Laparoscopy is effective for both diagnosis and treatment of NF1-associated GIST.

Genetic susceptibility in children, adolescents, and young adults diagnosed with soft-tissue sarcomas

Soft tissue sarcomas (STS) may arise as a consequence of germline variants in cancer predisposition genes (CPGs). We believe that elucidating germline sarcoma predisposition is critical for understanding disease biology and therapeutic requirements. Participation in surveillance programs may allow for early tumor detection, early initiation of therapy and, ultimately, better outcomes. Among children, adolescents, and adults diagnosed with soft-tissue sarcomas and examined as part of published germline sequencing studies, pathogenic/likely pathogenic (P/LP) variants in CPGs were reported in 7-33% of patients. P/LP germline variants were detected most frequently in TP53, NF1 and BRCA1/2. In this review, we describe reported associations between soft tissue sarcomas and germline variants in CPGs, with mentioning of locally aggressive and benign soft tissue tumors that have important associations with cancer predisposition syndromes. We also discuss recommendations for diagnostic germline genetic testing. Testing for sarcoma-predisposing germline variants should be considered as part of the routine clinical workup and care of any child, adolescent, or adult diagnosed with STS and take into account consequences for the whole family.

A case of jejunal GIST revealed by hematemesis: Unusual situation

Introduction

Gastrointestinal stromal tumors (GISTs) are rare tumors of the gastrointestinal (GI) tract, which can occur in majorly stomach, and rarely in the small intestine, rectum, and large intestine. We report a jejunal GIST presented with massive hematemesis in the current study.

Case presentation

A 39-years-old male, without any underlying history, was presented to our center with the complaint of massive hematemesis. Given the unstable hemodynamics of the patient, an upper GI endoscopy was requested, associated with a large amount of blood in the duodenal bulb without any sign of bleeding. The patient was sent to the operation room, and after laparotomy, a mass was seen in the jejunum, revealed as GIST after pathological study.

Discussion

Small-intestine-related etiologies are rare conditions related to upper GI bleeding (UGIB). Jejunal GIST usually manifests as asymptomatic subepithelial mass and is associated with abdominal discomfort or GI bleeding. Sudden unset bleeding is a rare manifestation of jejunal GIST, but it can be associated with the emergency outcome and may need emergency intervention.

Conclusion

UGIB can occur in jejunal GIST, which should be considered in the management of UGIB.

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Gastrointestinal stromal tumors (GISTs) are rare tumors of the gastrointestinal (GI) tract.

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GISTs are rarely found in the small intestine, compatible with abdominal discomfort.

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Jejunal GISTs usually manifest as intestinal obstruction and abdominal pain.

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Massive hematemesis is rare in jejunal GISTs and should be consider in the management of upper GI bleeding.