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Omura T, Ikawa K, Kudo E. Acute hemorrhagic cholecystitis related to diffuse neurofibroma of gallbladder in a patient with neurofibromatosis type 1. Surg Case Rep 2023; 9:62. [PMID: 37079137 PMCID: PMC10119345 DOI: 10.1186/s40792-023-01647-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 04/12/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND We report the first case of acute hemorrhagic cholecystitis with large hemoperitoneum related to gallbladder wall fragility caused by neurofibroma cell infiltration. CASE PRESENTATION A 46-year-old man with neurofibromatosis type 1 (NF1), who had been hospitalized for retroperitoneal hematoma and treated by transarterial embolization 9 days earlier, complained of right upper quadrant pain, bloating, nausea, and emesis. Computed tomography revealed fluid collection and a distended gallbladder with high-density contents. The patient was taken to the operating room for laparoscopic cholecystectomy, with consideration of the hemodynamic tolerance, for acute hemorrhagic cholecystitis. An initial laparoscopy revealed a significant amount of blood in the abdominal cavity exuding from the gallbladder. Due to its fragility, the gallbladder was easily ruptured by surgical manipulation. After conversion to open surgery, subtotal cholecystectomy was performed. Seventeen days after surgery, the patient was transferred to another hospital for rehabilitation. Histological examination revealed diffuse and nodular proliferation of spindle cells that had replaced the muscularis propria of the gallbladder wall. CONCLUSION This clinical case highlights how NF1 can cause various symptoms in the blood vessels and gastrointestinal tract, including the gallbladder.
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Affiliation(s)
- Takeshi Omura
- Department of Surgery, Tokushima Prefectural Central Hospital, Kuramoto-cho, 1-10-3, Tokushima, 770-8539, Japan.
- Emergency Surgery and Trauma Center, Tokushima Prefectural Central Hospital, Kuramoto-cho, 1-10-3, Tokushima, 770-8539, Japan.
| | - Koichi Ikawa
- Department of Surgery, Tokushima Prefectural Central Hospital, Kuramoto-cho, 1-10-3, Tokushima, 770-8539, Japan
- Emergency Surgery and Trauma Center, Tokushima Prefectural Central Hospital, Kuramoto-cho, 1-10-3, Tokushima, 770-8539, Japan
| | - Eiji Kudo
- Department of Pathology, Tokushima Prefectural Central Hospital, Kuramoto-cho, 1-10-3, Tokushima, 770-8539, Japan
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A case of planar-type gastrointestinal stromal tumor of the transverse colon with perforation. Clin J Gastroenterol 2021; 14:1157-1162. [PMID: 33728873 DOI: 10.1007/s12328-021-01385-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/08/2021] [Indexed: 10/21/2022]
Abstract
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumor of the human gastrointestinal tract. They usually develop in the stomach and small intestine, but extremely rarely in the colon. Although most GISTs form a mass, some cases showing a flatly proliferating lesion called planar-type GIST have been reported in the sigmoid colon and small intestine. Those are often associated with diverticular lesion and/or perforation. We present here a case of planar-type GIST of the transverse colon with perforation. A 49-year-old Japanese woman abruptly complained of abdominal pain, and was clinically diagnosed as perforation of the transverse colon. Partial resection of the transverse colon including the perforated site was done, and no apparent mass lesion was present. Histology showed that spindle cells flatly proliferated around the perforated area and replaced the layers from submucosa to subserosa. Immunohistochemistry revealed that the spindle cells were KIT-, DOG1- and CD34-positive. Codons 557 and 558 of exon 11 of the c-kit gene were heterozygously deleted at the lesional tissue but not at the normal mucosal tissue. Planar-type GIST of the transverse colon has not been reported yet, and the literature search for the similar cases was done.
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Shintaku Y, Asano Y, Watanabe T, Kihara T, Ishikawa E, Jiayin Y, Kimura N, Kinoshita K, Hirota S. A case of planar-type GIST of the sigmoid colon showing diverticular structure with perforation. World J Surg Oncol 2020; 18:125. [PMID: 32527279 PMCID: PMC7291680 DOI: 10.1186/s12957-020-01906-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 06/03/2020] [Indexed: 01/28/2023] Open
Abstract
Background Gastrointestinal stromal tumors (GISTs) generally form well-defined mass lesions. However, some cases of the flatly distributed and muscularis propria-replacing GISTs have been reported so far. We experienced an additional case of planar-type GIST of the sigmoid colon accompanied by a diverticulum with perforation. Case presentation A 68-year-old Japanese male with sudden onset of abdominal pain was clinically diagnosed with gastrointestinal perforation, and an emergency abdominal operation was performed. A diverticulum with rupture was found in the sigmoid colon, but no apparent tumor was observed. Histological examination revealed bland spindle cells flatly proliferating and diffusely replacing the muscularis propria at the diverticular structure. The spindle cells were positive for KIT, DOG1, and CD34. Mutational analysis of the c-kit gene revealed that the lesion had a heterozygous deletion of 2 amino acids at codons 557 and 558 of exon 11. The mutation was not observed in the normal mucosa of the surrounding tissue. Conclusion We diagnosed this case as an unusual planar-type GIST. Some similar cases have been reported in the sigmoid colon and other sites. We discuss the mechanism of development of the planar-type GISTs associated with the diverticulum.
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Affiliation(s)
- Yuka Shintaku
- Department of Pathology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Yuya Asano
- Department of Pathology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Takahiro Watanabe
- Department of Pathology, Chibune Hospital, 3-4-39 Fuku-machi, Nishi-yodogawaku, Osaka, Osaka, 555-0034, Japan
| | - Takako Kihara
- Department of Pathology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Eri Ishikawa
- Department of Pathology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Yuan Jiayin
- Department of Pathology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Neinei Kimura
- Department of Pathology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Koji Kinoshita
- Department of Surgery, Nomura-Kaihin Hospital, 2-1-41 Sumaura-dori, Suma-ku, Kobe, Hyogo, 654-0055, Japan
| | - Seiichi Hirota
- Department of Pathology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
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Asare EA, Davis CH, Chiang YJ, Sabir S, Rajkot NF, Phillips PR, Roland CL, Torres KE, Hunt KK, Feig BW. Management and outcomes of ruptured, perforated or fistulized tumors of mesenchymal origin. J Surg Oncol 2020; 121:474-479. [PMID: 31846095 DOI: 10.1002/jso.25807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 12/02/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Patients with ruptured, perforated or fistulized (RPF) sarcomas commonly have issues such as sepsis and malnutrition and are usually unsuitable for oncologic resection in the emergency setting. We present our approach for managing a series of patients and the outcomes which were achieved with multidisciplinary care. METHODS We reviewed records of patients referred to the section of sarcoma surgical oncology. Clinicopathologic factors, preoperative and operative interventions as well as short-term oncologic outcomes were assessed. RESULTS Sixteen patients were identified between 1 January 1998 to 31 December 2018. Median age was 42.8 years. Histologies were; Gastrointestinal stromal tumors (7), desmoid (4), spindle cell tumor (2), dedifferentiated liposarcoma (2), and nonseminomatous germ cell tumor (1). Five patients had preoperative sepsis, 8 received antimicrobials, and 50% required hospitalization with a median stay of 21 days. Total parenteral nutrition was administered to 5 (31.3%) patients. Median tumor size and estimated blood loss were 13.1 cm and 350 mL respectively. No perioperative mortality occurred. Two patients have expired at a median follow-up of 16.1 months. CONCLUSION Preoperative optimization, including the use of percutaneous drains, and antibiotics to control sepsis, where necessary, can lead to eventual oncologic resection with acceptable morbidity and no short-term mortality for patients with RPF sarcomas.
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Affiliation(s)
- Elliot A Asare
- Department of Surgical Oncology, University of Texas, M. D. Anderson Cancer Center, Houston, Texas.,Department of Surgery, University of Utah and Huntsman Cancer Institute, Salt Lake City, Utah
| | | | - Yi-Ju Chiang
- Department of Surgical Oncology, University of Texas, M. D. Anderson Cancer Center, Houston, Texas
| | - Sharjeel Sabir
- Department of Interventional Radiology, Scripps Mercy Hospital, San Diego, California
| | - Nikita F Rajkot
- Department of Surgical Oncology, University of Texas, M. D. Anderson Cancer Center, Houston, Texas
| | - Paula R Phillips
- Department of Surgical Oncology, University of Texas, M. D. Anderson Cancer Center, Houston, Texas
| | - Christina L Roland
- Department of Surgical Oncology, University of Texas, M. D. Anderson Cancer Center, Houston, Texas
| | - Keilla E Torres
- Department of Surgical Oncology, University of Texas, M. D. Anderson Cancer Center, Houston, Texas
| | - Kelly K Hunt
- Department of Surgical Oncology, University of Texas, M. D. Anderson Cancer Center, Houston, Texas
| | - Barry W Feig
- Department of Surgical Oncology, University of Texas, M. D. Anderson Cancer Center, Houston, Texas
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Feng F, Tian Y, Liu Z, Xu G, Liu S, Guo M, Lian X, Fan D, Zhang H. Clinicopathological features and prognosis of colonic gastrointestinal stromal tumors: evaluation of a pooled case series. Oncotarget 2016; 7:40735-40745. [PMID: 27166191 PMCID: PMC5130040 DOI: 10.18632/oncotarget.9196] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 04/16/2016] [Indexed: 01/03/2023] Open
Abstract
Background Due to the extremely rare incidence, data about colonic GISTs are limited. Therefore, aim of the present study was to explore clinicopathological characteristics and prognosis of colonic GISTs. Patients and Methods Colonic GISTs cases were obtained from our center and from case report and clinical studies extracted from MEDLINE. Clinicopathological features and survivals were analyzed. Results There were 79 colonic GISTs patients with a female predominance. The median age was 66 years (range 0.17-84). The median tumor size was 5.8 cm (range 0.5-29). The most common location was sigmoid colon (45.8%), followed by transverse colon (19.5%). The majority of colonic GISTs were high risk (70.8%). Mitotic index was correlated with gender (P = 0.002) and tumor size (P = 0.005), and tumor location was correlated with age (P = 0.017). The five year DFS and DSS were 57.4% and 61.6%, respectively. Mitotic index and NIH risk classification were associated with prognosis of colonic GISTs. However, mitotic index was the only independent risk factor. The distribution of tumor size and NIH risk classification were significantly different between colonic and gastric GISTs (both P = 0.000). The DFS and DSS of colonic GISTs were significantly lower than that of gastric GISTs (P = 0.012 and P = 0.002, respectively). Conclusions The most common location for colonic GISTs was sigmoid colon. Most tumors were high risk. Mitotic index was the only independent risk factor for prognosis of colonic GISTs. Colonic GISTs differ significantly from gastric GISTs in respect to clinicopathological features. The prognosis of colonic GISTs was worse than that of gastric GISTs.
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Affiliation(s)
- Fan Feng
- Department of Digestive Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Yangzi Tian
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Zhen Liu
- Department of Digestive Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Guanghui Xu
- Department of Digestive Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Shushang Liu
- Department of Digestive Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Man Guo
- Department of Digestive Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Xiao Lian
- Department of Digestive Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Daiming Fan
- Department of Digestive Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Hongwei Zhang
- Department of Digestive Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
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Ikemura M, Kunita A, Miwa Y, Jimbo K, Mori K, Seto Y, Fukayama M. Gut wall replacing type of gastrointestinal stromal tumor presenting as a perforation of the ileal diverticulum. Pathol Res Pract 2015; 211:892-5. [DOI: 10.1016/j.prp.2015.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 05/05/2015] [Accepted: 05/08/2015] [Indexed: 12/16/2022]
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Kono M, Tsuji N, Ozaki N, Matsumoto N, Takaba T, Okumura N, Kawasaki M, Tomita T, Umehara Y, Taniike S, Hatabe S, Funai S, Ono Y, Ochiai K, Maekura S, Kudo M. Primary leiomyosarcoma of the colon. Clin J Gastroenterol 2015. [PMID: 26208828 DOI: 10.1007/s12328-015-0584-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Primary leiomyosarcomas of the gastrointestinal (GI) tract are extremely rare and highly aggressive neoplasms, and only a small number of true cases have been reported since the concept of GI stromal tumors was established. Here, we report a case of a primary leiomyosarcoma of the transverse colon. A 46-year-old Japanese male with a large mass in the right upper abdomen was admitted to our hospital. Computed tomography and magnetic resonance imaging revealed long segments of wall thickening of the transverse colon with large consecutive tumors measuring 12 cm in diameter. A projecting irregular mass with marked mucosal necrosis was found on colonoscopy. Pathological examination revealed a spindle cell tumor growing circumferentially and transmurally to replace the muscularis propria in the transverse colon. The spindle cells were positive for smooth muscle actin, and negative for KIT, CD34, DOG-1, and S-100 protein. The patient has shown repeat recurrence in spite of sufficient surgical excision being promptly performed.
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Affiliation(s)
- Masashi Kono
- Department of Gastroenterology, Sakai Hospital Kinki University Faculty of Medicine, 2-7-1 Harayamadai, Minamiku, Sakai, 590-0132, Japan
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Alessiani M, Gianola M, Rossi S, Perfetti V, Serra P, Zelaschi D, Magnani E, Cobianchi L. Peritonitis secondary to spontaneous perforation of a primary gastrointestinal stromal tumour of the small intestine: A case report and a literature review. Int J Surg Case Rep 2014; 6C:58-62. [PMID: 25524303 PMCID: PMC4334641 DOI: 10.1016/j.ijscr.2014.12.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Revised: 12/03/2014] [Accepted: 12/05/2014] [Indexed: 12/12/2022] Open
Abstract
Emergency presentation of a GIST is not uncommon and one of its manifestations is acute abdome. The cases described in the literature are the tip of the iceberg and spontaneous rupture or perforation of GISTs are a far more frequent first presentation of this rare tumour. The jejunum was the more common location of perforation compared to the ileum. Emergency surgery is mandatory and should achieve radical resection.
Introduction A few cases of acute abdomen caused by perforation of small-intestinal gastrointestinal stromal tumours (GISTs) have been reported in the literature. Presentation of case Together with a review of the published cases, here we report a case of an elderly patient with peritonitis due to spontaneous perforation of a GIST of the jejunum. An 82-year-old man was admitted to the emergency unit of our hospital with fever and severe abdominal pain. An abdominal enhanced computed tomography scan detected a 6 cm solid mass in the left upper quadrant adherent to a jejunal loop and surrounded by free fluid and free air. Due to the radiological features of the mass, the diagnosis of a perforation of a GIST arising from the jejunum wall was suspected. The patient underwent emergency laparotomy. Intraoperative findings confirmed diffuse peritonitis secondary to jejunal tumour perforation. A segmental resection of the jejunum containing the mass was performed followed by a mechanical end-to-side anastomosis. The histopathologic examination of the mass confirmed the diagnosis of a perforated GIST of the small intestine (high-risk category). The post-operative course was uneventful and the patient was treated with adjuvant imatinib therapy. Discussion Twenty-one other cases of spontaneous perforation of small intestine GISTs are reported in the literature and are summarized in the present review. Conclusion The described case is the tip of the iceberg and spontaneous rupture or perforation of GISTs are a far more frequent first presentation of this rare tumour.
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Affiliation(s)
- Mario Alessiani
- Department of General Surgery, Varzi Hospital, Italy; Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Italy
| | - Marco Gianola
- Department of General Surgery, Varzi Hospital, Italy
| | | | - Vittorio Perfetti
- Department of Oncology, IRCCS San Matteo Hospital Foundation, Pavia, Italy.
| | - Piero Serra
- Department of General Surgery, Varzi Hospital, Italy.
| | | | - Enzo Magnani
- Department of General Surgery, Varzi Hospital, Italy.
| | - Lorenzo Cobianchi
- Unit of General Surgery 1, IRCCS San Matteo Hospital Foundation, Pavia, Italy; Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Italy.
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Ueno G, Maeda T, Arima R, Oka H, Hirota S. A planar gastrointestinal stromal tumor replacing the proper muscle layer causing fecaloma and perforation in the sigmoid colon: a case report and literature review. Clin J Gastroenterol 2014; 7:328-32. [DOI: 10.1007/s12328-014-0514-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 06/29/2014] [Indexed: 12/26/2022]
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