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Sheedy CM, Weinstein A, Chafitz O, Oladipo AF. Diagnosis and management of high risk gastrointestinal stromal tumor in first trimester pregnancy: A case report and review of the literature. Heliyon 2023; 9:e15858. [PMID: 37215772 PMCID: PMC10196775 DOI: 10.1016/j.heliyon.2023.e15858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 04/14/2023] [Accepted: 04/25/2023] [Indexed: 05/24/2023] Open
Abstract
Objective There are less than 20 reported cases of gastrointestinal stromal tumors in pregnancy. Of these reported cases, there are only two that detail GIST in the first trimester. We report our experience with the third known GIST diagnosis in the first trimester of pregnancy. Notably, our case report highlights the earliest known gestational age at time of GIST diagnosis. Methods We conducted a literature review of GIST diagnosis in pregnancy via PUBMED, using a combination of the following terms: (pregnancy or gestation) and (GIST). We utilized Epic for chart review of our patient's case report. Results A 24 year old G3P1011 presented to the Emergency Department at 4w6d by last menstrual period (LMP) with worsening abdominal cramping, bloating, and associated nausea. Physical exam revealed a large, mobile, nontender mass palpated in the right lower abdomen. Transvagianl ultrasound noted the presence of a large pelvic mass of unknown etiology. Pelvic magnetic resonance imaging (MRI) was obtained for further characterization, revealing a 7.3× 12.4 × 12.2 cm mass with multiple fluid levels, centered in the anterior mesentery. Exploratory laparotomy was performed with en bloc resection of small bowel and pelvic mass, with pathology demonstrating a 12.8 cm spindle cell neoplasm compatible with GIST and notable for a mitotic rate of 40 mitoses/50 high power field (HPF). Next generation sequencing (NGS) was pursued in order to predict tumor responsiveness to Imatinib, which revealed a mutation at KIT exon 11, suggesting a response to tyrosine kinase inhibitor therapy. The patient's multidisciplinary treatment team, consisting of medical oncologists, surgical oncologists, and maternal fetal medicine specialists, made the recommendation for adjuvant Imatinib therapy. The patient was offered termination of pregnancy with immediate initiation of Imatinib, as well as continuation of pregnancy with either immediate or delayed treatment. Interdisciplinary counseling focused on both the maternal and fetal implications of each proposed management plan. She ultimately elected termination of pregnancy, and underwent an uncomplicated dilation and evacuation. Conclusions GIST diagnosis in pregnancy is exceedingly rare. Patients with high-grade disease encounter a multitude of decision-making dilemmas, often with competing maternal and fetal interests. As additional cases of GIST in pregnancy are added to the literature, clinicians will be able to implement evidence-based options counseling for their patients. Shared decision-making is contingent upon patient understanding of diagnosis, risk of recurrence, available treatment options, and the treatment-related implications on maternal and fetal outcomes. A multidisciplinary approach is crucial for optimization of patient-centered care.
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Affiliation(s)
- Christina M. Sheedy
- Hackensack Meridian School of Medicine, 340 Kingsland St Building 123, Nutley, NJ, 07110, United States
| | - Anna Weinstein
- Obstetrics and Gynecology Department, Hackensack University Medical Center, 30 Prospect Avenue, Hackensack, NJ, 07601, United States
| | - Olivia Chafitz
- Obstetrics and Gynecology Department, Hackensack University Medical Center, 30 Prospect Avenue, Hackensack, NJ, 07601, United States
| | - Antonia F. Oladipo
- Obstetrics and Gynecology Department, Hackensack University Medical Center, 30 Prospect Avenue, Hackensack, NJ, 07601, United States
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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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3
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Huang PH, Chen YY, Chen HH, Ting WH, Lin HH, Chen KH, Hsiao SM. Factors affecting clinical outcomes in women with non-gastric gastrointestinal stromal tumors. Taiwan J Obstet Gynecol 2022; 61:306-311. [DOI: 10.1016/j.tjog.2022.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2020] [Indexed: 11/26/2022] Open
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4
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Tada Y, Yamamoto M, Sawata S, Hara K, Sugesawa K, Ueshima C, Tanio A, Kihara K, Matsunaga T, Tokuyasu N, Takano S, Sakamoto T, Honjo S, Hasegawa T, Fujiwara Y. Ruptured Small Intestinal Stromal Tumor Causing Concurrent Gastrointestinal and Intra-Abdominal Hemorrhage: A Case Report. Yonago Acta Med 2021; 64:137-142. [PMID: 33642915 DOI: 10.33160/yam.2021.02.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 02/12/2021] [Indexed: 12/14/2022]
Abstract
Gastrointestinal stromal tumors (GISTs) originate from mesenchymal cells throughout the gastrointestinal tract. A common symptom is gastrointestinal hemorrhage; intra-abdominal hemorrhage is relatively rare. There are few reports of GIST presenting with both types of hemorrhage concurrently. A 77-year-old man was admitted to our hospital because of melena and anemia (Hb: 4.7 g/dL). Computed tomography revealed a small bowel tumor and high-density fluid in both the small intestine and the pelvic floor. We diagnosed a small intestinal tumor with concurrent gastrointestinal and intra-abdominal hemorrhage, and performed emergency surgery. The tumor arose from the small intestine and was ruptured. We found hemorrhage in the pelvic cavity and performed partial small intestine resection. Pathological findings revealed that the tumor was positive for c-Kit protein and was diagnosed as GIST. The patient was discharged from the hospital on postoperative day 9 and received imatinib 1 month postoperatively. We experienced a very rare case of ruptured GIST originating from the small intestine associated with both gastrointestinal and intra-abdominal hemorrhage. We also reviewed the relevant literature.
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Affiliation(s)
- Yoichiro Tada
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Manabu Yamamoto
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Shohei Sawata
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Kazushi Hara
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Ken Sugesawa
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Chihiro Ueshima
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Akimitsu Tanio
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Kyoichi Kihara
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Tomoyuki Matsunaga
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Naruo Tokuyasu
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Shuichi Takano
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Teruhisa Sakamoto
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Soichiro Honjo
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Toshimichi Hasegawa
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Yoshiyuki Fujiwara
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
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Charo LM, Burgoyne AM, Fanta PT, Patel H, Chmielecki J, Sicklick JK, McHale MT. A Novel PRKAR1B-BRAF Fusion in Gastrointestinal Stromal Tumor Guides Adjuvant Treatment Decision-Making During Pregnancy. J Natl Compr Canc Netw 2019. [PMID: 29523662 DOI: 10.6004/jnccn.2017.7039] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Gastrointestinal stromal tumors (GISTs) are rare in pregnancy, with only 11 reported cases. Adjuvant imatinib therapy, which targets the most common driver mutations in GIST (KIT and PDGFRA), is recommended for patients with high-risk GIST, but it has known teratogenicity in the first trimester. A 34-year-old G3P2 woman underwent exploratory laparotomy at 16 weeks' gestation for a presumed adnexal mass. Surgical findings included normal adnexa and a 14-cm solid small bowel mass. The mass was resected en bloc with a segment of jejunum followed by a primary anastomosis. Histopathology and genomic analyses demonstrated a GIST with high-risk features but lack of KIT/PDGFRA mutations and identified the presence of a previously unreported, pathogenic PRKAR1B-BRAF gene fusion. Given her tumor profile, adjuvant therapy with imatinib was not recommended. GIST is rare in pregnancy, but can masquerade as an adnexal mass in women of childbearing age. Because neoadjuvant/adjuvant imatinib has risks of teratogenicity, tumor molecular profiling is critical as we identified a previously unreported gene fusion of PRKAR1B with BRAF that is predicted to be imatinib-resistant. In this case, testing provided the rationale for not offering adjuvant imatinib to avoid unnecessary toxicity to the patient and fetus.
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Affiliation(s)
- Lindsey M Charo
- From the Division of Gynecologic Oncology, Department of Reproductive Medicine, and Division of Hematology-Oncology, Department of Medicine, UC San Diego Moores Cancer Center, La Jolla, California; Foundation Medicine, Inc., Cambridge, Massachusetts; and Division of Surgical Oncology, Department of Surgery, UC San Diego Moores Cancer Center, La Jolla, California
| | - Adam M Burgoyne
- From the Division of Gynecologic Oncology, Department of Reproductive Medicine, and Division of Hematology-Oncology, Department of Medicine, UC San Diego Moores Cancer Center, La Jolla, California; Foundation Medicine, Inc., Cambridge, Massachusetts; and Division of Surgical Oncology, Department of Surgery, UC San Diego Moores Cancer Center, La Jolla, California
| | - Paul T Fanta
- From the Division of Gynecologic Oncology, Department of Reproductive Medicine, and Division of Hematology-Oncology, Department of Medicine, UC San Diego Moores Cancer Center, La Jolla, California; Foundation Medicine, Inc., Cambridge, Massachusetts; and Division of Surgical Oncology, Department of Surgery, UC San Diego Moores Cancer Center, La Jolla, California
| | - Hitendra Patel
- From the Division of Gynecologic Oncology, Department of Reproductive Medicine, and Division of Hematology-Oncology, Department of Medicine, UC San Diego Moores Cancer Center, La Jolla, California; Foundation Medicine, Inc., Cambridge, Massachusetts; and Division of Surgical Oncology, Department of Surgery, UC San Diego Moores Cancer Center, La Jolla, California
| | - Juliann Chmielecki
- From the Division of Gynecologic Oncology, Department of Reproductive Medicine, and Division of Hematology-Oncology, Department of Medicine, UC San Diego Moores Cancer Center, La Jolla, California; Foundation Medicine, Inc., Cambridge, Massachusetts; and Division of Surgical Oncology, Department of Surgery, UC San Diego Moores Cancer Center, La Jolla, California
| | - Jason K Sicklick
- From the Division of Gynecologic Oncology, Department of Reproductive Medicine, and Division of Hematology-Oncology, Department of Medicine, UC San Diego Moores Cancer Center, La Jolla, California; Foundation Medicine, Inc., Cambridge, Massachusetts; and Division of Surgical Oncology, Department of Surgery, UC San Diego Moores Cancer Center, La Jolla, California
| | - Michael T McHale
- From the Division of Gynecologic Oncology, Department of Reproductive Medicine, and Division of Hematology-Oncology, Department of Medicine, UC San Diego Moores Cancer Center, La Jolla, California; Foundation Medicine, Inc., Cambridge, Massachusetts; and Division of Surgical Oncology, Department of Surgery, UC San Diego Moores Cancer Center, La Jolla, California
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Kameyama H, Kanda T, Tajima Y, Shimada Y, Ichikawa H, Hanyu T, Ishikawa T, Wakai T. Management of rectal gastrointestinal stromal tumor. Transl Gastroenterol Hepatol 2018; 3:8. [PMID: 29552659 DOI: 10.21037/tgh.2018.01.08] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 01/16/2018] [Indexed: 12/18/2022] Open
Abstract
Gastrointestinal stromal tumor (GIST) is the most common mesenchymal neoplasm of the gastrointestinal tract. However, rectal GIST is rare, the incident rate of it is approximately 5% of all GISTs. Rectal GIST symptoms generally include bleeding and/or pain and occasionally, urinary symptoms. Immunohistochemical evaluation finds that most rectal GIST tumors are CD117 (KIT) positive, and are sometimes CD34, platelet-derived growth factor receptor alpha (PDGFRA), smooth muscle actin, S-100, or vimentin positive. The National Institutes of Health (NIH) classifies rectal GIST as very-low risk, low risk, intermediate risk, or high risk, and the frequencies have been estimated as 0-23.8% for very-low risk, 0-45% for low risk, 0-34% for intermediate risk, and 21-100% for high risk tumors. The first-line treatment for localized GIST is curative resection, but is difficult in rectal GIST because of anatomical characteristics such as the deep, narrow pelvis and proximity to the sphincter muscle or other organs. Several studies noted the efficacy of the minimally invasive surgery, such as trans-anal, trans-sacral, trans-vaginal resection, or laparoscopic resection. The appropriate surgical procedure should be selected depending on the case. Imatinib mesylate (IM) is indicated as first-line treatment of metastatic or unresectable GIST, and clinical outcomes are correlated with KIT mutation genotype. However, the KIT mutation genotypes in rectal GIST are not well known. In this review, as in other GISTs, a large proportion (59-100%) of rectal GISTs carry exon 11 mutations. Although curative resection is indicated for localized rectal GIST, a high rate of local recurrence is a problem. Multimodal therapy including perioperative IM may improve postoperative outcomes, contributing to anus-preserving surgery. Moreover, KIT mutation analysis before IM treatment is important. This review summarizes current treatment strategies for rectal GIST.
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Affiliation(s)
- Hitoshi Kameyama
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Tatsuo Kanda
- Department of Surgery, Sanjo General Hospital, Niigata, Japan
| | - Yosuke Tajima
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yoshifumi Shimada
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Hiroshi Ichikawa
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takaaki Hanyu
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takashi Ishikawa
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Toshifumi Wakai
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Fukuda S, Fujiwara Y, Wakasa T, Inoue K, Kitani K, Ishikawa H, Tsujie M, Yukawa M, Ohta Y, Inoue M. Small, spontaneously ruptured gastrointestinal stromal tumor in the small intestine causing hemoperitoneum: A case report. Int J Surg Case Rep 2017; 36:64-68. [PMID: 28549261 PMCID: PMC5443905 DOI: 10.1016/j.ijscr.2017.05.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 05/04/2017] [Accepted: 05/14/2017] [Indexed: 12/26/2022] Open
Abstract
Hemoperitoneum is a rare and potentially life-threatening complication of GISTs. Even small GISTs in the small intestine can rupture and cause hemoperitoneum. Because of their high vascularity, ruptured GISTs can cause massive hemoperitoneum.
Introduction Gastrointestinal stromal tumors (GISTs) are clinically asymptomatic until they reach a significant size; therefore, GISTs that are 2 cm or less are typically asymptomatic. Patients with symptomatic GISTs typically present with abdominal pain, gastrointestinal bleeding, or a palpable mass but rarely present with hemoperitoneum. Presentation of case A 72-year-old Japanese man presented to us with acute onset abdominal pain. Physical examination showed peritoneal irritation in the lower abdomen. Findings of abdominal computed tomography were suggestive of hemoperitoneum; therefore, urgent surgery was performed. Approximately 1500 ml of blood in the abdominal cavity was removed. A small, ruptured mass was found in the middle of the small intestine, and partial resection of the small intestine, including the mass, was performed. The resected tumor was 2 cm in size and exhibited an exophytic growth pattern. Immunohistochemical staining revealed that the tumor was positive for KIT and CD34; therefore, a final diagnosis of GIST was made. Treatment with imatinib at 400 mg per day was started from postoperative month 1. The patient is doing well without recurrence 5 months after surgery. Discussion Even small GISTs in the small intestine can spontaneously rupture and cause hemoperitoneum. Moreover, when a patient presents with sudden abdominal pain and hemoperitoneum without an evident mass on imaging, clinicians should be aware of the possibility of bleeding from a small GIST in the small intestine. Conclusion We present an extremely rare case of a patient with a small, spontaneously ruptured GIST in the small intestine, resulting in hemoperitoneum.
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Affiliation(s)
- Shuichi Fukuda
- Department of Gastroenterological Surgery, Kindai University Nara Hospital, Nara, Japan.
| | - Yoshinori Fujiwara
- Department of Gastroenterological Surgery, Kindai University Nara Hospital, Nara, Japan.
| | - Tomoko Wakasa
- Department of Pathology, Kindai University Nara Hospital, Nara, Japan.
| | - Keisuke Inoue
- Department of Gastroenterological Surgery, Kindai University Nara Hospital, Nara, Japan.
| | - Kotaro Kitani
- Department of Gastroenterological Surgery, Kindai University Nara Hospital, Nara, Japan.
| | - Hajime Ishikawa
- Department of Gastroenterological Surgery, Kindai University Nara Hospital, Nara, Japan.
| | - Masanori Tsujie
- Department of Gastroenterological Surgery, Kindai University Nara Hospital, Nara, Japan.
| | - Masao Yukawa
- Department of Gastroenterological Surgery, Kindai University Nara Hospital, Nara, Japan.
| | - Yoshio Ohta
- Department of Pathology, Kindai University Nara Hospital, Nara, Japan.
| | - Masatoshi Inoue
- Department of Gastroenterological Surgery, Kindai University Nara Hospital, Nara, Japan.
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Zarkavelis G, Petrakis D, Fotopoulos G, Mitrou S, Pavlidis N. Bone and soft tissue sarcomas during pregnancy: A narrative review of the literature. J Adv Res 2016; 7:581-7. [PMID: 27408761 PMCID: PMC4921935 DOI: 10.1016/j.jare.2016.01.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 01/12/2016] [Accepted: 01/13/2016] [Indexed: 12/18/2022] Open
Abstract
Bone or soft tissue sarcomas are rarely diagnosed during pregnancy. Until today 137 well documented cases have been reported in the English literature between 1963 and 2014. Thirty-eight pregnant mothers were diagnosed with osteosarcoma, Ewing's sarcoma or chondrosarcoma, whereas 95 other cases of soft tissue sarcomas of various types have been documented. We present the clinical picture and therapeutic management of this coexistence.
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Affiliation(s)
- George Zarkavelis
- Department of Medical Oncology, Ioannina University Hospital, 45110 Ioannina, Greece
| | - Dimitrios Petrakis
- Department of Medical Oncology, Ioannina University Hospital, 45110 Ioannina, Greece
| | - George Fotopoulos
- Department of Medicine, Sotiria General Hospital, Athens University, Athens, Greece
| | - Sotirios Mitrou
- REA Maternity Hospital, A. Sygrou Avenue, 383, P. Faliro, Athens, Greece
| | - Nicholas Pavlidis
- Department of Medical Oncology, Ioannina University Hospital, 45110 Ioannina, Greece
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9
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Gastrointestinal stromal tumors during pregnancy: a systematic review of an uncommon but treatable malignancy. Clin Transl Oncol 2015; 17:757-62. [PMID: 26055339 DOI: 10.1007/s12094-015-1315-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 05/27/2015] [Indexed: 12/13/2022]
Abstract
Although modern social structure and medical advances have led to the increasing number of women childbearing in older age, cancer remains a rare diagnosis during pregnancy. There is little given information throughout the literature concerning gestation associated with the coexistence of gastrointestinal stromal tumor (GIST). In this review, we present 12 reported cases of GIST during pregnancy and we discuss the maternal and fetal outcome, as well as the therapeutic plan that was followed in each situation. From the collected data, 8 out of 12 cases had an uneventful outcome of their fetus. In 11 out of 12 cases surgical excision of the tumor was the treatment of choice, while seven women were treated with imatinib. Two of them were already on imatinib therapy during conception due to preexisting GIST diagnosis. Surgery remains the gold standard for the treatment of local or resectable GIST, while published data concerning the use of imatinib during pregnancy indicate that teratogenicity or fetal loss might be induced, especially if given during the first trimester of pregnancy. GIST during gestational period is a rare tumor in which a multidisciplinary approach should be designed, taking always into consideration that it has a favorable outcome on targeted treatment.
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10
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Gastrointestinal stromal tumor mimicking ovarian malignancy in a woman with type I neurofibromatosis. Taiwan J Obstet Gynecol 2015; 54:330-1. [DOI: 10.1016/j.tjog.2014.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2014] [Indexed: 11/18/2022] Open
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Misawa SI, Takeda M, Sakamoto H, Kirii Y, Ota H, Takagi H. Spontaneous rupture of a giant gastrointestinal stromal tumor of the jejunum: a case report and literature review. World J Surg Oncol 2014; 12:153. [PMID: 24885725 PMCID: PMC4032489 DOI: 10.1186/1477-7819-12-153] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 05/02/2014] [Indexed: 12/16/2022] Open
Abstract
A few cases of a gastrointestinal stromal tumor (GIST) of the small intestine presenting as rupture have been reported in the medical literature. We report an unusual case of a large GIST of the jejunum that presented as a spontaneous rupture. A 70-year-old man was referred to our hospital because of fever and abdominal pain. An abdominal enhanced computed tomography (CT) scan detected a 10-cm tumor with heterogeneous staining, suggesting necrosis or abscess inside the tumor. The patient was treated with antibiotics but inflammation persisted and an operation was performed. Intraoperative findings showed an outgrowing 10-cm mass in the jejunum near Treitz's ligament. The tumor had ruptured with peritoneal metastasis. The solid parenchyma contained a focal area of necrosis within and the small ulcer located in the wall of the jejunum presented a communication with the large tumor cavity. H&E staining showed spindle-shaped cell proliferation, and immunohistochemical staining showed results positive for c-kit and CD34. The patient received a diagnosis of a GIST (high-risk group) of the jejunum and was treated with imatinib mesylate. The patient has remained in good health without recurrence or metastasis one year after the surgical procedure.
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Affiliation(s)
- Shun-ichi Misawa
- Department of Surgery, Matsumoto City Hospital, 4417-180 Hata, Matsumoto, Nagano 390-1401, Japan.
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12
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Increasingly hard to swallow--18 years of changing tonsillectomy practice in Northern Ireland. THE ULSTER MEDICAL JOURNAL 2013; 82:121-5. [PMID: 24082292 PMCID: PMC3756871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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13
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Epstein MG, Pasquetti AF, Costa SV, Favaro MDL, Contrucci Filho O, Ribeiro Junior MAF. Hemoperitoneum secondary to gastric GIST negative for c-KIT and positive for antibody anti-DOG1. EINSTEIN-SAO PAULO 2013; 10:377-9. [PMID: 23386022 DOI: 10.1590/s1679-45082012000300022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 01/17/2012] [Indexed: 11/22/2022] Open
Abstract
Although relatively rare, the gastrointestinal stromal tumors comprise most mesenchymal tumors of the digestive tract and account for 5% of all sarcomas. The most common symptoms are pain, gastrointestinal bleeding and palpable mass. This study reported the case of a young patient who developed hemoperitoneum due to gastric neoplasm rupture and required urgent surgical treatment. Pathology and immunohistochemistry analysis showed an epidemiologically rare case: epithelioid and c-KIT negative tumor.
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14
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Tan CB, Zhi W, Shahzad G, Mustacchia P. Gastrointestinal stromal tumors: a review of case reports, diagnosis, treatment, and future directions. ISRN GASTROENTEROLOGY 2012; 2012:595968. [PMID: 22577569 PMCID: PMC3332214 DOI: 10.5402/2012/595968] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Accepted: 02/05/2012] [Indexed: 12/13/2022]
Abstract
Gastrointestinal stromal tumor (GIST) is a nonepithelial, mesenchymal tumor first described by Mazur and Clark in 1983. Since then, its molecular biology has been studied in great detail. Special interest in the role of tyrosine kinase in its regulation has been the target by different drug research. Mutation in c-kit exons 9, 11, 13, 17 and PDGFRA mutation in exons 12, 14, 18 are responsible for activation of gene signaling system resulting in uncontrolled phosphorylation and tissue growth. However, 5 to 15% of GISTs does not harbor these mutations, which raises additional questions in another alternate signaling pathway mutation yet to be discovered. Diagnosis of GISTs relies heavily on KIT/CD117 immunohistochemical staining, which can detect most GISTs except for a few 3% to 5% that harbors PDGFRA mutation. Newer staining against PKC theta and DOG-1 genes showed promising results but are not readily available. Clinical manifestation of GISTs is broad and highly dependent on tumor size. Surgery still remains the first-line treatment for GISTs. The advancement of molecular biology has revolutionized the availability of newer drugs, Imatinib and Sunitinib. Together with its advancement is the occurrence of Imatinib/Sunitinib drug resistance. With this, newer monoclonal antibody drugs are being developed and are undergoing clinical trials to hopefully improve survival in patients with GISTs.
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Affiliation(s)
- Christopher B Tan
- Department of Internal Medicine, Nassau University Medical Center, East Meadow, NY 11554, USA
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15
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Parampalli U, Crossland C, Longley J, Morrison I, Sayegh M. A Rare Case of Gastrointestinal Stromal Tumour in Pregnancy Presenting with Upper Gastrointestinal Bleeding. J Gastrointest Cancer 2012; 43 Suppl 1:S80-3. [PMID: 22252170 DOI: 10.1007/s12029-011-9360-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- U Parampalli
- Department of General Surgery, Worthing Hospital, Lyndhurst Road, Worthing, West Sussex, BN11 2DH, UK.
| | - C Crossland
- Department of General Surgery, Worthing Hospital, Lyndhurst Road, Worthing, West Sussex, BN11 2DH, UK
| | - J Longley
- Department of General Surgery, Worthing Hospital, Lyndhurst Road, Worthing, West Sussex, BN11 2DH, UK
| | - I Morrison
- Department of Histopathology, Worthing Hospital, Lyndhurst Road, Worthing, West Sussex, BN11 2DH, UK
| | - M Sayegh
- Department of General Surgery, Worthing Hospital, Lyndhurst Road, Worthing, West Sussex, BN11 2DH, UK
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