Giant gastric gastrointestinal stromal tumor with severe peritoneal dissemination controlled by imatinib therapy following debulking surgery: a case report

Ruptured gastro-intestinal stromal tumor as a surgical emergency: A case report and literature review

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.

Debulking of Advanced Gastrointestinal Stromal Tumor With Peritoneal Carcinomatosis Refractory to Imatinib and Sunitinib: A Case Report

Gastrointestinal stromal tumors (GISTs) are non-epithelial stromal tumors that arise in the gastrointestinal tract. Pharmacological treatments for GIST are tyrosine kinase inhibitors. For metastatic disease, debulking may be helpful in reducing the tumor burden, thus increasing the effectiveness of tyrosine kinase inhibitors. Debate on whether resection would benefit the patient is still present. Here is a case of a 52-year-old African American male presenting with metastatic malignant GIST with peritoneal carcinomatosis refractory to imatinib and sunitinib. Since this patient had stage IV metastasis it was ultimately decided to proceed with a therapeutic debulking procedure. For this patient, the procedure increased the effectiveness of the medication and reduced mass effect symptoms, improving quality of life.

Giant GIST of the stomach: a successful case of safe resection with preoperative simulation using three-dimensional CT angiography: Case report

RATIONALE

We report a very rare case of safely resectable giant gastrointestinal stromal tumor (GIST) with preoperative three-dimensional computed tomography (3D-CT) angiography in spite of no neoadjuvant treatment.

PATIENT'S CONCERN

A 71-year-old woman presented to our hospital with an abdominal giant tumor. As this giant tumor could not be accurately diagnosed by preoperative investigation, we had to perform her surgical treatment without neoadjuvant treatment. However, preoperative 3D-CT angiography clearly showed that the tumor was supplied by the right gastroepiploic artery (RGA). Based on the preoperative information, a surgical procedure was undertaken.

DIAGNOSIS

Giant tumor of stomach with suspicion of GIST.

INTERVENTIONS

Laparotomy guided by 3D-CT imaging including angiography.

OUTCOME

The giant tumor originated from the greater curvature of the distal stomach and was supplied by the RGA, as expected. The tumor was resected easily under the accurate preoperative anatomical information. The tumor measured 20 cm × 20 cm in size and weighed 2500 g (Fig. 2C and D). Histopathological examination showed evidence of growth of spindle-shaped cells and a low mitotic index (3 per 50 high-power field, Fig. 3B). Immunohistochemical examination showed positive immunoreactions for KIT, CD34, and DOG1 (Fig. 3 C-E), but negative ones for SMA and S-100 protein (Fig. 3F and G). Consequently, we made a final diagnosis of an extra luminal GIST of the stomach. The post-operative course was uneventful, and so the patient was discharged on postoperative day 13.

LESSONS

Making full use of an imaging procedure such as 3D-CT angiography is one of the effective tools for the surgical management of giant-size tumors including giant GISTs.