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Hasnaoui A, Trigui R, Hassine MB, Kacem S, Bellamine H. A giant gastrointestinal stromal tumor revealed by a life-threatening hematemesis: A case report of a rare entity and a challenging management. Int J Surg Case Rep 2024; 114:109142. [PMID: 38096702 PMCID: PMC10758854 DOI: 10.1016/j.ijscr.2023.109142] [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: 10/21/2023] [Revised: 11/25/2023] [Accepted: 12/02/2023] [Indexed: 01/05/2024] Open
Abstract
INTRODUCTION Gastrointestinal stromal tumors (GIST) are the most common mesenchymal malignancies in the digestive tract. Despite the stomach being their site of predilection, only a few giant GISTs have been discovered in hypovolemic shock and require urgent surgery. CASE PRESENTATION A 62-year-old patient was admitted for hematemesis. Initial examination revealed a compensated hemodynamic shock with a mass in the left hemi abdomen of 20 cm without signs of portal hypertension or peritonitis. After resuscitation, an abdominal CT scan was performed, showing an exophytic mass of the gastric antrum without local or distant lymph node involvement. Later, the patient went into hemodynamic shock, requiring vasoactive drugs. An urgent midline laparotomy was performed, revealing a 20-cm gastric GIST in the anterior wall of the antrum. Wedge resection was performed. The anatomopathological report confirmed the diagnosis of gastric GIST with a moderate risk of recurrence. The patient received adjuvant therapy for 3 years. No recurrence was detected. CLINICAL DISCUSSION Bleeding gastric GISTs revealed by a hypovolemic shock is a rare yet critical scenario. Considering GISTs as an etiology of digestive bleeding in life-threatening cases requires a high index of clinical suspicion. Prompt intervention is vital to control hemostasis and ensure patient stability. CONCLUSION Open surgery is mandatory for large bleeding GISTs. The surgical approach must be tailored to the tumor's specific location. Diligent execution of the surgical procedure is vital to prevent tumor rupture. Despite their size, these tumors have a favorable prognosis, enhanced by adjuvant therapy for moderate to high recurrence risk.
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Affiliation(s)
- Anis Hasnaoui
- Department of General Surgery, Menzel Bourguiba Hospital, Rue Djebel Lakhdar, 1006 Tunis, Tunisia; Faculty of Medicine of Tunis, Tunis El Manar University, Tunisia
| | - Racem Trigui
- Department of General Surgery, Menzel Bourguiba Hospital, Rue Djebel Lakhdar, 1006 Tunis, Tunisia.
| | - Mohamed Ben Hassine
- Department of General Surgery, Menzel Bourguiba Hospital, Rue Djebel Lakhdar, 1006 Tunis, Tunisia
| | - Salma Kacem
- Department of General Surgery, Menzel Bourguiba Hospital, Rue Djebel Lakhdar, 1006 Tunis, Tunisia; Faculty of Medicine of Tunis, Tunis El Manar University, Tunisia
| | - Houda Bellamine
- Department of Anatomopathology, Menzel Bourguiba Hospital, Rue Djebel Lakhdar, 1006 Tunis, Tunisia
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Zhang H, Liu X, Zheng Z, Yin J, Zhang J. Safety, efficacy, and selection strategy of laparoscopic local gastrectomy for gastrointestinal stromal tumors in the esophagogastric junction. Front Surg 2022; 9:1015126. [PMID: 36238859 PMCID: PMC9551255 DOI: 10.3389/fsurg.2022.1015126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/13/2022] [Indexed: 11/30/2022] Open
Abstract
Objective To investigate the safety, efficacy, and selection strategy of laparoscopic local gastrectomy for stromal tumors in the esophagogastric junction. Methods Thirty-eight patients with mesenchymal tumors in the esophagogastric junction were retrospectively enrolled from April 2018 to July 2021 in which the upper edge of the tumor is less than 2 cm from the Z-line or has invaded the Z-line <1/2 circumference. Surgical outcomes, complications, recover, and postoperative gastroesophageal reflux of both groups were compared. Results 27 patients underwent wedge resection, and 11 underwent resection by opening all of the layers of the stomach wall. Operative time (90.0 vs. 181.8 min, respectively, P = 0.001) was shorter for the WR group vs. RASW. Blood loss (20 vs. 50 ml, respectively, P = 0.012) was less for the WR group vs. RASW. Recovery of the RASW group was slower in terms of time to pass gas (2 vs. 3 days, P = 0.034), time to oral intake (2 vs. 4 days, P = 0.007), time to semi-liquid food intake (4 vs. 8 days, P = 0.003), and postoperative hospitalization (5 vs. 8 days, P = 0.001) vs. WR. In terms of short-term complications (≤30 days), no significant between-group differences were observed. Cardia stenosis did not occur in either group. In the WR group, one patient experienced mild reflux at 6 months and recovered 1 year after surgery. In the RASW group, one patient experienced severe gastroesophageal reflux at 6 months and 1 year after surgery, which was not entirely relieved by taking antacids. No other patients have gastroesophageal reflux. Conclusion Laparoscopic local gastrectomy is safe and feasible for mesenchymal tumors in the esophagogastric junction in which the upper edge of the tumor is less than 2 cm from the Z-line or has invaded the Z-line <1/2 circumference, and has achieved an excellent short-term effect. The choice of surgery is based on the relationship between the tumor and the position of the cardia.
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Affiliation(s)
| | | | | | - Jie Yin
- Correspondence: Jie Yin Jun Zhang
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Zhang Y, Hu J, Li L, Zhao Y. Application of Computer-Based Simulation Teaching Combined with PBL in Colorectal Tumor Hemorrhage. Emerg Med Int 2022; 2022:1251388. [PMID: 36119913 PMCID: PMC9481396 DOI: 10.1155/2022/1251388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/08/2022] [Accepted: 08/18/2022] [Indexed: 11/17/2022] Open
Abstract
Objective This paper aims to explore the use of computer-based simulation teaching combined with PBL in colorectal tumor bleeding. Methods The outpatient department organized 21 nursing staffs to conduct computer simulation combined with PBL teaching, compared emergency theory and skill scores, and investigated the recognition of computer simulation teaching combined with PBL. Results The scores of theoretical knowledge examination before training were (84.31 ± 6.39) and (92.59 ± 2.93) after training; the scores of treatment skills examination were (85.69 ± 6.15) and (95.43 ± 2.88) after training; the scores of comprehensive treatment skills before training were (76.6 ± 6.31) and (91.43 ± 2.3) after training. The results of the questionnaires showed that the nurses were more agreeable to the new teaching methods and were able to complete the tasks in strict accordance with the requirements, ultimately achieving a level of satisfaction with their progress. Conclusion Computer simulation teaching combined with PBL can deepen general practitioners' understanding of knowledge, improve practical ability, and provide a clinical basis for improving patient resuscitation in specialized oncology hospitals.
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Affiliation(s)
- Yanling Zhang
- Medical Oncology Department of Thoracic Cancer, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang 110042, China
| | - Jinyan Hu
- Nursing Department, Chifeng Municipal Hospital, Chifeng 024000, China
| | - Lingling Li
- Medical Oncology Department of Thoracic Cancer, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang 110042, China
| | - Yunpeng Zhao
- Medical Oncology Department of Thoracic Cancer, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang 110042, China
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Zhao YJ, Qiu YQ, Zhong LY, Zheng WZ, Zhuang LP, Wei Z, Ning ZL. Hand-assisted laparoscopic resection versus total laparoscopic gastric surgery for primary gastric gastrointestinal stromal tumors (GISTs): an analysis from a high-volume institution. BMC Surg 2022; 22:219. [PMID: 35672812 PMCID: PMC9171982 DOI: 10.1186/s12893-022-01668-y] [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: 04/10/2022] [Accepted: 05/26/2022] [Indexed: 11/10/2022] Open
Abstract
Background Laparoscopic resection of gastric gastrointestinal stromal tumors (GISTs) is technically feasible and associated with favorable outcomes. We compared the clinical efficacy of hand-assisted laparoscopic surgery (HLS) and total laparoscopic surgery (TLS) for gastric GISTs. Methods We retrospectively analyzed the clinical data of 69 consecutive patients diagnosed with a gastric GIST in a tertiary referral teaching hospital from December 2016 to December 2020. Surgical outcomes were compared between two groups. Results Fifty-three patients (TLS group: n = 36; HLS group: n = 17) were included. The mean age was 56.9 and 58.1 years in the TLS and HLS groups, respectively. The maximum tumor margin was significantly shorter in the HLS group than in the TLS group (2.3 ± 0.9. vs. 3.0 ± 0.8 cm; P = 0.004). The operative time of the HLS group was significantly shorter than that of the TLS group (70.6 ± 19.1 min vs. 134.4 ± 53.7 min; P < 0.001). The HLS group had less intraoperative blood loss, a shorter time to first flatus, and a shorter time to fluid diet than the TLS group (P < 0.05). No significant difference was found between the groups in the incidence or severity of complications within 30 days after surgery. Recurrence or metastasis occurred in four cases (HLS group; n = 1; TLS group; n = 3). Conclusions This study demonstrated that compared with TLS, HLS for gastric GISTs has the advantages of simpler operation, shorter operative time, and faster postoperative recovery.
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Affiliation(s)
- Ya-Jun Zhao
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230031, Anhui, China
| | - Yong-Qiang Qiu
- Department of Anesthesiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Li-Ying Zhong
- Department of Clinical Medicine, Xiamen Medical College, Xiamen, China
| | - Wen-Ze Zheng
- The Graduate School of Fujian Medical University, Fujian Medical University, Fuzhou, China
| | - Lv-Ping Zhuang
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Zhong Wei
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230031, Anhui, China
| | - Zhong-Liang Ning
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230031, Anhui, China.
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Li TH, Yang FF, Lee CT, Chan RH. Intra-abdominal multicentric inflammatory myofibroblastic tumors mimicking ruptured appendicitis. Int J Surg Case Rep 2022; 93:106990. [PMID: 35367948 PMCID: PMC8976137 DOI: 10.1016/j.ijscr.2022.106990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/02/2022] [Accepted: 03/26/2022] [Indexed: 12/04/2022] Open
Abstract
Inflammatory myofibroblastic tumors (IMTs) are a rare soft tissue neoplasm, usually seen in children and adolescents, which are predominantly found in the pulmonary region. The extrapulmonary multicentric lesions are exceedingly rare. We herein report the case of a 19-year-old female who developed acute bowel obstruction which caused by multicentric IMTs. We described her clinical presentations, operative finding, and pathological finding. The extrapulmonary multicentric inflammatory myofibroblastic tumor is a very rare disease. The most effective treatment is complete surgical excision. The first report of intra-abdominal multicentric inflammatory myofibroblastic tumor mimicking ruptured appendicitis.
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Complete laparoscopic wedge resection of a giant locally advanced gastric GIST with near pathological complete response after preoperative treatment with imatinib mesylate: A case report. Int J Surg Case Rep 2021; 90:106735. [PMID: 34972011 PMCID: PMC8724964 DOI: 10.1016/j.ijscr.2021.106735] [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: 11/19/2021] [Revised: 12/22/2021] [Accepted: 12/22/2021] [Indexed: 02/04/2023] Open
Abstract
Introduction and importance Surgical resection is the only curative treatment for gastrointestinal stromal tumor (GIST). Laparoscopic approach for large (>5 cm) and giant (>10 cm) gastric GIST remains under controversy. What's more, whether laparoscopic surgery could be performed after preoperative imatinib treatment of giant gastric GIST is still unknown. Case presentation We report a 68-year-old man with a giant (almost 30 cm) locally advanced gastric GIST which required resection of contiguous organs initially. After received 12 months imatinib therapy, the tumor became resectable and he finally achieved a complete laparoscopic wedge resection. Pathological evaluation of the resected specimen revealed a near pathological complete response was obtained. The imatinib treatment was ongoing after surgical resection and there was no radiological or clinical evidence of disease recurrence until to October 2021. Clinical discussion Laparoscopic approach is safe and effective for gastric GIST. Even for lesions greater for 5 cm. However, there are few reports for the application of laparoscopic wedge resection for gastric GIST larger than 10 cm. Preoperative use of imatinib can decrease the tumor size, so that may increase the chance of laparoscopic approach. Conclusion Preoperative imatinib therapy was effective for reducing the gastric GIST, which may increase the chance of minimally invasive approach and organ preservation. Patients with locally advanced GIST could benefit from the multidisciplinary approach. A man with a giant (almost 30 cm) locally advanced gastric GIST achieved a complete laparoscopic wedge resection with preoperative imatinib therapy. Pathological evaluation of the resected specimen revealed a near pathological complete response was obtained. Preoperative imatinib therapy may facilitate R0 resection, organ preservation and increase the chance of minimally invasive approach. Multidisciplinary approach is the optimal treatment for patients with locally advanced GIST.
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A Case of Accidentally Found Gastrointestinal Stromal Tumor in a 57-Year-Old Candidate of Gastric Bypass Surgery. Obes Surg 2021; 31:5096-5099. [PMID: 34383258 DOI: 10.1007/s11695-021-05598-1] [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: 04/13/2021] [Revised: 07/09/2021] [Accepted: 07/15/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION GIST tumors are the most common mesenchymal tumors in the alimentary tract but are rather rare compared to other GI tract tumors and are usually found incidentally. Studies about cases of GIST tumor in bariatric surgery are scarce and there is no specific guideline for treatment. Most of previous cases were managed by sleeve gastrectomy due to their location which were usually in the body and greater curvature. METHODS This patient had a GIST on lesser curvature and therefore underwent laparoscopic Roux-en-Y bypass. The follow-up was done with imaging studies and CT scan since the location of the tumor was no longer accessible to endoscopy after the gastric bypass. RESULTS The post-operative course was uneventful and after 2 years the patient is still in good health and had no other complications. The patient has been followed up by imaging studies. DISCUSSION There are pros and cons to this compared with sleeve gastrectomy. The most important advantage for this approach is that we have the stomach preserved; thus, our operation has the reversibility potential in case of any complication which requires revision operations. However, on the flip side, the limitation of such intervention is that we are not able to use the EGD to monitor and follow up our patient. Based on the relevant literature, for following up and monitoring the postoperative condition of these patients with relatively small GISTs, imaging studies specially abdominal computed tomography scan (CT scan) would be highly beneficial. It is also worth of mentioning that performing a EGD before a bariatric surgery, which is well noted in IFSO position statements and is well explained and discussed in other literature, had a major role in diagnosing this patient's GIST tumor and is proved to be beneficial and essential, once again.
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Dhali A, Ray S, Dhali GK, Ghosh R, Sarkar A. Refractory hypoglycaemia in a localised gastrointestinal stromal tumour: Case report. Int J Surg Case Rep 2021; 83:106023. [PMID: 34090190 PMCID: PMC8188391 DOI: 10.1016/j.ijscr.2021.106023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 05/18/2021] [Accepted: 05/21/2021] [Indexed: 02/07/2023] Open
Abstract
Introduction GIST and NICTH are mesenchymal in origin however there are very few reports of GIST associated with NICTH which is a para neoplastic syndrome, generally diagnosed when a tumour induced hypoglycaemia is noted. Case presentation A 46 years old female with prime complain of awareness of a mass in the upper abdomen was admitted for evaluation and further management. Detailed investigation revealed the mass to be gastrointestinal stromal tumour. On the day of admission patient was found to be hypoglycaemic which didn't resolve even after 10% glucose infusion. A growth hormone releasing peptide-2 (GHRP-2) assay was carried out which showed an excessive reaction of basal growth hormone however corticotropin releasing hormone (CRH) tests were within normal limits. She was suspected to be Non Islet cell tumour hypoglycaemia (NICTH) and hypoglycaemia resolved upon administering dexamethasone. Later she underwent chemotherapy and surgical resection after which her blood sugar levels were within normal limits. Discussion Expression of big IGF-II on the surface of GIST be it metastatic or nonmetastatic can cause refractory hypoglycaemia and can be fatal if left untreated. Conclusion Clinicians should be aware of refractory hypoglycaemia in patients with large GIST's as glucocorticoid therapy may prove to be extremely useful and lifesaving even before considering any forms of definitive management of the tumour. Localised GISTS may present with refractory hypoglycaemia. If not diagnosed due to clinical vague nature, it can be fatal. It responds very well to steroid treatment and can prevent a potentially fatal condition.
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Affiliation(s)
- Arkadeep Dhali
- Department of GI Surgery, IPGME&R, School of Digestive & Liver Diseases, Kolkata, India.
| | - Sukanta Ray
- Department of GI Surgery, IPGME&R, School of Digestive & Liver Diseases, Kolkata, India
| | - Gopal Krishna Dhali
- Department of Gastroenterology, IPGME&R, School of Digestive & Liver Diseases, Kolkata, India
| | - Ranajoy Ghosh
- Department of GI Pathology, IPGME&R, School of Digestive & Liver Diseases, Kolkata, India
| | - Avik Sarkar
- Department of GI Radiology, IPGME&R, School of Digestive & Liver Diseases, Kolkata, India
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Alberto RG, Eliana LZ, Mauricio TM, Eduardo GH. Cecal splenosis mimicking gastrointestinal stroma tumor. Case report and review of the literature. Int J Surg Case Rep 2021; 83:105992. [PMID: 34062360 PMCID: PMC8178097 DOI: 10.1016/j.ijscr.2021.105992] [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: 04/28/2021] [Revised: 05/15/2021] [Accepted: 05/16/2021] [Indexed: 01/31/2023] Open
Abstract
Introduction Abdominal splenosis is a rare condition where autotransplanted ectopic spleen tissue is found in the abdominal cavity after spleen injury or splenectomy. While abdominal splenosis is mostly described as asymptomatic, bowel splenosis can present with abdominal pain, obstipation or gastrointestinal (GI) bleeding. Scarce information on bowel splenosis exists and high index of suspicion is needed for diagnosis. We present the case of a patient with abdominal pain and a cecal mass mimicking gastrointestinal stroma tumor (GIST) found to have bowel splenosis after laparoscopic resection. Presentation of case A 45-year-old female was evaluated for a 6-month history of abdominal pain in right-lower quadrant. She had past medical history of blunt abdominal trauma and splenectomy 35 years before symptoms. An abdominal contrast-enhanced computed tomography (CT) reported a 4.2 × 4.6 × 4.6 cm solid mass located in the antimesenteric border of the cecum, with calcifications and arterial enhancement. Colonoscopy found no epithelial lesions. A diagnostic laparoscopy was done, and resection of the mass achieved. Transoperative histopathological diagnosis revealed ectopic spleen tissue. Discussion It is difficult to know whether abdominal pain in bowel splenosis is actually triggered by splenosis itself or by an unrelated cause, making diagnosis incidental. There are no particular imaging findings suggestive of splenosis, and surgical resection is often done under uncertain diagnosis. Conclusion Bowel splenosis could present as abdominal pain variable time after spleen injury or splenectomy. Clinical features and imaging characteristics are nonspecific and similar to those of GIST. Most cases of splenosis are diagnosed after surgery. Bowel splenosis is a rare entity scarcely reported in the literature. 2nd case with more years from risk factor reported. We expose a review of the literature analyzing common findings.
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Affiliation(s)
- Riojas-Garza Alberto
- Escuela de Medicina y Ciencias de la Salud del Tecnológico de Monterrey, Nuevo León, México.
| | - López-Zamora Eliana
- Escuela de Medicina y Ciencias de la Salud del Tecnológico de Monterrey, Nuevo León, México
| | | | - Guzmán-Huerta Eduardo
- Escuela de Medicina y Ciencias de la Salud del Tecnológico de Monterrey, Nuevo León, México.
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Diamantis A, Samara AA, Baloyiannis I, Symeonidis D, Diamantis AM, Tolia M, Bouliaris K, Koukoulis G, Tepetes K. Gastrointestinal Stromal Tumor (GIST) and Synchronous Intra-Abdominal Liposarcoma: A Report of Two Rare Cases and Literature Review. Int J Surg Oncol 2021; 2021:2626635. [PMID: 34518784 PMCID: PMC8434899 DOI: 10.1155/2021/2626635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 08/25/2021] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Gastrointestinal stromal tumors (GISTs) quite frequently occur synchronously with other malignancies, with most cases being adenocarcinomas. GISTs and liposarcomas are both of mesenchymal origin, and their coexistence is extremely rare. METHODS We conducted a review of the current literature regarding the synchronous occurrence of GISTs and intra-abdominal liposarcomas. An electronic search of the literature was undertaken using MEDLINE (database provider PubMed). Furthermore, we present the first described case of an 86-year-old male with a GIST and synchronous liposarcoma, both located in the stomach, as well as a 66-year-old male with a gastric GIST and concurrent retroperitoneal liposarcoma. RESULTS A total of 5 cases of synchronous GIST and intra-abdominal liposarcoma have been reported in the literature to date, with the most recent cases included in the present study. CONCLUSION Further research is required to explain any possible correlation in the coexistence of these different neoplasms of the same origin. Meanwhile, R0 resection of both tumors remains the treatment of choice.
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Affiliation(s)
| | - Athina A. Samara
- Department of General Surgery, University Hospital of Larissa, Larissa, Greece
| | - Ioannis Baloyiannis
- Department of General Surgery, University Hospital of Larissa, Larissa, Greece
| | | | | | - Maria Tolia
- Department of Radiotherapy, University of Crete, Heraklion, Greece
| | | | - Georgios Koukoulis
- Department of Pathology, University Hospital of Larissa, Larissa, Greece
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Aguayo WG, Moyon FX, Molina GA, Moyon MA, Rivadeneira DJ, Rojas CL, Cárdenas BA, Cobo MM, Romero AK. A bleeding GIST in pandemic times, a cooperative approach to a delayed complication, a case report. Int J Surg Case Rep 2020; 77:880-884. [PMID: 33395916 PMCID: PMC7732962 DOI: 10.1016/j.ijscr.2020.11.138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 11/28/2020] [Accepted: 11/29/2020] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Upper gastrointestinal bleeding is one of the major manifestations of the stomach's gastrointestinal stromal tumors; when gastric GISTs bleed, they are associated with a poor prognosis and must be treated promptly to avoid dangerous complications. A worrisome side effect of the Covid-19 pandemic is the delay in surgical treatment for seriously ill patients, a rise in surgical complications due to delayed care, lack of access to the healthcare system, and patients' hesitancy to seek care due to fear of the virus. In Ecuador, where limitations were present even in the absence of a pandemic, we are yet to fully know the full extent of the damage this pandemic has caused to ourselves and our patients. PRESENTATION OF CASE We present the case of a 51-year-old female; she presented with upper gastrointestinal bleeding, and a gastric GIST was diagnosed. Due to the size and the symptoms, surgery was planned. Nonetheless, as Ecuador was hit hard by the Covid-19 pandemic to cope with the respiratory patients, surgeries were delayed or canceled. Our patient surgery was delayed for five months until she presented with severe gastrointestinal bleeding that required urgent action and care. Thankfully, she completely recovered. DISCUSSION AND CONCLUSIONS This case is an example of the many complications we expect due to the pandemic; delay in treatment leads to troublesome complications. In these emergencies, time is of the essence, and surgical services must rise to the challenge; in a particular way, this case also proves that if there are the necessary tools to enhance the patient's recovery, we should hesitate to use them. Complete resection of the gastric GIST in a prompt matter must be done to avoid these potentially deadly complications.
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Affiliation(s)
| | | | - Gabriel A Molina
- Iess Quito-Sur & Universidad San Francisco de Quito (USFQ), Quito, Ecuador.
| | | | | | | | | | - Maria M Cobo
- Universidad San Francisco de Quito (USFQ), Quito, Ecuador.
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