Screening for Differentially Expressed Genes of Gastric Stromal Tumor Originating from Muscularis Propria

Association of right breast cancer and ileal gastrointestinal stromal tumor in a patient with type I neurofibromatosis: Case report and review of the literature

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The association of breast cancer and ileal GIST in Neurofibromatosis type 1 is extremely rare.

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Laparoscopy is associated with better perioperative outcomes and shorter hospital stay.

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Laparoscopic resection of small bowel GIST has shown in some studies to have oncological outcomes comparable to laparotomy.

Introduction

The Neurofibromatosis type I (NF1) is an autosomal dominant syndrome that affects 1/3000–1/4000 individuals. Patients with this condition are predisposed to different tumors, like neurofibromas, optic nerve gliomas, gastrointestinal stromal tumors (GIST) and breast cancers.

Presentation of case

A 78-year-old female patient affected by NF1 in May 2018 during follow-up for a carcinoma of the right breast had persistent anemia requiring regular blood transfusions. She presented with NF 1 with disseminated cutaneous neurofibromas, asthma, hypothyroidism, arterial hypertension and uterine prolapse.

She had performed gastroscopy and colonoscopy both negative for neoplastic lesions. She was subjected to chest and abdomen CT which revealed the presence of an ileal lesion of 6.5 × 4 cm suspected of GIST.

The patient underwent laparoscopic ileal resection in 120 min and was discharged on the sixth postoperative day.

Discussion

NF1 is caused by biallelic loss of a tumor suppressor gene. Most GISTs are localized in the stomach and small intestine. Surgery is the first line of treatment for localized disease. The main goal of surgery is complete excision with negative margins. The association between breast cancer and intestinal GIST in NF1 is reported only from two previous studies.

Conclusion

It is a rare case of association of breast cancer and ileal GIST in NF1. Laparoscopic resection of intestinal GIST has shown in some studies to have oncological outcomes comparable to laparotomy. Furthermore, laparoscopy is associated with better perioperative outcomes and shorter hospital stays. Further studies with a higher level of evidence are needed.

Laparoscopic Versus Open Resection of Small Bowel Gastrointestinal Stromal Tumors: Systematic Review and Meta-Analysis

BACKGROUND

Laparoscopic resection (LAP) for small bowel gastrointestinal stromal tumors (GISTs) is not as common as for stomach. This study aimed to evaluate the safety and efficacy of LAP for small bowel GISTs with systematic review and meta-analysis.

METHODS

The Web of Science, Cochrane Library, Embase, and PubMed databases before December 2016 were comprehensively searched to retrieve comparative trials of LAP and conventional open resection (OPEN) for GISTs of small bowel with a relevance of review object. These researches reported intraoperative and postoperative clinical course (operation time, blood loss, time to first flatus and oral intake, hospital stay, morbidity, and mortality), oncologic outcomes, and long-term survival status.

RESULTS

Six studies involving 391 patients were identified. Compared to OPEN, LAP had associated with a shorter operation time (weighted mean difference [WMD] = -27.97 min, 95% confidence interval [CI]: -49.40--6.54, P < 0.01); less intraoperative blood loss (WMD = -0.72 ml; 95% CI: -1.30--0.13, P = 0.02); earlier time to flatus (WMD = -0.83 day; 95% CI: -1.44--0.22, P < 0.01); earlier time to restart oral intake (WMD = -1.95 days; 95% CI: -3.31--0.60, P < 0.01); shorter hospital stay (WMD = -3.00 days; 95% CI: -4.87--1.13, P < 0.01); and a decrease in overall complications (risk ratio = 0.56, 95% CI: 0.33-0.97, P = 0.04). In addition, the tumor recurrence and long-term survival rate showed that there was no significant difference between the two groups of patients.

CONCLUSIONS

LAP for small bowel GISTs is a safe and feasible procedure with shorter operation time, less blood loss, less overall complications, and quicker recovery. Besides, tumor recurrence and the long-term survival rate are similar to open approach. Because of the limitations of this study, methodologically high-quality studies are needed for certain appraisal.