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Rahma DY, Atmaja MHS. Gastrointestinal stromal tumor as mimicking gynecological mass finding on CT scan imaging: A case report. Int J Surg Case Rep 2022; 94:107092. [PMID: 35468377 PMCID: PMC9052138 DOI: 10.1016/j.ijscr.2022.107092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/12/2022] [Accepted: 04/12/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Gastrointestinal stromal tumor (GIST) is a term to describe the distant spread (metastasis) of primary tumors to the peritoneal cavity. Case presentation A 48-year-old woman complained of dilated stomach, stomachache, and nausea. Laboratory findings showed an increase in the tumor marker, CA-125147 U/mL and also LDH 350 U/L while quantitative total β HCG and CEA were normal. Ultrasonography showed dominantly a huge solid mass with the cystic component in pelvic cavity extended to the abdominal cavity, with vascularized on Doppler ultrasound, difficult to identify uterine or adnexa origin. Afterward, an abdominal CT scan with and without contrast was performed and showed a solid mass with cystic and necrotic component impression originating from GI tract with feeding branch of an artery mesenteric, attached to the mesenteric small bowel and peritoneal carcinomatosis. Core biopsy and immunohistochemical were also performed with the result suggesting GIST. Discussion The diagnosis of GIST was established based on laboratory findings, abdominal ultrasound, abdominal CT-scan, and confirmation of GIST. Conclusion The diagnosis of GIST can be distinguished from gynecological mass despite their similarities. A Gastrointestinal stromal tumor (GIST) can be distinguished from gynecological carcinoma using ROMA criteria. The accuracy of carcinoma diagnosis can be confirmed by post-analysis of pathology anatomy. ROMA Algorithm helps in differentiating tumors in the abdominal.
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Affiliation(s)
- Devy Yuspita Rahma
- Study Program of Radiology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Muhammad Hidayat Surya Atmaja
- Department of Radiology, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.
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2
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Turner LM, Jeans P, Robson S. A pedunculated small bowel gastrointestinal stromal tumour (GIST) masquerading as an ovarian tumour. J Surg Case Rep 2021; 2021:rjab514. [PMID: 34888030 PMCID: PMC8652019 DOI: 10.1093/jscr/rjab514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 10/25/2021] [Indexed: 11/13/2022] Open
Abstract
While gastro-intestinal stromal tumours (GIST) are the most common non-epithelial neoplasms of the gastrointestinal tract, 10% occur externally. Symptomatology is therefore broad, dependent on location. A 42-year-old female presented to the Emergency Department after 12 hours of severe right lower abdominal, preceded by vague pain over two weeks. Imaging revealed a right-sided 7.5 × 5.8 × 5.6 cm ovarian cystic lesion, suspicious for torsion. Laparoscopically, the lesion was densely adherent to small and large bowel, and she was proceeded to resection of an assumed primary ovarian neoplasm. Histopathology revealed an infarcted epithelioid GIST, high-grade with clear margins (stage pT3). There are only 24 cases of GISTs pre-operatively mistaken for gynaecological neoplasms. Additionally, there are reports of GISTs metastasizing to ovaries. Both computed tomography and ultrasound are non-specific, including hypo- and hyperechoic features. In all published cases, imaging was not able to identify presumed gynaecological neoplasms as GISTS. Differential diagnoses for pelvic masses should include non-gynaecological tumours.
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Affiliation(s)
- Lauren M Turner
- Department of Surgery, Division of Critical Care, Canberra Hospital, Garran, ACT, Australia
| | - Phillip Jeans
- Department of Surgery, Division of Critical Care, Canberra Hospital, Garran, ACT, Australia
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Jejunal GIST masquerading as an ovarian mass: A case report. Int J Surg Case Rep 2021; 82:105960. [PMID: 33964715 PMCID: PMC8114170 DOI: 10.1016/j.ijscr.2021.105960] [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: 04/12/2021] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Gastrointestinal stromal tumors (GIST) are rare mesenchymal tumors originating in the wall of the gastrointestinal tract. Jejunal GIST is the rarest subtype. Large GIST can present with an abdominopelvic mass which can be preoperatively misdiagnosed as a gynecological tumor. CASE HISTORY A 44-year regularly menstruating woman presented with lower abdominal pain which was diagnosed as a malignant ovarian tumor preoperatively with an MRI. However, intraoperatively, a lobulated mass was present in the abdominal cavity arising from a jejunal portion of the small intestine. With an intraoperative diagnosis of jejunal GIST, the mass was excised and jejunum anastomosed. Histopathology examination report showed GIST which was further confirmed by immunohistochemistry. DISCUSSION GIST presenting as a large abdominopelvic mass can mimic a gynecological tumor. Contrast-enhanced CT scan is the preferred imaging modality for the evaluation of patients with suspected GIST to determine the extent of the tumor, the presence or absence of metastatic disease alongside evaluation of the possibility of complete resection. Adjuvant imatinib therapy following complete excision can decrease the disease recurrence. CONCLUSION Gynecologists should keep in mind that primary gastrointestinal tumors can present as a pelvic mass. A proper histopathological examination helps to confirm the diagnosis. Complete surgical removal of the tumor should be obtained as it determines the prognosis of the disease.
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Ambrosio M, Testa AC, Moro F, Franchi D, Scifo MC, Rams N, Epstein E, Alcazar JL, Hidalgo JJ, Van Holsbeke C, Burgetova A, Dundr P, Cibula D, Fischerova D. Imaging in gynecological disease (19): clinical and ultrasound features of extragastrointestinal stromal tumors (eGIST). ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 56:749-758. [PMID: 31909545 DOI: 10.1002/uog.21968] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 12/18/2019] [Accepted: 12/20/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To describe the clinical and sonographic characteristics of extragastrointestinal stromal tumors (eGISTs). METHODS This was a retrospective multicenter study. The data of patients with a histological diagnosis of eGIST who had undergone preoperative ultrasound examination were retrieved from the databases of nine large European gynecologic oncology centers. One investigator from each center reviewed stored images and ultrasound reports, and described the lesions using the terminology of the International Ovarian Tumor Analysis and Morphological Uterus Sonographic Assessment groups, following a predefined ultrasound evaluation form. Clinical, surgical and pathological information was also recorded. RESULTS Thirty-five women with an eGIST were identified; in 17 cases, the findings were incidental, and 18 cases were symptomatic. Median age was 57 years (range, 21-85 years). Tumor marker CA 125 was available in 23 (65.7%) patients, with a median level of 23 U/mL (range, 7-403 U/mL). The vast majority of eGISTs were intraperitoneal lesions (n = 32 (91.4%)); the remaining lesions were retroperitoneal (n = 2 (5.7%)) or preperitoneal (n = 1 (2.9%)). The most common site of the tumor was the abdomen (n = 23 (65.7%)), and less frequently the pelvis (n = 12 (34.3%)). eGISTs were typically large (median largest diameter, 79 mm) solid (n = 31 (88.6%)) tumors, and were less frequently multilocular-solid tumors (n = 4 (11.4%)). The echogenicity of solid tumors was uniform in 8/31 (25.8%) cases, which were all hypoechogenic. Twenty-three solid eGISTs were non-uniform, either with mixed echogenicity (9/23 (39.1%)) or with cystic areas (14/23 (60.9%)). The tumor shape was mainly lobular (n = 19 (54.3%)) or irregular (n = 10 (28.6%)). Tumors were typically richly vascularized (color score of 3 or 4, n = 31 (88.6%)) with no shadowing (n = 31 (88.6%)). Based on pattern recognition, eGISTs were usually correctly classified as a malignant lesion in the ultrasound reports (n = 32 (91.4%)), and the specific diagnosis of eGIST was the most frequent differential diagnosis (n = 16 (45.7%)), followed by primary ovarian cancer (n = 5 (14.3%)), lymphoma (n = 2 (5.7%)) and pedunculated uterine fibroid (n = 2 (5.7%)). CONCLUSIONS On ultrasound, eGISTs were usually solid, non-uniform pelvic or abdominal lobular tumors of mixed echogenicity, with or without cystic areas, with rich vascularization and no shadowing. The presence of a tumor with these features, without connection to the bowel wall, and not originating from the uterus or adnexa, is highly suspicious for eGIST. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- M Ambrosio
- Department of Obstetrics and Gynecology, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - A C Testa
- Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Dipartimento Scienze della Vita e Sanità pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - F Moro
- Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - D Franchi
- Division of Gynecology, European Institute of Oncology, Milan, Italy
| | - M C Scifo
- Department of Obstetrics and Gynecology, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - N Rams
- Hospital Santa Cruz y San Pablo, Barcelona, Spain
| | - E Epstein
- Department of Clinical Science and Education, Karolinska Institutet & Department of Obstetrics and Gynecology, Södersjukhuset, Stockholm, Sweden
| | - J L Alcazar
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain
| | - J J Hidalgo
- Department of Obstetrics and Gynecology, Clinic Hospital Valencia, Valencia, Spain
| | | | - A Burgetova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - P Dundr
- Department of Pathology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - D Cibula
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - D Fischerova
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
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HORTU İ, KOCAOĞLU G, ALGÜL F, SERİN G, AKDEMİR A. Adneksiyal kitleyi taklit eden ileum kökenli gastrointestinal stromal tümör. EGE TIP DERGISI 2020. [DOI: 10.19161/etd.790590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Abstract
Once a pelvic mass is identified on an ultrasound examination, the first step in the differential diagnostic work up is to determine its origin. Most lateral pelvic masses in women are ovarian in origin, and the distinction between ovarian and nonovarian mimics of ovarian cancer is critical for appropriate clinical and surgical management. Adnexal masses detected on ultrasound can be further characterized by magnetic resonance imaging (MRI) when needed. Superior contrast resolution, multiplanar imaging, characteristic signal intensity of common pathology such as dermoid tumors or endometriomas allows one to accurately evaluate adnexal tumors with supplemental use of MRI. Commonly encountered extraovarian abnormalities that mimic ovarian malignancies are categorized as being either predominantly cystic or solid. The common causes of such extraovarian lesions that mimic ovarian pathology include fallopian tube diseases, paroaovarian cysts, peritoneal inclusion cysts, and a pedunculated or a broad ligament fibroid. Less common causes of cystic and solid nonovarian mimics of ovarian malignancy include mucocele of the appendix, lymphocele, spinal meningeal cysts, extraovarian endometriomas, extraovarian fibrothecomas, and gastrointestinal stromal tumors (Table 1). Identifying a normal appearing ovary is the key in distinguishing an extraovarian pelvic mass from an ovarian tumor. This becomes particularly challenging in postmenopausal women with atrophic ovaries. In this scenario, MRI comes into use by identifying small atrophic ovaries more often than ultrasound is able to. Extraovarian lesions typically displace the pelvic sidewall vasculature medially, ureters tend to be compressed, encased or medially displaced, enhancement matches pelvic arteries and may be associated with engorged mesenteric vessels compared to gonadal vessel engorgement seen with ovarian tumors.
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7
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Kho CL, Toh L, Tan KT. Unusual case of a small bowel leiomyoma presenting as an adnexal mass. BMJ Case Rep 2018; 2018:bcr-2018-225320. [PMID: 30061132 DOI: 10.1136/bcr-2018-225320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
This case report will discuss an interesting case of a premenopausal woman who presented with an adnexal mass consistent with a leiomyoma on imaging. However, intraoperatively, the mass was thought to be a gastrointestinal stromal tumour but histological diagnosis subsequently confirmed a leiomyoma arising from the small bowel.
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Affiliation(s)
- Chye Lee Kho
- Department of O&G, KK Women's and Children's Hospital, Singapore, Singapore
| | - Luke Toh
- Department of Radiology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Kim Teng Tan
- Department of O&G, KK Women's and Children's Hospital, Singapore, Singapore
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8
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Dayan E, Zhu H, Copperman AB, Lewis S, Kamath A. Gastrointestinal stromal tumor presenting as a right adnexal mass with histopathologic correlation. Clin Imaging 2017; 44:97-100. [PMID: 28494279 DOI: 10.1016/j.clinimag.2017.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 04/30/2017] [Accepted: 05/01/2017] [Indexed: 11/16/2022]
Abstract
The authors report and discuss a rare case of a gastrointestinal stromal tumor (GIST) in a 35-year-old female, which was pre-procedurally characterized as a right ovarian mass by magnetic resonance imaging (MRI) features. This manuscript reviews the imaging and clinical features of GISTs with pathologic correlation, and emphasizes how this entity may present a diagnostic challenge in certain anatomic regions owing in large part to its exophytic nature. This case is unique among similarly reported cases in that there was a "claw sign" with the right ovary, which provided convincing evidence of its point of origin.
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Affiliation(s)
- Etan Dayan
- Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY 10029, United States.
| | - Hongfa Zhu
- The Lillian and Henry Stratton-Hans Popper Department of Pathology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY 10029, United States
| | - Alan B Copperman
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY 10029, United States
| | - Sara Lewis
- Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY 10029, United States
| | - Amita Kamath
- Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY 10029, United States
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9
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Patsikas M, Papazoglou LG, Jakovljevic S, Papaioannou NG, Papadopoulou PL, Soultani CB, Chryssogonidis IA, Kouskouras KA, Tziris NE, Charitanti AA. Radiographic and ultrasonographic findings of uterine neoplasms in nine dogs. J Am Anim Hosp Assoc 2016; 50:330-7. [PMID: 25028432 DOI: 10.5326/jaaha-ms-6130] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The records of nine female intact dogs with histologically confirmed uterine tumors were reviewed retrospectively, and the related radiographic and ultrasonographic signs of the lesions detected were recorded. Radiography revealed a soft-tissue opacity between the urinary bladder and colon in six of seven dogs with uterine body and/or cervical tumors, and a soft-tissue opacity in the midventral abdomen in two dogs with uterine horn tumors. Ultrasonography revealed masses in all dogs with uterine body/cervical tumors and could delineate the origin of the mass in one of two dogs with uterine horn tumors. The mass was characterized ultrasonographically as solid in three dogs (all leiomyomas), solid with cystic component in four dogs (two adenocarcinomas, one leiomyoma, and one fibroleiomyoma), and cystic in two (both leiomyomas). Hyperechoic foci in the mass were observed in three dogs. Ultrasonography was a useful method for demonstrating uterine body and/or cervical tumors. However, it was not possible to ascertain sonographically that a mass originated in a uterine horn unless there was associated evidence of uterine horn to which the mass could be traced. The ultrasonographic appearance of uterine tumors was variable, and the type of neoplasm could only be determined by taking biopsies of the mass.
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Affiliation(s)
- Michail Patsikas
- School of Veterinary Medicine (M.P., L.P., N.P., P.P., C.S.) and School of Medicine (I.C., K.K., N.T., A.C.), Aristotle University of Thessaloniki, Thessaloniki, Greece; and Dick White Referrals Ltd., New Market, UK (S.J.)
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10
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Gastrointestinal Stromal Tumor Mimicking as Ovarian Tumor in Gynaecologic Oncology. Indian J Surg Oncol 2015; 7:56-61. [PMID: 27065683 DOI: 10.1007/s13193-015-0479-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 10/13/2015] [Indexed: 02/02/2023] Open
Abstract
To report the clinical presentation and outcomes of a series of patients who presented with abdominal/pelvic mass or pelvic pain and were diagnosed with a gastrointestinal stromal tumor (GIST). Retrospective data were collected of all patients who presented with an abdominal/pelvic mass or pelvic pain between January 2010 and July 2015 and who were ultimately diagnosed with a GIST. The patients' medical records were reviewed. A literature review was also conducted. The event free survival and overall survival was calculated for all patients using Kaplan Meier curve (SPSS19-SPSS Inc. USA). A total ten patients were identified with GIST during the study period. Eight of ten patients had a tumor in the small intestine, one in sigmoid colon and one in base of small bowel mesentry. The mean tumor size was 13.9 cm (range, 3.9 to 24 cm). A complete resection was achieved in all 10 patients. No patient had distance metastasis. There were no intraoperative complications. One patient developed postoperative intestinal fistula and was managed conservatively. All patients were treated with imatinib after surgery. The mean follow-up time was 18 months (range, 2 to 47 months). The seven of the 10 patients (70 %) with no evidence of disease, two (20 %) lost follow up and one patient developed recurrence during follow up period and was started on sunitinib and patient died during follow up period because of disease. Gastrointestinal stromal tumors should be considered in the differential diagnosis of patients presenting with an abdominal/pelvic mass or pelvic pain in Gynaecologic oncology department. In such unusual circumstances the complete resection and appropriate adjuvant treatment results in complete durable remission.
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11
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Karaca N, Akpak YK, Tatar Z, Batmaz G, Erken A. Gastrointestinal Stromal Tumor: May Mimic Adnexal Mass. Glob J Health Sci 2015; 8:20-6. [PMID: 26383211 PMCID: PMC4803964 DOI: 10.5539/gjhs.v8n2p20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 06/01/2015] [Indexed: 11/17/2022] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are rare tumor of the gastrointestinal tract. GISTs occur in the entire gastrointestinal tract and may also arise from the retroperitoneum, omentum and mesenteries. They are originated from gastrointestinal pacemaker cells (Cajal's interstitial cells) and range from benign tumors to sarcomas at all sites of occurrence. Diagnosis of GIST could be deceptive because of their similarity in appearance to gynecological neoplasms. We would like to present a case of a woman with GIST in the small intestine giving a imprint of an adnexal mass was diagnosed correctly during surgery. The diagnosis and treatment of GIST has been reformed over the past years. It is crucial to separate GISTs from possible misdiagnosis because their prognosis and treatment could be unlike clearly. The purpose of this case is to evaluate this rarely seen clinical entity, and thus, make some contribution to the literature.
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Affiliation(s)
- Nilay Karaca
- Bezmi Alem Vakif University, Medical Faculty, Department of Obstetrics and Gynecology, Istanbul, Turkey.
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12
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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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13
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Cengiz H, Yıldız S, Kaya C, Ekin M. A diagnostic dilemma of acute abdomen in pregnancy: Leiomyoma of the small intestine. J Turk Ger Gynecol Assoc 2014; 15:60-2. [PMID: 24790519 DOI: 10.5152/jtgga.2013.38233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 08/07/2013] [Indexed: 11/22/2022] Open
Abstract
Small intestinal tumours are rare and difficult to diagnose. This neoplasms may be responsible for haemorrhage, occlusion, perforation and subsequent emergent surgeries. A 28 year old G2P1 woman in her 22nd week of pregnancy was referred to our emergency department with a complaint of left lower abdominal pain that had begun the day before. She underwent an emergent laparotomy with the general surgeons. Histopathological examination defined the diagnosis of leiomyoma of the small intestine. Gastrointestinal pathologies should always be taken into consideration in the differential diagnosis of acute abdomen in pregnancy.
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Affiliation(s)
- Hüseyin Cengiz
- Department of Obstetrics and Gynecology, Bakırköy Dr. Sadi Konuk Teaching and Research Hospital, İstanbul, Turkey
| | - Sükrü Yıldız
- Department of Obstetrics and Gynecology, Bakırköy Dr. Sadi Konuk Teaching and Research Hospital, İstanbul, Turkey
| | - Cihan Kaya
- Department of Obstetrics and Gynecology, Bakırköy Dr. Sadi Konuk Teaching and Research Hospital, İstanbul, Turkey
| | - Murat Ekin
- Department of Obstetrics and Gynecology, Bakırköy Dr. Sadi Konuk Teaching and Research Hospital, İstanbul, Turkey
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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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Muñoz M, Ramirez PT, Echeverri C, Alvarez LG, Palomino MA, Pareja LR. Gastrointestinal stromal tumors as an incidental finding in patients with a presumptive diagnosis of ovarian cancer. J Gynecol Oncol 2012; 23:48-52. [PMID: 22355467 PMCID: PMC3280347 DOI: 10.3802/jgo.2012.23.1.48] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 10/31/2011] [Accepted: 12/13/2011] [Indexed: 12/13/2022] Open
Abstract
Objective To report the clinical presentation and oncologic outcomes of a series of patients who presented with an abdominal or pelvic mass and were diagnosed with a gastrointestinal stromal tumor (GIST). Methods Data were obtained on all patients who presented with an abdominal or pelvic mass between September 2007 and June 2010 and who were ultimately diagnosed with a GIST. The patients' medical records were reviewed. A literature review was also conducted. Results Six patients were identified who met the inclusion criteria. All six patients had a tumor in the intestinal tract arising from the small bowel. The mean tumor size was 12 cm (range, 6 to 22 cm). A complete resection was achieved in five of the six patients. There were no intraoperative complications; one patient had a postoperative complication. Two patients were treated with imatinib after surgery. The mean follow-up time was 32 months (range, 0.3 to 40 months). At the last follow-up, five of the six patients were without any evidence of disease. One patient died of an unrelated hepatic encephalopathy. The incidence in our institution is 3%. Conclusion GISTs are uncommon; however, they should be considered in the differential diagnosis of patients presenting with an abdominal or pelvic mass.
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Affiliation(s)
- Mario Muñoz
- Department of General Surgery, Instituto de Cancerologia, Clínica las Américas, Medellin, Colombia
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16
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Yayci E, Guler OT, Kuzey GM, Comuoglu C, Atacag T, Cetin A, Bas KK, Alicioglu B. Gastrointestinal stromal tumor mimicking gynecological mass: A case report. GYNECOLOGIC ONCOLOGY CASE REPORTS 2012; 2:107-9. [PMID: 24371636 DOI: 10.1016/j.gynor.2012.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Accepted: 05/15/2012] [Indexed: 11/26/2022]
Abstract
► GISTs do not have a unique appearance on ultrasound examination. ► If a pelvic mass is detected, the possibility of a non-gynecological tumor like GISTs has to be considered.
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Affiliation(s)
- Eyup Yayci
- Department of Obstetrics and Gynecology, Near East University, Faculty of Medicine, Nicosia, TRNC, Turkey
| | - Omer Tolga Guler
- Department of Obstetrics and Gynecology, Near East University, Faculty of Medicine, Nicosia, TRNC, Turkey
| | - Gamze Mocan Kuzey
- Department of Pathology, Near East University, Faculty of Medicine, Nicosia, TRNC, Turkey
| | - Cem Comuoglu
- Department of Pathology, Near East University, Faculty of Medicine, Nicosia, TRNC, Turkey
| | - Tijen Atacag
- Department of Obstetrics and Gynecology, Near East University, Faculty of Medicine, Nicosia, TRNC, Turkey
| | - Ali Cetin
- Department of Obstetrics and Gynecology, Near East University, Faculty of Medicine, Nicosia, TRNC, Turkey
| | - Kadir Koray Bas
- Department of General Surgery, Near East University, Faculty of Medicine, Nicosia, TRNC, Turkey
| | - Banu Alicioglu
- Department of Radiology, Near East University, Faculty of Medicine, Nicosia, TRNC, Turkey
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17
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Rodríguez-Mias NL, González-Núñez S, Miguel LGD, Bláquez-Ventura A, Valladares-Pérez E, Lailla-Vicens JM. Gastrointestinal Stromal Tumor as Adnexal Tumor Differential Diagnosis: Two Cases. J Gynecol Surg 2011. [DOI: 10.1089/gyn.2010.0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Nuria-Laia Rodríguez-Mias
- Department of Obstetrics and Gynecology, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Santiago González-Núñez
- Department of Obstetrics and Gynecology, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Laura Garcia-De Miguel
- Department of Obstetrics and Gynecology, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Anna Bláquez-Ventura
- Department of Obstetrics and Gynecology, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Esther Valladares-Pérez
- Department of Obstetrics and Gynecology, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Josep Maria Lailla-Vicens
- Department of Obstetrics and Gynecology, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
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18
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Teoh WC, Teo SY, Ong CL. Gastrointestinal stromal tumors presenting as gynecological masses: usefulness of multidetector computed tomography. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2011; 37:107-109. [PMID: 20737452 DOI: 10.1002/uog.8801] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Large extraluminal gastrointestinal tumors (GISTs) may present as pelvic masses and thus mimic gynecological neoplasms in female patients. On clinical examination and pelvic ultrasound, these tumors resemble pedunculated fibroids or ovarian tumors. Multidetector computed tomography (CT), with its ability to perform isotropic multiplanar reconstruction, is useful in differentiating GISTs from true gynecological masses by demonstrating the pedicle sign connecting a pelvic GIST to its organ of origin. This allows a preoperative diagnosis to be made, which may be helpful in guiding therapeutic options and management. We present two cases of GISTs presenting as pelvic masses in which ultrasound findings suggested a gynecological cause, but multidetector CT with multiplanar reconstruction was able to determine their true organ of origin.
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Affiliation(s)
- W C Teoh
- Department of Diagnostic Imaging, Kandang Kerbau Women's and Children's Hospital, Singapore.
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