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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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2
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Tanaka N, Tamada S, Ueno N, Ishida M, Kodama J, Kubota T. A rare maternal gastrointestinal stromal tumor found in the second trimester of pregnancy: A case report. Case Rep Womens Health 2020; 28:e00251. [PMID: 32995306 PMCID: PMC7508991 DOI: 10.1016/j.crwh.2020.e00251] [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: 08/13/2020] [Accepted: 08/19/2020] [Indexed: 12/03/2022] Open
Abstract
Gastrointestinal stromal tumors are rare, and in pregnancy they are extremely rare. We present a case of a maternal gastrointestinal stromal tumor found in the second trimester of pregnancy. A 29-year-old woman, gravida 1 para 0, complained of bloody vomiting at 14 weeks of gestation. She had no significant medical history. We performed plain computed tomography and upper gastrointestinal endoscopy. Precise examination revealed a large mass in the stomach and an exposed blood vessel on the surface. An exposed blood vessel can be harmful for mother and fetus as it might rupture during the pregnancy. We performed a distal gastrectomy at 16 weeks of gestation. Histology confirmed a localized gastrointestinal stromal tumor with a high risk of recurrence, and adjuvant imatinib was recommended. The patient elected to delay adjuvant imatinib until after delivery. The postoperative and antenatal course was favorable, and the patient was followed up by ultrasound every 2 months after the operation. After she gave birth at 40 weeks of gestation, she started adjuvant imatinib 400 mg/day. There was no evidence of recurrence 1 year after surgery. There are no guidelines for the management of gastrointestinal stromal tumors in pregnancy. Given the treatment challenges, we believe that pregnant patients should be managed by a multidisciplinary team with expertise in gastrointestinal tumors and fetal-maternal medicine. Gastrointestinal stromal tumors are extremely rare in pregnancy. We describe a patient with a localized gastrointestinal stromal tumor and exposed blood vessels. We performed an open distal gastrectomy at 16 weeks of gestation. The patient started adjuvant imatinib therapy 7.5 months after tumor resection. One year after the operation there was no evidence of recurrence.
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Affiliation(s)
- Naoko Tanaka
- Department of Obstetrics and Gynecology, Hiroshima City Hiroshima Citizens Hospital, Japan
| | - Shoko Tamada
- Department of Obstetrics and Gynecology, Hiroshima City Hiroshima Citizens Hospital, Japan
| | - Naoko Ueno
- Department of Obstetrics and Gynecology, Hiroshima City Hiroshima Citizens Hospital, Japan
| | - Makoto Ishida
- Department of Obstetrics and Gynecology, Hiroshima City Hiroshima Citizens Hospital, Japan
| | - Junichi Kodama
- Department of Obstetrics and Gynecology, Hiroshima City Hiroshima Citizens Hospital, Japan
| | - Tetsushi Kubota
- Department of Gastroenterological Surgery, Hiroshima City Hiroshima Citizens Hospital, Japan
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3
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Bu H, Jin C, Fang Y, Ma Y, Wang X, Chen J, Chen L. Successful pregnancy after complete resection of leiomyomatosis peritonealis disseminate without recurrence:a case report with next-generation sequencing analysis and literature review. World J Surg Oncol 2020; 18:85. [PMID: 32359372 PMCID: PMC7196235 DOI: 10.1186/s12957-020-01857-0] [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: 02/08/2020] [Accepted: 04/20/2020] [Indexed: 12/29/2022] Open
Abstract
Background Peritoneal leiomyomatosis disseminate (LPD) is a rare disease characterized by widespread dissemination of leiomyomas nodules throughout the peritoneal and omental surfaces. Reports of pregnancy with LPD are even rarer. Therefore, there is no clear consensus on the treatment of LPD on pregnancy, and the pathogenesis is still unclear. Case presentation We reported a case of LPD patient who developed during pregnancy. The patient underwent a cesarean section at 32 weeks of gestation while removing all visible tumors, and no LPD lesions were seen in the subsequent cesarean section at full term. NGS of LPD lesions detected 4 mutations with focal high-level amplifications of CDK4 (cyclin-dependent kinases 4), NBN (Nibrin), DAXX (death domain associated protein), and MYC (myelocytomatosis oncogene). Immunohistochemistry staining analysis among benign leiomyoma, LPD, and leiomyosarcoma verified that LPD was an unusual intermediate between benign and malignant uterine smooth muscle tumors. Besides, LPD is a hormonal-dependent leiomyoma. After a detailed literature search, we summarized the detailed clinical features and follow-up information of patients with LPD during pregnancy. Conclusions This is the first reported LPD case of successful term pregnancy without recurrence, following resection of all visible lesions in a prior pregnancy. LPD is an unusual intermediate between benign and malignant uterine smooth muscle tumors.
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Affiliation(s)
- Hualei Bu
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, 107 Wenhua Xi Road, Jinan, 250012, People's Republic of China
| | - Chengjuan Jin
- Department of Obstetrics and Gynecology, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, 650 XinSongjiang Road, Shanghai, 201620, People's Republic of China
| | - Yan Fang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, 107 Wenhua Xi Road, Jinan, 250012, People's Republic of China
| | - Yana Ma
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, 107 Wenhua Xi Road, Jinan, 250012, People's Republic of China
| | - Xiao Wang
- Department of Pathology, Qilu Hospital of Shandong University, 107 Wenhua Xi Road, Jinan, 250012, People's Republic of China
| | - Jingying Chen
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, 107 Wenhua Xi Road, Jinan, 250012, People's Republic of China
| | - Lijun Chen
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, 107 Wenhua Xi Road, Jinan, 250012, People's Republic of China.
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4
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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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5
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Favero G, Pfiffer T, Riedlinger WFJ, Chiantera V, Schneider A. Uncommon Synchronous Association between Ovarian Carcinoma and Gastrointestinal Stromal Tumor: A Case Study and Literature Review. TUMORI JOURNAL 2018; 99:e70-2. [DOI: 10.1177/030089161309900232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background The association of gastrointestinal stromal tumors (GIST) and other cancers is well known, but its synchronous occurrence with gynecological malignancies is very uncommon. Usually, the diagnosis is accidentally established. We describe a patient with GIST and concurrent ovarian cancer and discuss the clinical implications of this finding. Case report A 64-year-old woman with a prior diagnosis of ovarian cancer developed a second recurrence after having undergone two operations and adjuvant chemotherapy. While tumor debulking was performed, a small, nonsuspicious lesion was removed from the greater curvature of the stomach. Histology revealed a GIST. Conclusion The association of GIST and ovarian cancer is a rarity and its synchronicity may alter the oncological prognosis and therapy of the patient.
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Affiliation(s)
- Giovanni Favero
- Department of Gynecology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Tatiana Pfiffer
- Department of Gynecology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Vito Chiantera
- Department of Gynecology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Achim Schneider
- Department of Gynecology, Charité Universitätsmedizin Berlin, Berlin, Germany
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6
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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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7
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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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8
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Bayrak S, Pasaoglu E, Cakar E, Bektas H, Colak S, Sevinc MM, Kinaci E. Disseminated peritoneal leiomyomatosis with chronic constipation: a case report. J Med Case Rep 2014; 8:114. [PMID: 24708548 PMCID: PMC3977977 DOI: 10.1186/1752-1947-8-114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 02/17/2014] [Indexed: 11/10/2022] Open
Abstract
Introduction Disseminated peritoneal leiomyomatosis is a rare disease. Almost all disseminated peritoneal leiomyomatosis cases described in the literature are associated with a gynecological disorder or a mass in the abdominal cavity. Disseminated peritoneal leiomyomatosis with only chronic constipation has not been reported in the English literature. We present a case of a patient with disseminated peritoneal leiomyomatosis who manifested solely with chronic constipation. Case presentation A 49-year-old premenopausal nulliparous Caucasian woman was admitted with complaints of abdominal distention and chronic constipation. Open subtotal colectomy with ileorectal anastomosis was performed. There were diffuse nodular and polypoid tumor formations in her colonic mesoderm. Based on morphological and pathological evaluation of the resection material, she was diagnosed with disseminated peritoneal leiomyomatosis. Conclusions In general, disseminated peritoneal leiomyomatosis is seen in women who are of childbearing age with estrogen hypersecretion. Preoperative diagnosis of disseminated peritoneal leiomyomatosis is almost impossible and it can be confused with disseminated intra-abdominal malignancies. There are no specific methods to diagnose disseminated peritoneal leiomyomatosis in a preoperative period.
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Affiliation(s)
- Savas Bayrak
- Department of General Surgery, Istanbul Training and Research Hospital, Kasap İlyas Mah, Org, Abdurrahman Nafiz Gürman Cd, PK: 34098,, Istanbul (212) 4596000, Turkey.
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9
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An elective combined caesarean section and small bowel GIST resection during the third trimester of pregnancy: Report of a case. Int J Surg Case Rep 2012; 4:121-4. [PMID: 23174524 DOI: 10.1016/j.ijscr.2012.10.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 10/23/2012] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Gastro-Intestinal Stromal Tumours (GISTs) are rare with an estimated incidence of only 11-15 per million. In pregnancy, GISTs are an extremely rare occurrence and are thus complex to manage from an ethical, surgical and oncological perspective. PRESENTATION OF CASE We present the first reported case in the literature of a successful combined lower segment caesarean section (LSCS) and a tumour resection in a 31-year-old pregnant patient presenting with a small bowel GIST. DISCUSSION We compare and contrast our case with other reported cases of GIST resection in pregnancy and discuss the challenges faced by both patients and clinicians. CONCLUSION Our case demonstrates that a combined LSCS and GIST resection is feasible. In addition, our case highlights the importance of both the multidisciplinary setting and the consideration of patients' wishes in the successful management of this complex group of patients.
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10
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Igras ET, Fosh BG, Neuhaus SJ. Maternal GIST in twin pregnancy: Case report of a rare and complex management challenge. GYNECOLOGIC ONCOLOGY CASE REPORTS 2012; 2:133-5. [PMID: 24371645 DOI: 10.1016/j.gynor.2012.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 08/08/2012] [Indexed: 11/19/2022]
Abstract
► Twin pregnancy ► GIST tumour ► Multidisciplinary team.
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Affiliation(s)
- Emma T Igras
- Senior Clinical Academic Fellow in Oncology, Cancer Care Services, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD 4029, Australia
| | - Beverley G Fosh
- Surgical Fellow, Flinders Medical Centre, Bedford Park, SA 5042, Australia
| | - Susan J Neuhaus
- Associate Professor Susan Neuhaus, Associate Professor of Surgery, University Department of Surgery, The Royal Adelaide Hospital, Adelaide SA 5000, Australia
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11
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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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12
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Stubbs BM, Desai A, Singh S, Seddon B, Khan F. Gastrointestinal stromal tumour in pregnancy. BMJ Case Rep 2011; 2011:bcr.01.2011.3737. [PMID: 22689595 DOI: 10.1136/bcr.01.2011.3737] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Gastrointestinal stromal tumour (GIST) in pregnancy is rare. There have been only three previously reported cases, all of which have been diagnosed on postoperative histology. The authors present the first case of a preoperatively diagnosed GIST arising in a 31-year-old pregnant woman. With a suspected diagnosis, the patient was managed through a combined obstetric and upper gastrointestinal multidisciplinary team meeting, resulting in planned early caesarean section and surgical removal of the tumour. This case emphasises the fact that early and effective multidisciplinary discussion allows for proper treatment planning and more informed patient decisions.
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13
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Varras M, Vlachakos N, Akrivis C, Vasilakaki T, Skafida E. Malignant gastrointestinal stromal tumor presenting with hemoperitoneum in puerperium: report of a case with review of the literature. World J Surg Oncol 2010; 8:95. [PMID: 21054898 PMCID: PMC2993706 DOI: 10.1186/1477-7819-8-95] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Accepted: 11/07/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors that develop in the wall of the gastrointestinal tract and their diagnosis during pregnancy or puerperium is extremely rare. CASE A 28-year old patient presented with acute abdomen due to hemoperitoneum from a large mass arising of the small intestine with distended vessels on its top and a ruptured superficial vessel bleeding into the peritoneal cavity. The patient was at the tenth postpartum day of her first pregnancy. The preoperative diagnosis was a possible ovarian or uterine mass. After an emergency exploratory laparotomy a segmental bowel resection was performed, removing the tumor with a part of 3-cm of the small intestine. Histology revealed GIST with maximum diameter of 13 cm and mitotic rates more than 5 mitoses per 50 high power fields with some atypical forms, indicating a high risk malignancy. Immunohistochemical staining of the tumor tissue demonstrated strongly positive reactivity to CD 117 (c-kit) and CD34 in almost all the tumor cells. The patient was treated with oral imatinib mesylate (Gleevec) 400 mg daily for one year. Three years after surgery, the patient was alive without evidence of metastases or local recurrence. CONCLUSION Considering that only few patients with gastrointestinal stromal tumors have been reported in the obstetrical and gynecological literature, the awareness of such an entity by the obstetricians-gynecologists is necessary in order to facilitate coordinated approach with the general surgeons and oncologists for the optimal care of the patients.
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Affiliation(s)
- Michail Varras
- Department of Obstetrics and Gynecology, Tzaneio General State Hospital, Piraeus, Greece.
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14
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Gastrointestinal stromal tumor in pregnancy: a case report. Case Rep Med 2009; 2009:456402. [PMID: 19763238 PMCID: PMC2745024 DOI: 10.1155/2009/456402] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Accepted: 07/22/2009] [Indexed: 12/17/2022] Open
Abstract
Background. Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the digestive tract and are diagnosed relatively seldom in pregnancy. Case. We describe a remarkable clinical course and long-term outcome, now nine years after first diagnosis, of a massive and metastatic, with a high malignancy grade GIST case, found in and treated from the first trimester of pregnancy onwards. Conclusion. GIST occurring during pregnancy is extremely rare. However, early diagnosis is important for optimal management. The recent better understanding of oncogenesis, the use of immunohistochemistry for differential diagnosis of GISTs, and the use of imatinib mesylate as the treatment of first choice are—as shown in this case—important for care of pregnant women with this type of malignancy.
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15
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TAN TH, HEMMINGS C, STAFFORD-BELL M, ROBSON S, GOLDSTEIN D, YIP D. The successful management of two pregnancies with wild type metastatic gastrointestinal stromal tumors. Asia Pac J Clin Oncol 2009. [DOI: 10.1111/j.1743-7563.2009.01225.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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16
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Jeyarajah S, Chow A, Lloyd J, Zacharakis E, Purkayastha S, Tekkis P. Follow-up in patients with disseminated peritoneal leiomyomatosis: a report of an unusual, high-risk case. BMJ Case Rep 2009; 2009:bcr08.2008.0802. [PMID: 21686624 DOI: 10.1136/bcr.08.2008.0802] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Leiomyomatosis peritonei disseminata is a condition seen uncommonly in states of oestrogen hypersecretion in women of childbearing age. There are no clear guidelines for the primary management and follow-up of these patients. Here, a rare case in a postmenopausal woman with a normal hormonal state who may be considered higher risk is presented, with a review suggesting a management pathway in these patients.
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Affiliation(s)
- Santhini Jeyarajah
- St Mary's Hospital, Academic Surgical Unit, Praed Street, London, W2 1NY, UK
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Pinto V, Ingravallo G, Cicinelli E, Pintucci A, Sambati GS, Marinaccio M, D'Addario V. Gastrointestinal stromal tumors mimicking gynecological masses on ultrasound: a report of two cases. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2007; 30:359-61. [PMID: 17721899 DOI: 10.1002/uog.4097] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Gastrointestinal stromal tumors (GISTs) are among the most common mesenchymal tumors of the gastrointestinal tract. Diagnosis of GIST on ultrasound examination can be difficult because of their similarity in appearance to gynecological neoplasms. We present two cases of GIST originating from the small bowel and the stomach, which were preoperatively misdiagnosed as a uterine leiomyoma and an ovarian tumor, respectively. The ultrasonographic differential diagnosis of these pelvic masses is discussed.
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Affiliation(s)
- V Pinto
- Department of Gynecology and Obstetrics, Bari University Medical School, Bari, Italy.
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Kirsch R, Gao ZH, Riddell R. Gastrointestinal stromal tumors: diagnostic challenges and practical approach to differential diagnosis. Adv Anat Pathol 2007; 14:261-85. [PMID: 17592256 DOI: 10.1097/pap.0b013e3180ca826a] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Over the last decade, gastrointestinal stromal tumors (GISTs) have evolved from histogenetically obscure gastrointestinal mesenchymal tumors to well-defined tumors with distinctive clinical, morphologic, ultrastructural, histogenetic, and molecular characteristics, for which targeted therapy is available. This is largely attributable to the discovery of CD117 overexpression and activating mutations in c-kit or platelet-derived growth factor alpha genes in most of GISTs. The availability of specific diagnostic tests and targeted therapy for GISTs has led to an increased awareness of these tumors. At the same time, the list of potential GIST mimics has lengthened considerably and it has become increasingly important that GISTs be distinguished from their mimics because correct diagnosis has implications for both treatment and prognosis. The purpose of this review is to provide an update of the expanding differential diagnosis of GISTS, to draw attention to unusual GIST variants, to provide a practical approach the differential diagnosis of GISTs and to highlight some of the challenges faced by pathologists in resolving this differential diagnosis.
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Affiliation(s)
- Richard Kirsch
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
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Hsu S, Chen SS, Chen YZ. Gastrointestinal stromal tumors presenting as gynecological tumors. Eur J Obstet Gynecol Reprod Biol 2006; 125:139-40. [PMID: 16159693 DOI: 10.1016/j.ejogrb.2005.07.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2005] [Revised: 06/16/2005] [Accepted: 07/27/2005] [Indexed: 10/25/2022]
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Lanzafame S, Minutolo V, Caltabiano R, Minutolo O, Marino B, Gagliano G, D'Asta S. About a case of GIST occurring during pregnancy with immunohistochemical expression of epidermal growth factor receptor and progesterone receptor. Pathol Res Pract 2006; 202:119-23. [PMID: 16413690 DOI: 10.1016/j.prp.2005.08.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2005] [Accepted: 08/29/2005] [Indexed: 12/17/2022]
Abstract
The coexistence of gastrointestinal stromal tumors (GISTs) and pregnancy is very rare. We are the first to add to the literature a case report of GIST occurring during pregnancy with immunohistochemical staining for epidermal growth factor receptor (EGFR) and progesterone receptor (PgR). A role of PgR and EGFR in tumor growth should not be excluded, and these findings indicate that the expression of these receptors could provide pertinent biological information required to determine adequate therapeutic regimens. In conclusion, considering that GIST occurring during pregnancy is a rare event, with frequent delay in diagnosis, it is important to consider this diagnosis for early recognition, correct diagnosis, and a better outcome.
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Affiliation(s)
- S Lanzafame
- Department G.F. Ingrassia, Section of Anatomic Pathology, University of Catania, Santa Sofia 87 Street, 95123 Catania, Italy.
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Abstract
The frequency, symptoms, and complication rate of PUD seem to decrease during pregnancy. Yet clinicians often have to treat dyspepsia or pyrosis of undetermined origin during pregnancy because the frequency of pyrosis significantly increases during pregnancy, and clinicians reluctantly perform EGD during pregnancy for pyrosis to differentiate reliably between GERD and PUD. Dyspepsia or pyrosis during pregnancy is initially treated with dietary and lifestyle modifications. If the symptoms do not remit with these modifications, sucralfate or antacids, preferably magnesium-containing or aluminum-containing antacids, should be administered. Histamine2 receptor antagonists are recommended when symptoms are refractory to antacid or sucralfate therapy. Ranitidine seems to be a relatively safe H2 receptor antagonist. If symptoms continue despite H2 receptor antagonist therapy, the patient should be evaluated for possible EGD or PPI therapy. Pregnant women with hemodynamically significant upper gastrointestinal bleeding or other worrisome clinical findings should undergo EGD. Indications for surgery include ulcer perforation, ongoing active bleeding from an ulcer requiring transfusion of six or more units of packed erythrocytes, gastric outlet obstruction refractory to intense medical therapy, and a malignant gastric ulcer without evident metastases.
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Affiliation(s)
- Mitchell S Cappell
- Division of Gastroenterology, Department of Medicine, Woodhull Medical Center, 760 Broadway Avenue, Brooklyn, NY 11206, USA
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Bekkers RL, Willemsen WN, Schijf CP, Massuger LF, Bulten J, Merkus JM. Leiomyomatosis peritonealis disseminata: does malignant transformation occur? A literature review. Gynecol Oncol 1999; 75:158-63. [PMID: 10502446 DOI: 10.1006/gyno.1999.5490] [Citation(s) in RCA: 92] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Leiomyomatosis peritonealis disseminata (LPD) is a rare smooth muscle tumor. In the literature more than 100 cases have been described. LPD is characterized by multiple small nodules on the peritoneal surface, mimicking a malignant process with metastases, but generally demonstrates benign histologic features. Exposure to estrogen seems to play an etiologic role. Many patients have uterine leiomyomas as well. The diagnosis of LPD is easily made on biopsy. Reduction of estrogen exposure is generally sufficient to cause regression of LPD. Surgical castration or gonadotrophin releasing hormone agonists seem good alternatives in the case of progression or recurrence of LPD. In six patients a malignant leiomyosarcoma has been described shortly after the diagnosis of LPD was made. Five of these patients did not have uterine leiomyomas or exposure to exogenous or increased endogenous estrogen. The relationship with pregnancy in the sixth patient may be coincidental. Whether malignant transformation of LPD occurs remains uncertain. Characteristics of these patients differ from those of LPD patients and may indicate a high malignant potential, necessitating a different approach.
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Affiliation(s)
- R L Bekkers
- Department of Obstetrics and Gynaecology, University Hospital, St. Radboud, Nijmegen, 6500 HB, The Netherlands
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