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Tarallo M, Carruezzo C, Dentice Di Accadia FM, Del Gaudio A, Caruso D, Polici M, Crocetti D, Costi U, Polistena A, Panzuto F, Laghi A, Cavallaro G, Fiori E. A Case Report of Multiple Gastrointestinal Stromal Tumors: Imaging Findings, Surgical Approach, and Review of the Literature. Front Surg 2022; 9:886135. [PMID: 36017517 PMCID: PMC9396543 DOI: 10.3389/fsurg.2022.886135] [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: 02/28/2022] [Accepted: 04/25/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction Multiple gastrointestinal stromal tumors (GISTs) are rare tumors. Differential diagnosis between metastatic and multiple GISTs represents a challenge for a proper workup, prediction prognosis, and therapeutic strategy. Case presentation We present the case of 67-year-old man with computed tomography (CT) evidence of multiple exophytic lesions in the abdomen, reaching diameters ranging from 1 to 9 cm, without any signs of organs infiltration, and resulting positive at 18F-FDG-PET/CT. Laparoscopic biopsy revealed multiple GISTs, and surgical resection by using an open approach was performed to achieve radicality. Moreover, an extensive review of the current literature was performed. Results Small GISTs (<5 cm) can be treated by the laparoscopic approach, while in the case of large GISTs (>5 cm), tumor location and size should be taken into account to reach the stage of radical surgery avoiding tumor rupture. For metastatic GISTs, Imatinib represents the first choice of treatment, and surgery should be considered only in a few selected cases when all lesions are resectable. Conclusion Sporadic multiple GISTs are a rare event, imaging findings are not specific for GISTs, and biopsy requires a secure diagnosis and proper management. In the case of large lesions, with a high risk of vessels injury, laparotomy excision should be considered to achieve radicality and to avoid tumor rupture.
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Affiliation(s)
- Mariarita Tarallo
- Department of Surgery Pietro Valdoni, University of Rome Sapienza, Rome, Italy
- Correspondence: Mariarita Tarallo
| | - Cristina Carruezzo
- Department of Surgery Pietro Valdoni, University of Rome Sapienza, Rome, Italy
| | | | - Antonella Del Gaudio
- Department of Medical Surgical Sciences and Translational Medicine, Radiology Unit, Sant’Andrea University Hospital, University of Rome Sapienza, Rome, Italy
| | - Damiano Caruso
- Department of Medical Surgical Sciences and Translational Medicine, Radiology Unit, Sant’Andrea University Hospital, University of Rome Sapienza, Rome, Italy
| | - Michela Polici
- Department of Medical Surgical Sciences and Translational Medicine, Radiology Unit, Sant’Andrea University Hospital, University of Rome Sapienza, Rome, Italy
| | - Daniele Crocetti
- Department of Surgery Pietro Valdoni, University of Rome Sapienza, Rome, Italy
| | - Umberto Costi
- Department of Surgery Pietro Valdoni, University of Rome Sapienza, Rome, Italy
| | - Andrea Polistena
- Department of Surgery Pietro Valdoni, University of Rome Sapienza, Rome, Italy
| | - Francesco Panzuto
- Department of Medical Surgical Sciences and Translational Medicine, Radiology Unit, Sant’Andrea University Hospital, University of Rome Sapienza, Rome, Italy
- Department of Medical Surgical Sciences and Translational Medicine, Digestive Disease Unit, Sant'Andrea University Hospital, University of Rome Sapienza, Rome, Italy
| | - Andrea Laghi
- Department of Medical Surgical Sciences and Translational Medicine, Radiology Unit, Sant’Andrea University Hospital, University of Rome Sapienza, Rome, Italy
| | - Giuseppe Cavallaro
- Department of Surgery Pietro Valdoni, University of Rome Sapienza, Rome, Italy
| | - Enrico Fiori
- Department of Surgery Pietro Valdoni, University of Rome Sapienza, Rome, Italy
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Alhyari A, Görg C, Dietrich CF, Kawohl S, Safai Zadeh E. Diagnostic Performance of Point Shear Wave Elastography (pSWE) Using Acoustic Radiation Force Impulse (ARFI) Technology in Mesenteric Masses: A Feasibility Study. Diagnostics (Basel) 2022; 12:diagnostics12020523. [PMID: 35204612 PMCID: PMC8870845 DOI: 10.3390/diagnostics12020523] [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: 01/12/2022] [Revised: 02/04/2022] [Accepted: 02/14/2022] [Indexed: 02/06/2023] Open
Abstract
Purpose: To evaluate the diagnostic performance of ultrasound point shear wave elastography (pSWE) using acoustic radiation force impulse (ARFI) technology in different benign and malignant mesenteric masses (MMs). Methods: A total of 69 patients with MMs diagnosed from September 2018 to November 2021 were included retrospectively in the study. The inclusion criteria were (1) an MM over 1 cm; (2) valid ARFI measurements; and (3) confirmation of the diagnosis of an MM by histological examination and/or clinical and radiological follow-up. To examine the mean ARFI velocities (MAVs) for potential cut-off values between benign and malignant MMs, a receiver operating characteristics analysis was implemented. Results: In total, 37/69 of the MMs were benign (53.6%) and 32/69 malignant (46.4%). Benign MMs demonstrated significantly lower MAVs than mMMs (1.59 ± 0.93 vs. 2.76 ± 1.01 m/s; p < 0.001). Selecting 2.05 m/s as a cut-off value yielded a sensitivity and specificity of 75.0% and 70.3%, respectively, in diagnosing malignant MMs (area under the curve = 0.802, 95% confidence interval 0.699–0.904). Conclusion: ARFI elastography may represent an additional non-invasive tool for differentiating benign from malignant MMs. However, to validate the results of this study, further prospective randomized studies are required.
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Affiliation(s)
- Amjad Alhyari
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstraße, 35033 Marburg, Germany; (A.A.); (S.K.); (E.S.Z.)
- Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Giessen and Marburg, Philipp University of Marburg, Baldingerstraße, 35033 Marburg, Germany
| | - Christian Görg
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstraße, 35033 Marburg, Germany; (A.A.); (S.K.); (E.S.Z.)
- Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Giessen and Marburg, Philipp University of Marburg, Baldingerstraße, 35033 Marburg, Germany
- Correspondence: ; Tel.: +49-6421-58-61538; Fax: +49-6421-58-62825
| | - Christoph Frank Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Bern, Beau Site, Salem und Permanence, 3018 Bern, Switzerland;
| | - Svenja Kawohl
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstraße, 35033 Marburg, Germany; (A.A.); (S.K.); (E.S.Z.)
| | - Ehsan Safai Zadeh
- Interdisciplinary Center of Ultrasound Diagnostics, University Hospital Giessen and Marburg, Philipps University Marburg, Baldingerstraße, 35033 Marburg, Germany; (A.A.); (S.K.); (E.S.Z.)
- Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, University Hospital Giessen and Marburg, Philipp University of Marburg, Baldingerstraße, 35033 Marburg, Germany
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