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Takahashi A, Inada K, Kitani Y, Koseki T, Maeshiro T. Laparoscopic-Assisted Resection for an Extra-gastrointestinal Stromal Tumor Arising From the Mesentery of the Small Intestine: A Case Report. Cureus 2024; 16:e60897. [PMID: 38784684 PMCID: PMC11112530 DOI: 10.7759/cureus.60897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2024] [Indexed: 05/25/2024] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors that arise in the muscular or submucosal layers of the gastrointestinal tract. Extra-gastrointestinal stromal tumors (EGISTs) are rare primary entities that develop outside the digestive tract which are histologically and immunologically similar to GISTs. We present the case of a 52-year-old female diagnosed with a primary EGIST arising in the small bowel mesentery four months after undergoing hormone therapy for multiple uterine myomas. Transvaginal ultrasonography and MRI revealed a pelvic mass suspected to be a GIST. The patient was treated with laparoscopic-assisted partial resection of the small bowel. Histopathological examination of the surgical specimen confirmed the diagnosis of an EGIST. Imatinib treatment was initiated, and no clinical evidence of recurrence or metastasis was detected postoperatively. Because EGISTs are extremely rare, the differences between EGISTs and GISTs, the degree of malignancy, and prognosis have not been fully investigated. Further studies are needed to accumulate additional cases. The present case shows that laparoscopic-assisted excision can be successfully used to manage EGISTs.
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Affiliation(s)
- Ayano Takahashi
- Department of Gastrointestinal Surgery, Saitama Prefectural Cancer Center, Saitama, JPN
- Department of Surgery, Tokyo Metropolitan Bokutoh Hospital, Tokyo, JPN
| | - Kentaro Inada
- Department of Surgery, Tokyo Metropolitan Bokutoh Hospital, Tokyo, JPN
| | - Yusuke Kitani
- Department of Surgery, Tokyo Metropolitan Bokutoh Hospital, Tokyo, JPN
| | - Takayoshi Koseki
- Department of Surgery, Tokyo Metropolitan Bokutoh Hospital, Tokyo, JPN
| | - Tsuyoshi Maeshiro
- Department of Surgery, Tokyo Metropolitan Bokutoh Hospital, Tokyo, JPN
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Almeida M, Sousa F, Resende F, Devesa V, Ferrão A, Carneiro S, Canão P, Barbosa E, Barbosa J. Primary EGIST of the greater omentum - a rare presentation. Acta Chir Belg 2024; 124:137-142. [PMID: 37027318 DOI: 10.1080/00015458.2023.2201084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 04/04/2023] [Indexed: 04/21/2023]
Abstract
Extragastrointestinal stromal tumors (EGISTs) are rare mesenchymal neoplasms, which develop in the retroperitoneum, mesentery, and omentum, lacking continuity to the stomach or intestines. Authors hereby present a female patient with a large heterogeneous abdominal mass as a case of an omental EGIST. A 46-year-old woman was referred to our hospital due to an insidious enlargement and colicky pain in the right iliac fossa. Abdominal palpation revealed a voluminous, freely mobile, and non-pulsatile mesoabdominal bulge expanding to the hypogastrium. On exploratory midline laparotomy, the tumor was densely fused to the greater omentum, not connected to the stomach, without gross involvement of adjacent structures. The large mass was completely excised after adequate mobilization. Immunohistochemical techniques showed strong and diffuse expression of WT1, actin and DOG-1, as well as multifocal c-KIT marking. Mutational study concluded a double mutation of KIT exon 9 and a mutation of PDGFRA exon 18. The patient was submitted to adjuvant treatment with imatinib mesylate 800 mg/day. Despite an extremely diverse presentation, omental EGISTs often remain clinically silent for a long time having enough space to grow before becoming symptomatic. These tumors have a consistent pattern of metastasis that typically spares lymph nodes unlike epithelial gut neoplasms. Surgery remains the preferred treatment for non-metastatic EGISTs of the greater omentum. It is possible that DOG-1 will supplant KIT as the leading marker in the future. The scarcity of knowledge on omental EGISTs implies a close monitoring of these patients to detect local relapse or distant metastasis.
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Affiliation(s)
- Miguel Almeida
- General Surgery Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Fabiana Sousa
- General Surgery Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Fernando Resende
- General Surgery Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Vítor Devesa
- General Surgery Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - António Ferrão
- General Surgery Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Silvestre Carneiro
- General Surgery Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Pedro Canão
- Pathology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Elisabete Barbosa
- General Surgery Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - José Barbosa
- General Surgery Department, Centro Hospitalar Universitário de São João, Porto, Portugal
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Song T, Hong Q, Wu Y. Pancreatic Extragastrointestinal Stromal Tumor: A Case Report. Cureus 2024; 16:e54514. [PMID: 38516419 PMCID: PMC10955504 DOI: 10.7759/cureus.54514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2024] [Indexed: 03/23/2024] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are soft tissue sarcomas that originate from the mesenchymal cells of the gastrointestinal tract. Extra-GISTs (EGISTs) are caused by sites outside the gastrointestinal tract. We reported a case of EGIST of the pancreas in a 51-year-old woman. Enhanced CT scan showed a rounded, slightly hypointense focus in the head of the pancreas and the right pars compacta of the descending duodenum. Routine laboratory and endocrine tests were unremarkable. The patient underwent laparoscopic surgery. The diagnosis of EGIST was confirmed through histopathological and immunohistochemical examination. The tumor was found to be CD117+, CD34+, and DOG+ with a high risk of malignancy. No recurrence was observed during the nine-month postoperative follow-up.
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Affiliation(s)
- Tianyu Song
- Department of Surgery, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, CHN
| | - Qiang Hong
- Department of Surgery, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, CHN
| | - Yulian Wu
- Department of Surgery, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, CHN
- Department of Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, CHN
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Bathobakae L, Bashir R, Vera S, Yasin S, Koodirile A, Bhattacharyya R, Kumar M. A Unique Case of Mesenteric Gastrointestinal Stromal Tumor Presenting as an Acute Abdomen. J Investig Med High Impact Case Rep 2024; 12:23247096241253348. [PMID: 38757744 PMCID: PMC11102691 DOI: 10.1177/23247096241253348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 04/14/2024] [Accepted: 04/20/2024] [Indexed: 05/18/2024] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors in the digestive tract and arise from the interstitial cells of Cajal in the mesenteric plexus. These tumors can originate in any part of the GI tract; however, a higher burden has been observed in the stomach and small intestines. Mesenteric GISTs are exceedingly rare, with unique clinicopathological features and a poorer prognosis. Herein, we describe a unique case of a 66-year-old female with a remote history of appendectomy who presented to the emergency room complaining of severe abdominal pain and vomiting. On imaging, the patient was found to have a large inflammatory mass associated with small bowel loops, and the pathology confirmed a mesenteric GIST. The tumor was resected, and the genomic test results confirmed the KIT (exon 11) mutation. Although the tumor had a low mitotic rate, the tumor was large enough to warrant the initiation of adjuvant imatinib mesylate for 36 months with regular bloodwork and imaging.
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Affiliation(s)
| | | | | | | | | | | | - Mehandar Kumar
- St. Joseph’s University Medical Center, Paterson, NJ, USA
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Guo JJ, Tang XB, Qian QF, Zhuo ML, Lin LW, Xue ES, Chen ZK. Application of ultrasonography in predicting the biological risk of gastrointestinal stromal tumors. Scand J Gastroenterol 2022; 57:352-358. [PMID: 34779685 DOI: 10.1080/00365521.2021.2002396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To explore and establish a reliable and noninvasive ultrasound model for predicting the biological risk of gastrointestinal stromal tumors (GISTs). MATERIALS AND METHODS We retrospectively reviewed 266 patients with pathologically-confirmed GISTs and 191 patients were included. Data on patient sex, age, tumor location, biological risk classification, internal echo, echo homogeneity, boundary, shape, blood flow signals, presence of necrotic cystic degeneration, long diameter, and short/long (S/L) diameter ratio were collected. All patients were divided into low-, moderate-, and high-risk groups according to the modified NIH classification criteria. All indicators were analyzed by univariate analysis. The indicators with inter-group differences were used to establish regression and decision tree models to predict the biological risk of GISTs. RESULTS There were statistically significant differences in long diameter, S/L ratio, internal echo level, echo homogeneity, boundary, shape, necrotic cystic degeneration, and blood flow signals among the low-, moderate-, and high-risk groups (all p < .05). The logistic regression model based on the echo homogeneity, shape, necrotic cystic degeneration and blood flow signals had an accuracy rate of 76.96% for predicting the biological risk, which was higher than the 72.77% of the decision tree model (based on the long diameter, the location of tumor origin, echo homogeneity, shape, and internal echo) (p = .008). In the low-risk and high-risk groups, the predicting accuracy rates of the regression model reached 87.34 and 81.82%, respectively. CONCLUSIONS Transabdominal ultrasound is highly valuable in predicting the biological risk of GISTs. The logistic regression model has greater predictive value than the decision tree model.
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Affiliation(s)
- Jing-Jing Guo
- Department of Ultrasound, Fujian Medical University Affiliated Union Hospital, Fuzhou, Fujian, China
| | - Xiu-Bin Tang
- Department of Ultrasound, Fujian Medical University Affiliated Union Hospital, Fuzhou, Fujian, China
| | - Qing-Fu Qian
- Department of Ultrasound, Fujian Medical University Affiliated Union Hospital, Fuzhou, Fujian, China
| | - Min-Ling Zhuo
- Department of Ultrasound, Fujian Medical University Affiliated Union Hospital, Fuzhou, Fujian, China
| | - Li-Wu Lin
- Department of Ultrasound, Fujian Medical University Affiliated Union Hospital, Fuzhou, Fujian, China
| | - En-Sheng Xue
- Department of Ultrasound, Fujian Medical University Affiliated Union Hospital, Fuzhou, Fujian, China
| | - Zhi-Kui Chen
- Department of Ultrasound, Fujian Medical University Affiliated Union Hospital, Fuzhou, Fujian, China
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Oliveira Santos P, Cunha TM, Lemos MM. An unusual presentation of an extragastrointestinal stromal tumour: a case report. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00297-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Gastrointestinal stromal tumours (GISTs) account for most mesenchymal gastrointestinal tumours, which in turn represent 1% of all gastrointestinal cancers. They mainly affect older adults, with a slight male preponderance. These lesions can be found along the digestive tract and most frequently in the stomach. Extragastrointestinal stromal tumours (EGISTs) are even rarer lesions, with few cases or series reported.
Case presentation
A 51-year-old woman was referred to our hospital due to progressive abdominal volume increase. Evaluation by multidetector computed tomography (MDCT) revealed a large intraperitoneal mixed tumour with few solid components, measuring up to 30 cm and compressing the surrounding structures, thought to be an ovarian tumour. Diagnostic laparotomy showed that the lesion was adherent to the greater gastric curvature and the vesical peritoneum. The lesion was removed without complications.
Conclusions
Imaging plays an essential role in the diagnosis of large intraperitoneal tumours. MDCT is the preferred technique to stage and to follow-up EGISTs.
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Arellano-Gutiérrez G, Martínez-Aldrete LF, Pérez-Fabián A, Maldonado-García EL. Primary extra-gastrointestinal stromal tumor (EGIST) of the mesentery: Case report and review of literature. Ann Med Surg (Lond) 2020; 60:480-483. [PMID: 33294179 PMCID: PMC7691126 DOI: 10.1016/j.amsu.2020.11.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/02/2020] [Accepted: 11/04/2020] [Indexed: 02/07/2023] Open
Abstract
Introduction Gastrointestinal stromal tumors (GISTs) represent <1% of all gastrointestinal (GI) tumors. Extra-gastrointestinal stromal tumors (EGISTs) are mesenchymal tissue neoplasm arising outside the GI tract. This rare group comprises only 5% of all GISTs. This case demonstrates a rare entity in a patient with non-specific symptoms, a large tumor size and unremarkable past personal and family history. Presentation of case We present a 45-year old man with non-specific symptoms who was diagnosed with a primary EGIST arising in the small bowel mesentery after surgery. The tumor was not compromising the GI tract and it was completely resected. The tumor was sent for pathological examination that confirmed the diagnosis. Histological examination revealed a 15 cm in diameter mass, comprised of spindle cells and high mitotic activity. Treatment with imatinib mesylate was initiated. Discussion There have been only a few previous reports of EGISTs arising from the small bowel mesentery. It is believed that EGISTs originate from cells with similar pathological characteristics and biological behaviour as the intestinal cells of Cajal. Such tumors are associated with poorer prognosis, lager tumor size and younger presentation than their GI counterparts. The preferred treatment is complete surgical resection. The addition of specific tyrosine kinase inhibitors such as imatinib mesylate is recommended for high risk patients. Even though morphological and immunohistochemical similarities between GISTs and EGISTs are described, their pathogenesis, incidence, genetic background, complications and prognosis are not completely known because they are extremely rare. Conclusion EGISTs are very rare tumors which originate from cells outside the GI tract and are associated with a more aggressive biological behavior than their GI counterparts. These tumors may grow without any clinical implications and should be kept in mind in the differential diagnosis for patients presenting with an abdominal mass. Further studies are needed due to lack of large patient cohort studies and long-term follow-up regarding the prognosis and management of this rare pathology. EGISTs are extremely rare. They represent only 5% of all GISTs, which comprises only <0.05% of all GI tumors. High index of suspicion in patients with nonspecific symptoms and the presence of an abdominal mass is necessary. The preferred treatment is a complete surgical resection in low-risk patients. Clinicopathologic parameters and clinical implications are not yet described in literature.
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Affiliation(s)
- Gregorio Arellano-Gutiérrez
- Department of Surgery, Hospital General de Zona No. 16, Instituto Mexicano del Seguro Social, Torreón, Coahuila, México
| | | | - Abraham Pérez-Fabián
- Department of Surgery, Hospital General de Zona No. 16, Instituto Mexicano del Seguro Social, Torreón, Coahuila, México
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Nguyen TTMH, Dang CT, Pham AV, Nguyen TT. Retroperitoneal gastrointestinal stromal tumor: A case report and literature review. Radiol Case Rep 2020; 15:1823-1828. [PMID: 32793324 PMCID: PMC7415774 DOI: 10.1016/j.radcr.2020.07.041] [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: 07/12/2020] [Accepted: 07/15/2020] [Indexed: 11/16/2022] Open
Abstract
Retroperitoneal gastrointestinal tumor is the rarest subtype among 3 subtypes of extragastrointestinal tumors, which are uncommon stromal tumors. We herein report a case of a 55-year-old man with retroperitoneal gastrointestinal tumor detected by magnetic resonance imaging and confirmed by postoperative histology and immunohistochemistry.
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Affiliation(s)
- Thai Thi My Hanh Nguyen
- Department of Radiology, Hue University of Medicine and Pharmacy, Hue University, Hue, Viet Nam
| | - Cong Thuan Dang
- Department of Histology, Embryology, Pathology and Forensic Medicine, Hue University of Medicine and Pharmacy, Hue University, Hue, Viet Nam
| | - Anh Vu Pham
- Department of Surgery, Hue University of Medicine and Pharmacy, Hue University, Hue, Viet Nam
| | - Thanh Thao Nguyen
- Department of Radiology, Hue University of Medicine and Pharmacy, Hue University, Hue, Viet Nam
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