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Ono Y, Okubo Y, Washimi K, Mikayama Y, Doiuch T, Hasegawa C, Yoshioka E, Ono K, Shiozawa M, Yokose T. Primary omental smooth muscle tumor in an adult male: a diagnostic dilemma for leiomyoma: a case report. J Med Case Rep 2024; 18:222. [PMID: 38704583 DOI: 10.1186/s13256-024-04537-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 04/02/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND The greater omentum comprises peritoneal, adipose, vascular, and lymphoid tissues. Most omental malignancies are metastatic tumors, and the incidence of primary tumors is rare. We report on a prior omental smooth muscle tumor case in an adult male patient. CASE PRESENTATION A 54-year-old Japanese male patient with no relevant medical history was diagnosed with an abdominal mass during a routine medical checkup. Subsequent contrast-enhanced computed tomography revealed a mass of approximately 3 cm in size in the greater omentum, and a laparotomy was performed. A 27 × 25 × 20 mm raised lesion was found in the omentum. Microscopically, spindle cells were observed and arranged in whorls and fascicles. Individual tumor cells had short spindle-shaped nuclei with slightly increased chromatin and were characterized by a slightly eosinophilic, spindle-shaped cytoplasm. The mitotic count was less than 1 per 50 high-power fields. The tumor cells showed positive immunoreactivity for α smooth muscle actin, HHF35, and desmin on immunohistochemical examination. The Ki-67 labeling index using the average method was 1.76% (261/14806). No immunoreactivity was observed for any of the other tested markers. We considered leiomyoma owing to a lack of malignant findings. However, primary omental leiomyoma has rarely been reported, and it can be difficult to completely rule out the malignant potential of smooth muscle tumors in soft tissues. Our patient was decisively diagnosed with a primary omental smooth muscle tumor considering leiomyoma. Consequently, the patient did not undergo additional adjuvant therapy and was followed up. The patient was satisfied with treatment and showed neither recurrence nor metastasis at the 13-month postoperative follow-up. DISCUSSION AND CONCLUSION We encountered a primary smooth muscle tumor of the greater omentum with no histological findings suggestive of malignancy in an adult male patient. However, omental smooth muscle tumors are extremely difficult to define as benign, requiring careful diagnosis. Further case reports with long-term follow-up and case series are required to determine whether a true omental benign smooth muscle tumor (leiomyoma) exists. In addition, proper interpretation of the Ki-67 labeling index should be established. This case study is a foundation for future research.
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Affiliation(s)
- Yukari Ono
- Department of Pathology, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-Ku, Yokohama, Kanagawa, 241-8515, Japan
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-Ku, Yokohama, Kanagawa, 241-8515, Japan
| | - Yoichiro Okubo
- Department of Pathology, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-Ku, Yokohama, Kanagawa, 241-8515, Japan.
| | - Kota Washimi
- Department of Pathology, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-Ku, Yokohama, Kanagawa, 241-8515, Japan
| | - Yo Mikayama
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-Ku, Yokohama, Kanagawa, 241-8515, Japan
| | - Tsunehiro Doiuch
- Department of Diagnostic and Interventional Radiology, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-Ku, Yokohama, Kanagawa, 241-8515, Japan
| | - Chie Hasegawa
- Department of Pathology, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-Ku, Yokohama, Kanagawa, 241-8515, Japan
| | - Emi Yoshioka
- Department of Pathology, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-Ku, Yokohama, Kanagawa, 241-8515, Japan
| | - Kyoko Ono
- Department of Pathology, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-Ku, Yokohama, Kanagawa, 241-8515, Japan
| | - Manabu Shiozawa
- Department of Pathology, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-Ku, Yokohama, Kanagawa, 241-8515, Japan
| | - Tomoyuki Yokose
- Department of Pathology, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-Ku, Yokohama, Kanagawa, 241-8515, Japan
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Santos I, Simão MI, Lúcio MJ, Santos MO, Sacramento G, Cabral CI, Vaz J. Acute Pyelonephritis and an Incidental Diagnosis. Cureus 2024; 16:e54446. [PMID: 38510889 PMCID: PMC10951936 DOI: 10.7759/cureus.54446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2024] [Indexed: 03/22/2024] Open
Abstract
Gastrointestinal stromal tumors (GISTs) arise from the gastrointestinal tract. In rare cases, extra-gastrointestinal stromal tumors (EGISTs) occur in the omentum, mesentery, et cetera. They are mostly asymptomatic or have unspecific symptoms. Risk stratification classification systems are based on tumor size, mitotic rate, location, and perforation. The gold standard for diagnosis is a computed tomography (CT) scan. Ultrasound/CT-guided percutaneous biopsy allows histopathology and immunochemistry results (most stain positive for CD117 (c-KIT), CD34, and/or DOG1). Mutational analysis (most are in proto-oncogene c-KIT and platelet-derived growth factor receptor A (PDGFRA)) determines appropriate therapy. Surgical resection is the gold standard of treatment, with adjuvant and neoadjuvant molecular-targeted therapies depending on recurrence risk and mutations. This report describes a rare case of GIST (omentum EGIST) with a rare presentation (acute pyelonephritis) in a 67-year-old woman. Abdominal examination showed tenderness and a positive Murphy sign on the left side. Blood analysis presented microcytic hypochromic anemia, aggravated renal function, leukocytosis, and increased C-reactive protein. Abdominal CT revealed a heterogeneous abdominal mass, and a CT-guided biopsy showed epithelioid cells positive for CD117 and DOG1, which is compatible with a GIST. The patient underwent surgery that determined the GIST's origin from the greater omentum. Histology revealed an epithelioid GIST with large dimensions and a high histologic grade. Genetic testing detected a variant in the PDGFRA gene. With a high risk of progression, the patient received a three-year course of imatinib.
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Affiliation(s)
- Inês Santos
- Internal Medicine, Hospital Egas Moniz, Lisbon, PRT
| | | | | | - Miguel O Santos
- Oncology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, PRT
| | | | | | - Joana Vaz
- Internal Medicine, Unidade Local de Saúde de Matosinhos, Matosinhos, PRT
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Liu L, Feng Y, Ye Y, Wang Z, Xu X. Survival analysis of extragastrointestinal stromal tumors based on the SEER database: a population-based study. Surg Endosc 2023; 37:8498-8510. [PMID: 37770606 DOI: 10.1007/s00464-023-10433-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/31/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND Extragastrointestinal stromal tumors (EGISTs) are rare mesenchymal neoplasms that originate outside the gastrointestinal tract. However, the population-level survival analysis of EGIST remains poorly grasped. Therefore, we aimed to analyze the survival of EGIST patients using the Surveillance, Epidemiology, and End Results (SEER) database. METHODS All patients diagnosed with GIST and EGIST between 2000 and 2019 were identified through utilization of the SEER database. Missing data were handled using multiple imputation methodology. Kaplan-Meier analyses and Cox proportional hazard models were employed to assess the influence of demographic and clinical characteristics on both overall survival (OS) and cancer-specific survival (CSS). RESULTS A total of 13,330 patients were enrolled in the study, comprising 12,627 diagnosed with GIST and 703 with EGIST. EGIST patients demonstrated significantly poorer OS [hazard ratio (HR) 1.732, 95% confidence interval (CI) 1.522-1.970, P < 0.001] and CSS (HR 2.167, 95% CI 1.821-2.577, P < 0.001) compared to GIST patients. The mean 1-year, 3-year, 5-year, and 10-year OS rates for EGIST patients were 78.3%, 61.9%, 50.5%, and 32.5%, respectively, with corresponding mean CSS rates of 84.3%, 70.8%, 61.3%, and 46.5%. Multivariate Cox regression analysis identified age, race, sex, grade, size, and surgical type as independent risk factors for OS in EGIST patients, while age, sex, year of diagnosis, grade, surgical type, and radiation therapy were identified as independent risk factors for CSS. Patients with EGIST who underwent surgical treatment exhibited significantly higher 5-year OS rates (49.0% vs. 39.9%, P = 0.035) and CSS rates (63.9% vs. 53.0%, P = 0.028) compared to those who did not undergo surgery. CONCLUSIONS EGIST patients have a poorer prognosis compared to GIST patients; however, surgical treatment has been shown to improve the prognosis.
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Affiliation(s)
- Luojie Liu
- Department of Gastroenterology, Changshu Hospital Affiliated to Soochow University, Suzhou, China
| | - Yunfu Feng
- Endoscopy Center, First People's Hospital of Kunshan, Suzhou, China
| | - Ye Ye
- Department of Gastroenterology, Changshu Hospital Affiliated to Soochow University, Suzhou, China
| | - Zhibing Wang
- Department of Gastroenterology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
| | - Xiaodan Xu
- Department of Gastroenterology, Changshu Hospital Affiliated to Soochow University, Suzhou, China.
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Masucci MT, Motti ML, Minopoli M, Di Carluccio G, Carriero MV. Emerging Targeted Therapeutic Strategies to Overcome Imatinib Resistance of Gastrointestinal Stromal Tumors. Int J Mol Sci 2023; 24:ijms24076026. [PMID: 37046997 PMCID: PMC10094678 DOI: 10.3390/ijms24076026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/17/2023] [Accepted: 03/19/2023] [Indexed: 04/14/2023] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are the most common malignant mesenchymal neoplasms of the gastrointestinal tract. The gold standard for the diagnosis of GISTs is morphologic analysis with an immunohistochemical evaluation plus genomic profiling to assess the mutational status of lesions. The majority of GISTs are driven by gain-of-function mutations in the proto-oncogene c-KIT encoding the tyrosine kinase receptor (TKR) known as KIT and in the platelet-derived growth factor-alpha receptor (PDGFRA) genes. Approved therapeutics are orally available as tyrosine kinase inhibitors (TKIs) targeting KIT and/or PDGFRA oncogenic activation. Among these, imatinib has changed the management of patients with unresectable or metastatic GISTs, improving their survival time and delaying disease progression. Nevertheless, the majority of patients with GISTs experience disease progression after 2-3 years of imatinib therapy due to the development of secondary KIT mutations. Today, based on the identification of new driving oncogenic mutations, targeted therapy and precision medicine are regarded as the new frontiers for GISTs. This article reviews the most important mutations in GISTs and highlights their importance in the current understanding and treatment options of GISTs, with an emphasis on the most recent clinical trials.
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Affiliation(s)
- Maria Teresa Masucci
- Preclinical Models of Tumor Progression Unit, Istituto Nazionale Tumori IRCCS 'Fondazione G. Pascale', 80131 Naples, Italy
| | - Maria Letizia Motti
- Preclinical Models of Tumor Progression Unit, Istituto Nazionale Tumori IRCCS 'Fondazione G. Pascale', 80131 Naples, Italy
- Department of Movement Sciences and Wellbeing, University "Parthenope", 80133 Naples, Italy
| | - Michele Minopoli
- Preclinical Models of Tumor Progression Unit, Istituto Nazionale Tumori IRCCS 'Fondazione G. Pascale', 80131 Naples, Italy
| | - Gioconda Di Carluccio
- Preclinical Models of Tumor Progression Unit, Istituto Nazionale Tumori IRCCS 'Fondazione G. Pascale', 80131 Naples, Italy
| | - Maria Vincenza Carriero
- Preclinical Models of Tumor Progression Unit, Istituto Nazionale Tumori IRCCS 'Fondazione G. Pascale', 80131 Naples, Italy
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Inoue M, Ohmori I, Watanabe A, Kajikawa R, Kajiwara R, Sawada H, Miyamoto K, Ikeda M, Toyota K, Sadamoto S, Takahashi T. A duodenal gastrointestinal stromal tumor mimicking a pancreatic neuroendocrine tumor: a case report. J Med Case Rep 2022; 16:308. [PMID: 35974415 PMCID: PMC9380295 DOI: 10.1186/s13256-022-03468-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 05/26/2022] [Indexed: 11/25/2022] Open
Abstract
Background Duodenal gastrointestinal stromal tumors are rare. If tumor growth is extraluminal and involves the head of the pancreas, the diagnosis of a duodenal gastrointestinal stromal tumor is difficult. Case presentation A 44-year-old Japanese woman was referred to our hospital with anemia. An enhanced computed tomography scan showed a hypervascular mass 30 mm in diameter, but the origin of the tumor, either the duodenum or the head of the pancreas, was unclear. Upper gastrointestinal endoscopy revealed bulging accompanied by erosion and redness in part of the duodenal bulb. Mucosal biopsy was not diagnostic. Endoscopic ultrasound fine-needle aspiration was difficult to perform because a pulsating blood vessel was present in the region to be punctured. These findings led to a diagnosis of pancreatic neuroendocrine tumor invasion to the duodenum. The patient underwent pancreaticoduodenectomy. Histologically, the tumor was made up of spindle-shaped cells immunohistochemically positive for c-Kit and CD34. The tumor was ultimately diagnosed as a duodenal gastrointestinal stromal tumor. Conclusion Extraluminal duodenal gastrointestinal stromal tumors are rare and mimic pancreatic neuroendocrine tumors. Endoscopic ultrasound fine-needle aspiration is useful for preoperative diagnosis, but it is not possible in some cases. Intraoperative diagnosis based on a completely resected specimen of the tumor may be useful for modifying the surgical technique.
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Affiliation(s)
- Masashi Inoue
- Department of Surgery, National Hospital Organization Higashihiroshima Medical Center, 513 Jike, Saijo-cho, Higashihiroshima, 739-0041, Japan.
| | - Ichiro Ohmori
- Department of Surgery, National Hospital Organization Higashihiroshima Medical Center, 513 Jike, Saijo-cho, Higashihiroshima, 739-0041, Japan
| | - Atsuhiro Watanabe
- Department of Surgery, National Hospital Organization Higashihiroshima Medical Center, 513 Jike, Saijo-cho, Higashihiroshima, 739-0041, Japan
| | - Ryujiro Kajikawa
- Department of Surgery, National Hospital Organization Higashihiroshima Medical Center, 513 Jike, Saijo-cho, Higashihiroshima, 739-0041, Japan
| | - Ryotaro Kajiwara
- Department of Surgery, National Hospital Organization Higashihiroshima Medical Center, 513 Jike, Saijo-cho, Higashihiroshima, 739-0041, Japan
| | - Hiroyuki Sawada
- Department of Surgery, National Hospital Organization Higashihiroshima Medical Center, 513 Jike, Saijo-cho, Higashihiroshima, 739-0041, Japan
| | - Kazuaki Miyamoto
- Department of Surgery, National Hospital Organization Higashihiroshima Medical Center, 513 Jike, Saijo-cho, Higashihiroshima, 739-0041, Japan
| | - Masahiro Ikeda
- Department of Surgery, National Hospital Organization Higashihiroshima Medical Center, 513 Jike, Saijo-cho, Higashihiroshima, 739-0041, Japan
| | - Kazuhiro Toyota
- Department of Surgery, National Hospital Organization Higashihiroshima Medical Center, 513 Jike, Saijo-cho, Higashihiroshima, 739-0041, Japan
| | - Seiji Sadamoto
- Department of Surgery, National Hospital Organization Higashihiroshima Medical Center, 513 Jike, Saijo-cho, Higashihiroshima, 739-0041, Japan
| | - Tadateru Takahashi
- Department of Surgery, National Hospital Organization Higashihiroshima Medical Center, 513 Jike, Saijo-cho, Higashihiroshima, 739-0041, Japan.,Department of Gastrointestinal and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Lee W, Li X, Lee S, Chandan VS. Primary pancreatic gastrointestinal stromal tumor. Hepatobiliary Pancreat Dis Int 2021; 20:391-3. [PMID: 32878724 DOI: 10.1016/j.hbpd.2020.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 08/04/2020] [Indexed: 02/05/2023]
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Pickhardt PJ, Perez AA, Elmohr MM, Elsayes KM. CT imaging review of uncommon peritoneal-based neoplasms: beyond carcinomatosis. Br J Radiol 2021; 94:20201288. [PMID: 33353398 DOI: 10.1259/bjr.20201288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Pathologic involvement of the peritoneum can result from a wide variety of conditions, including both neoplastic and non-neoplastic entities. Neoplastic involvement of the peritoneal ligaments, mesenteries, and spaces from malignant spread of epithelial cancers, termed peritoneal carcinomatosis, is frequently encountered at CT evaluation. However, a host of other more unusual benign and malignant neoplasms can manifest with peritoneal disease, including both primary and secondary peritoneal processes, many of which can closely mimic peritoneal carcinomatosis at CT. In this review, we discuss a wide array of unusual peritoneal-based neoplasms that can resemble the more common peritoneal carcinomatosis. Beyond reviewing the salient features for each of these entities, particular emphasis is placed on any specific clinical and CT imaging clues that may allow the interpreting radiologist to appropriately narrow the differential diagnosis and, in some cases, make an imaging-specific diagnosis.
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Affiliation(s)
- Perry J Pickhardt
- The University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
| | - Alberto A Perez
- The University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
| | - Mohab M Elmohr
- Department of Diagnostic Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Khaled M Elsayes
- Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Nougaret S, Nikolovski I, Paroder V, Vargas HA, Sala E, Carrere S, Tetreau R, Hoeffel C, Forstner R, Lakhman Y. MRI of Tumors and Tumor Mimics in the Female Pelvis: Anatomic Pelvic Space-based Approach. Radiographics 2020; 39:1205-1229. [PMID: 31283453 DOI: 10.1148/rg.2019180173] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Pelvic masses can present a diagnostic challenge owing to the difficulty in assessing their origin and the overlap in imaging features. The majority of pelvic tumors arise from gastrointestinal or genitourinary organs, with less common sites of origin including the connective tissues, nerves, and lymphovascular structures. Lesion evaluation usually starts with clinical assessment followed by imaging, or the lesion may be an incidental finding at imaging performed for other clinical indications. Since accurate diagnosis is essential for optimal management, imaging is useful for suggesting the correct diagnosis or narrowing the differential possibilities and distinguishing tumors from their mimics. Some masses may require histologic confirmation of the diagnosis with biopsy and/or up-front surgical resection. In this case, imaging is essential for presurgical planning to assess mass size and location, evaluate the relationship to adjacent pelvic structures, and narrow differential possibilities. Pelvic US is often the first imaging modality performed in women with pelvic symptoms. While US is often useful to detect a pelvic mass, it has significant limitations in assessing masses located deep in the pelvis or near gas-filled organs. CT also has limited value in the pelvis owing to its inferior soft-tissue contrast. MRI is frequently the optimal imaging modality, as it offers both multiplanar capability and excellent soft-tissue contrast. This article highlights the normal anatomy of the pelvic spaces in the female pelvis and focuses on MRI features of common tumors and tumor mimics that arise in these spaces. It provides an interpretative algorithm for approaching an unknown pelvic lesion at MRI. It also discusses surgical management, emphasizing the value of MRI as a road map to surgery and highlighting anatomic locations where surgical resection may present a challenge. ©RSNA, 2019.
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Affiliation(s)
- Stephanie Nougaret
- From the Montpellier Cancer Research Institute (IRCM), INSERM U1194, Montpellier, France (S.N.); Departments of Radiology (S.N., R.T.) and Surgery (S.C.), Montpellier Cancer Institute, University of Montpellier, 208 Ave des Apothicaires, Montpellier 34298, France; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (I.N., V.P., H.A.V., Y.L.); Department of Radiology, Cambridge Biomedical Campus, Cambridge, England (E.S.); Department of Radiology, CHU Reims, Reims, France (C.H.); CReSTIC, URCA, Reims University, Reims, France (C.H.); and Department of Radiology, Universitätsklinikum, PMU, Salzburg, Austria (R.F.)
| | - Ines Nikolovski
- From the Montpellier Cancer Research Institute (IRCM), INSERM U1194, Montpellier, France (S.N.); Departments of Radiology (S.N., R.T.) and Surgery (S.C.), Montpellier Cancer Institute, University of Montpellier, 208 Ave des Apothicaires, Montpellier 34298, France; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (I.N., V.P., H.A.V., Y.L.); Department of Radiology, Cambridge Biomedical Campus, Cambridge, England (E.S.); Department of Radiology, CHU Reims, Reims, France (C.H.); CReSTIC, URCA, Reims University, Reims, France (C.H.); and Department of Radiology, Universitätsklinikum, PMU, Salzburg, Austria (R.F.)
| | - Viktoriya Paroder
- From the Montpellier Cancer Research Institute (IRCM), INSERM U1194, Montpellier, France (S.N.); Departments of Radiology (S.N., R.T.) and Surgery (S.C.), Montpellier Cancer Institute, University of Montpellier, 208 Ave des Apothicaires, Montpellier 34298, France; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (I.N., V.P., H.A.V., Y.L.); Department of Radiology, Cambridge Biomedical Campus, Cambridge, England (E.S.); Department of Radiology, CHU Reims, Reims, France (C.H.); CReSTIC, URCA, Reims University, Reims, France (C.H.); and Department of Radiology, Universitätsklinikum, PMU, Salzburg, Austria (R.F.)
| | - Hebert A Vargas
- From the Montpellier Cancer Research Institute (IRCM), INSERM U1194, Montpellier, France (S.N.); Departments of Radiology (S.N., R.T.) and Surgery (S.C.), Montpellier Cancer Institute, University of Montpellier, 208 Ave des Apothicaires, Montpellier 34298, France; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (I.N., V.P., H.A.V., Y.L.); Department of Radiology, Cambridge Biomedical Campus, Cambridge, England (E.S.); Department of Radiology, CHU Reims, Reims, France (C.H.); CReSTIC, URCA, Reims University, Reims, France (C.H.); and Department of Radiology, Universitätsklinikum, PMU, Salzburg, Austria (R.F.)
| | - Evis Sala
- From the Montpellier Cancer Research Institute (IRCM), INSERM U1194, Montpellier, France (S.N.); Departments of Radiology (S.N., R.T.) and Surgery (S.C.), Montpellier Cancer Institute, University of Montpellier, 208 Ave des Apothicaires, Montpellier 34298, France; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (I.N., V.P., H.A.V., Y.L.); Department of Radiology, Cambridge Biomedical Campus, Cambridge, England (E.S.); Department of Radiology, CHU Reims, Reims, France (C.H.); CReSTIC, URCA, Reims University, Reims, France (C.H.); and Department of Radiology, Universitätsklinikum, PMU, Salzburg, Austria (R.F.)
| | - Sebastien Carrere
- From the Montpellier Cancer Research Institute (IRCM), INSERM U1194, Montpellier, France (S.N.); Departments of Radiology (S.N., R.T.) and Surgery (S.C.), Montpellier Cancer Institute, University of Montpellier, 208 Ave des Apothicaires, Montpellier 34298, France; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (I.N., V.P., H.A.V., Y.L.); Department of Radiology, Cambridge Biomedical Campus, Cambridge, England (E.S.); Department of Radiology, CHU Reims, Reims, France (C.H.); CReSTIC, URCA, Reims University, Reims, France (C.H.); and Department of Radiology, Universitätsklinikum, PMU, Salzburg, Austria (R.F.)
| | - Raphael Tetreau
- From the Montpellier Cancer Research Institute (IRCM), INSERM U1194, Montpellier, France (S.N.); Departments of Radiology (S.N., R.T.) and Surgery (S.C.), Montpellier Cancer Institute, University of Montpellier, 208 Ave des Apothicaires, Montpellier 34298, France; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (I.N., V.P., H.A.V., Y.L.); Department of Radiology, Cambridge Biomedical Campus, Cambridge, England (E.S.); Department of Radiology, CHU Reims, Reims, France (C.H.); CReSTIC, URCA, Reims University, Reims, France (C.H.); and Department of Radiology, Universitätsklinikum, PMU, Salzburg, Austria (R.F.)
| | - Christine Hoeffel
- From the Montpellier Cancer Research Institute (IRCM), INSERM U1194, Montpellier, France (S.N.); Departments of Radiology (S.N., R.T.) and Surgery (S.C.), Montpellier Cancer Institute, University of Montpellier, 208 Ave des Apothicaires, Montpellier 34298, France; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (I.N., V.P., H.A.V., Y.L.); Department of Radiology, Cambridge Biomedical Campus, Cambridge, England (E.S.); Department of Radiology, CHU Reims, Reims, France (C.H.); CReSTIC, URCA, Reims University, Reims, France (C.H.); and Department of Radiology, Universitätsklinikum, PMU, Salzburg, Austria (R.F.)
| | - Rosemarie Forstner
- From the Montpellier Cancer Research Institute (IRCM), INSERM U1194, Montpellier, France (S.N.); Departments of Radiology (S.N., R.T.) and Surgery (S.C.), Montpellier Cancer Institute, University of Montpellier, 208 Ave des Apothicaires, Montpellier 34298, France; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (I.N., V.P., H.A.V., Y.L.); Department of Radiology, Cambridge Biomedical Campus, Cambridge, England (E.S.); Department of Radiology, CHU Reims, Reims, France (C.H.); CReSTIC, URCA, Reims University, Reims, France (C.H.); and Department of Radiology, Universitätsklinikum, PMU, Salzburg, Austria (R.F.)
| | - Yulia Lakhman
- From the Montpellier Cancer Research Institute (IRCM), INSERM U1194, Montpellier, France (S.N.); Departments of Radiology (S.N., R.T.) and Surgery (S.C.), Montpellier Cancer Institute, University of Montpellier, 208 Ave des Apothicaires, Montpellier 34298, France; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (I.N., V.P., H.A.V., Y.L.); Department of Radiology, Cambridge Biomedical Campus, Cambridge, England (E.S.); Department of Radiology, CHU Reims, Reims, France (C.H.); CReSTIC, URCA, Reims University, Reims, France (C.H.); and Department of Radiology, Universitätsklinikum, PMU, Salzburg, Austria (R.F.)
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10
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Abstract
RATIONALE Although capillary hemangiomas, common lesions involving the proliferation of small capillary vessels and a single layer of endothelial cells, can arise in any organ, they are rarely reported in the greater or lesser omentum. Here in, we report a case of capillary hemangioma arising from the lesser omentum in an adult with interesting diagnostic imaging findings, including changes in tumor size over time on computed tomography (CT), that was resected using laparoscopic surgery. To our knowledge, this is the first English report to describe a capillary hemangioma arising from the lesser omentum. PATIENT CONCERNS A 63-year-old Japanese man received hemodialysis for chronic renal failure due to diabetic nephropathy, and a small, gradually enlarging tissue mass was found near the lesser curvature of the stomach on plain CT performed annually, without any associated complaints. Diagnostic imaging revealed an 18 × 15-mm tumor with a homogenous, highly enhanced effect in the early phase that was attenuated but prolonged in the delayed phase. Magnetic resonance imaging showed a mass with low signal intensity on T1-weighted imaging and relatively high signal intensity on T2-weighted imaging. DIAGNOSIS The patient was diagnosed with capillary hemangioma arising from the lesser omentum according to the pathological and immunohistological findings. INTERVENTIONS The patient underwent laparoscopy for excision of the tumor from the lesser omentum. OUTCOMES At the 1 year follow-up, the patient had no recurrence of the tumor. LESSONS We describe the first case worldwide of capillary hemangioma that was a true vascular tumor arising from the lesser omentum. Although capillary hemangioma arising from the lesser omentum is extremely rare, it should be considered in the differential diagnosis of patients presenting with a highly enhanced lesser omental tumor, and laparoscopy can be safely applied for the excision of this tumor.
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Affiliation(s)
- Hideki Nagano
- Department of Surgery, Japan Community Health Care Organization Fukui Katsuyama General Hospital, Nagayama-cho
- Department of Surgery, National Hospital Organization Tsuruga Medical Center, Sakuragaoka
| | - Takanori Goi
- First Department of Surgery, Faculty of Medicine, University of Fukui, Matsuokashimoaizuki, Eiheiji-cho, Yoshida-gun
| | - Seiichi Taguchi
- Department of Surgery, Japan Community Health Care Organization Fukui Katsuyama General Hospital, Nagayama-cho
| | - Takayoshi Tsubaki
- Department of Surgery, Japan Community Health Care Organization Fukui Katsuyama General Hospital, Nagayama-cho
| | - Toshikuni Tsuchiyama
- Department of Surgery, Japan Community Health Care Organization Fukui Katsuyama General Hospital, Nagayama-cho
| | - Hidemasa Uematsu
- Department of Radiology, Japan Community Health Care Organization Fukui Katsuyama General Hospital, Nagayama-cho
| | - Sakon Noriki
- First Department of Pathology, Faculty of Medicine, University of Fukui, Matsuokashimoaizuki, Eiheiji-cho, Yoshida-gun, Japan
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11
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Saijo F, Sato K, Handa T, Narushima Y, Matsumura N, Iwama N, Nakayama F, Tokumura H. First Account of Primary Leiomyosarcoma of the Lesser Omentum since Establishment of c-Kit Mutations in Gastrointestinal Stromal Tumors. Case Rep Surg 2019; 2019:2426092. [PMID: 31781464 DOI: 10.1155/2019/2426092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 10/30/2019] [Indexed: 11/22/2022] Open
Abstract
Background Primary omental leiomyosarcoma is an extremely rare type of tumor. Leiomyosarcomas originating from the lesser omentum have not been reported since immunohistochemical staining for c-kit has been used for the diagnosis of mesenchymal abdominal tumors. They are yet to be reported since gastrointestinal stromal tumors were categorized. Here we reported a case of successful resection of a lesser omental leiomyosarcoma. Case Presentation A 71-year-old man underwent ultrasonography at the outpatient clinic through which an upper abdominal tumor was identified. Following computed tomography and endoscopy, a 4.5 cm submucosal tumor in the lesser curvature of the stomach was highly suspected. A laparoscopic partial resection of the stomach was performed. Histopathological examination revealed the tumor to be a leiomyosarcoma arising from the lesser omentum that did not invade the stomach. Immunohistochemical staining showed that the tumor was negative for CD34, c-kit, and S-100 and positive for desmin and α-smooth muscle actin. No recurrence had been observed 1 year after surgery without adjuvant chemotherapy. Conclusions Primary lesser omental leiomyosarcoma, which is difficult to diagnose before surgery given the location of the primary tumor in the lesser omentum, has rarely been reported. Considering the high possibility of malignancy, close observation is essential.
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12
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Popivanov G, Tabakov M, Mantese G, Cirocchi R, Piccinini I, D'Andrea V, Covarelli P, Boselli C, Barberini F, Tabola R, Pietro U, Cavaliere D. Surgical treatment of gastrointestinal stromal tumors of the duodenum: a literature review. Transl Gastroenterol Hepatol 2018; 3:71. [PMID: 30363779 DOI: 10.21037/tgh.2018.09.04] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 09/04/2018] [Indexed: 01/10/2023] Open
Abstract
Background Gastrointestinal stromal tumors (GIST) are the most frequent mesenchymal tumours in the digestive tract. The duodenal GIST (dGIST) is the rarest subtype, representing only 4-5% of all GIST, but up to 21% of the resected ones. The diagnostic and therapeutic management of dGIST may be difficult due to the rarity of this tumor, its anatomical location, and the clinical behavior that often mimic a variety of conditions; moreover, there is lack of consent for their treatment. This study has evaluated the scientific literature to provide consensus on the diagnosis of dGIST and to outline possible options for surgical treatment. Methods An extensive research has been carried out on the electronic databases MEDLINE, Scopus, EMBASE and Cochrane to identify all clinical trials that report an event or case series of dGIST. Results Eighty-six studies that met the inclusion criteria were identified with five hundred forty-nine patients with dGIST: twenty-seven patients were treated with pancreatoduodenectomy and ninety-six with only local resection (segmental/wedge resections); in four hundred twenty-six patients it is not possible identify the type of treatment performed (pancreatoduodenectomy or segmental/wedge resections). Conclusions dGISTs are a very rare subset of GISTs. They may be asymptomatic or may involve symptoms of upper GI bleeding and abdominal pain at presentation. Because of the misleading clinical presentation the differential diagnosis may be difficult. Tumours smaller than 2 cm have a low biological aggressiveness and can be followed annually by endoscopic ultrasound. The biggest ones should undergo radical surgical resection (R0). In dGIST there is no uniformly adopted surgical strategy because of the low incidence, lack of experience, and the complex anatomy of the duodenum. Therefore, individually tailored surgical approach is recommended. R0 resection with 1-2 cm clear margin is required. Lymph node dissection is not recommended due to the low incidence of lymphatic metastases. Tumor rupture should be avoided.
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Affiliation(s)
- Georgi Popivanov
- Military Medical Academy, Clinic of Endoscopic, Endocrine surgery and Coloproctology, Sofia, Bulgaria
| | - Mihail Tabakov
- University Hospital Sv. Ivan Rilski, Surgical Clinic, Sofia, Bulgaria
| | - George Mantese
- Department of Surgical Sciences, The University of Rome "La Sapienza", Rome, Italy
| | - Roberto Cirocchi
- Department of Surgical Sciences, The University of Rome "La Sapienza", Rome, Italy
| | - Irene Piccinini
- Department of Surgical Sciences, The University of Rome "La Sapienza", Rome, Italy
| | - Vito D'Andrea
- Department of Surgical and Biomedical Sciences, University of Perugia, Italy
| | - Piero Covarelli
- Department of Surgical Sciences, The University of Rome "La Sapienza", Rome, Italy
| | - Carlo Boselli
- Department of Surgical Sciences, The University of Rome "La Sapienza", Rome, Italy
| | - Francesco Barberini
- Department of Surgical Sciences, The University of Rome "La Sapienza", Rome, Italy
| | - Renata Tabola
- Department and Clinic of Gastrointestinal and General Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Ursi Pietro
- Department of Surgical and Biomedical Sciences, University of Perugia, Italy
| | - Davide Cavaliere
- General Surgery and Surgical Oncology, Morgagni-Pierantoni Hospital, Forlì, Italy
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