Gastroduodenal intussusception due to pedunculated polypoid gastrointestinal stromal tumor

The gastrointestinal stromal tumor (GIST) is a mesenchymal tumor of the digestive tract showing differentiation along the line of interstitial cell of Cajal. The most GISTs in the stomach generally show the appearance of submucosal tumors. It is rare for GISTs to appear as a pedunculated polypoid lesion on endoscopy. We experienced a case of a 51-year-old man who had a pedunculated polypoid GIST. He was admitted to our hospital for nausea, vomiting, melena and severe anemia (hemoglobin 3.4 g/dL, hematocrit 10.8%). An upper endoscopy showed gastroduodenal intussusception due to a pedunculated polypoid mass. This report presents a rare case of endoscopically proven gastroduodenal intussusceptions due to pedunculated polypoid GIST in the stomach.     

Ileocolic intussusception due to ileal lymphoma (Case report).

Intussusception occurs rarely in adults. It presents with a variety of acute, intermittent, and chronic symptoms, thus making its preoperative diagnosis difficult. In adults, intussusceptions are mostly caused by organic lesions and the majority of these lesions are benign tumours. Computed tomography scanning and endoscopy have proved to be the most useful diagnostic methods. Confirmation of diagnosis and treatment of adult intussusception is surgical, with surgical resection of the intussusception without reduction being the preferred treatment in adults, as almost half of both colonic and enteric intussusceptions are associated with malignancy. We report the case of a patient with ileocolic intussusception due to an ileal lymphoma.     

Upper gastrointestinal hemorrhage due to duodenal stromal tumor

BACKGROUND: Gastrointestinal stromal tumor represents a rare neoplasm that originates in the muscular wall of the hollow viscera. AIM: To report gastrointestinal stromal tumor as a source of upper gastrointestinal bleeding, which required urgent surgical control. PATIENT/METHOD: A man with 61 years old was admitted to the emergency service sustaining hematemesis and melena. Endoscopy showed active bleeding from a tumor in the second portion of the duodenum, which was controlled by heater probe cauterization. Surgery was performed through a median laparotomy. A local resection of a 4 cm tumor in the second portion of the duodenum was carried out, together with a primary end-to-end anastomosis and a duodenal diverticulization. No complications happened during the post-operative period. Morphologic examination showed gastrointestinal stromal tumor with no atypical mitosis and a preserved capsule. CONCLUSION: Albeit not being common, gastrointestinal stromal tumors can represent a source of substantial gastrointestinal hemorrhage.     

Ileocolic intussusception due to a large B cell lymphoma in a patient with AIDS

Adult intussusception is rare. Here, we describe a case of an AIDS adult patient who developed an ileocolic intussusception secondary to a large B cell lymphoma of the cecum. Surgical findings included the ileon free of the tumor and invaginated within the cecum with infiltrating neoplasm. Surgical treatment included the resection of the right hemicolon because of the tumor, located in the cecum, causing intussusception. The English and Spanish literature is reviewed.     

Ileocolic intussusception in adult due to malignant lymphoma in the cecum with intramural metatasis

A rare adult case of intussusception caused by malignant lymphoma of the cecum with intramural metastasis is reported. The patient was a 24-year-old man. Ileocolic intussusception was diagnosed by characteristic findings on abdominal computed tomography. Endoscopic examination revealed a massive protuberant tumor, 3 cm in diameter, and a semipedunculated polyp, 1 cm in diameter, in the cecum, which had caused the ileocolic intussusception. Endoscopic biopsy specimens failed to yield a definitive diagnosis histologically, but right hemicolectomy with lymph node dissection was performed. On histologic examination of the surgical specimens, both the tumor and the polyp were diagnosed as diffuse lymphoma of medium-sized cell type, and no lymph node involvement was found. The patient responded well to surgical and chemotherapeutic treatment, and has had no recurrence of malignant lymphoma in the 2 years since the surgical treatment. This was a very rare case of an intussusception in an adult patient due to malignant lymphoma in the cecum with intramural metastasis and without lymph node involvement.     

Ileocolic intussusception in an adult

Two weeks after appendectomy a right hemicolectomy was performed on a 35-year-old man because of an ileocolic intussusception. The appendiceal stump was the leading point of the intussusception. Ileocolic intussusception is a very rare complication after appendectomy. The clinical symptoms, diagnostic features, and mode of treatment are discussed.     

Colorectal gastrointestinal stromal tumor

Gastrointestinal stromal tumor (GIST) is the most common mesenchymal neoplasm arising in the digestive tract, with an estimated prevalence of 15-20 per 1,000,000. GISTs are related to the interstitial cells of Cajal and are characterized by constitutive over-expression of the transmembrane tyrosine kinase receptor KIT. This is produced by a patognomonic mutation of the proto-oncogene c-kit that occurs in up to 90% of cases. Exon 11 is affected most frequently; exons 9 and 13 are less commonly involved. One-third of GISTs lacking KIT mutations exhibits alternative activating mutations in the PDGFRα gene. Colorectal GISTs represent about 5-10% of the cases, mainly located in the rectum that is the third common site. Benign GISTs are more common, but many tumors are of uncertain malignant potential; tumor size and rate of mitosis are still the most reliable criteria for assessing the risk of an aggressive behavior. Surgery is the first-line treatment for resectable non-metastatic colorectal GIST. Standard oncologic resection is inappropriate because skip metastases and lymphatic spread are rarely reported. Segmental colectomy with negative margins is recommended, and local excision is oncologically adequate in highly selected rectal tumors. Radical surgery alone is not always curative especially in high-risk GISTs, and half of patients develops local recurrences or distant metastases after R0 operation. Medical therapeutic strategies have rapidly evolved after the introduction of targeted molecular therapy. Efficacy and safety of imatinib mesylate was first demonstrated in patients with metastatic and unresectable disease. Adjuvant and neoadjuvant use of imatinib are promising therapeutic options to improve the outcome of surgery to downstage unresectable lesions and to allow less extensive resections.     

Primary pancreatic gastrointestinal stromal tumor

正Gastrointestinal stromal tumor (GIST) arises from the interstitial cells of Cajal (ICC) and is the most common mesenchymal tumor of the gastrointestinal tract,accounting for approximately 1%-2%of all malignant gastrointestinal tract tumors[1].The most common sites of origin are stomach and small bowel.     

Ileocolic intussusception secondary to Hodgkin´s lymphoma. Report of a case

Intussusception is a rare J75condition in adults and represents 1% to 5% of the total cases of intestinal obstruction. Preoperative diagnosis occurs only in a few patients and most of the cases are diagnosed during surgery. A demonstrable etiology is found in 70% to 90% of cases in adult intussusceptions, and approximately 40% of them are caused by primary or secondary malignant tumors. We report the case of a 32 year old male patient with an ileocolic intussusception secondary to Hodgkin's lymphoma, as well as the surgical treatment, and outcome.     

Cowden syndrome complicated by a gastrointestinal stromal tumor

To our knowledge, this is the first report of Cowden syndrome complicated by a gastrointestinal stromal tumor (GIST) of the small bowel. A 42‐year‐old female patient was found to have an abdominal mass that was diagnosed as the cause of anemia and was surgically extracted. The surgical specimen was found to be a GIST. During the same period, the patient underwent an endoscopic examination of the entire gastrointestinal tract. She was also diagnosed as having Cowden syndrome based on gastrointestinal polyps and skin, thyroid and breast lesions. Cowden syndrome is associated with germline mutations in the tumorsuppressor gene PTEN. PTEN expression may be essential to tumor growth and is a predictive biomarker of the prognosis of both diseases. The present report of such a case is expected to further the analysis of Cowden syndrome.     

Ileocolic intussusception in a recurrent non-Hodgkin's lymphoma; report of a case

The adult intussusception is rare. Here, we describe a case of an adult patient with ileocolic intussusception secondary to a recurrent lymphoma of the terminal ileum. The patient was a 42-year-old female, who had a history of the subtotal gastrectomy because of the primary gastric lymphoma. Eight months after the operation, she had a relapse in the abdomen and received the combination chemotherapy. She acquired the complete remission, but six months after the completion of the chemotherapy, she suffered from the right lower abdominal pain and diarrhea. Physical examination revealed a soft mass with tenderness in the right iliac fossa. Barium studies and abdominal computed tomography showed an ileocolic intussusception. At laparotomy, a 4.5 cm polypoid tumor was found in the terminal ileum and it passed through the ileocaecal valve to form an intussusception. Histologic examination disclosed the follicular lymphoma of medium-sized cell type. So far as we are aware, this is the first report of an adult patient with intussusception secondary to a lymphoma in Japan.