Esophageal gastrointestinal stromal tumor surrounding the middle esophagus with dysphagia for 8 years; report of a case

In September 2002, a 24-year-old woman complaining dysphagia with an abnormal shadow in a chest X-ray was admitted to our hospital. Endoscopic ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) showed a hypo-echoic, low-density mass surrounding the middle esophagus. Bronchofiberscopy and gastrofiberscopy showed compression from the outside of bronchus and esophagus. No ulcer formation was found. Transbronchial aspiration biopsy and esophageal biopsy showed no malignancy. After 14 cm thoractomy, extirpation of the tumor was performed. The solid tumor was 10.5 x 3.0 x 2.5 cm in dimension, and the cut surface of the tumor was light yellow. Immunohistochemically, the tumor cells were positive for c-kit, SMA, CD34, and S-100. Histopathologically, the tumor was diagnosed as gastrointestinal stromal tumor (GIST), combined smooth muscle-neural type. A postoperative upper gastrointestinal tract barium study showed no stenosis. She is doing well without evidence of tumor recurrence at 12 months postoperatively. Although GIST is the most common mensenchymal tumor of the human gastrointestinal tract, this case is reported because the GIST arising from the middle esophagus is very rare.     

Gastrointestinal stromal tumor of the stomach mimicking adrenal tumor: a case report

A gastrointestinal stromal tumor of the stomach mimicking an adrenal tumor in a 67-year-old woman is reported. The patient sought medical attention for left flank pain in December 2001. A spherical calcification was evident in the left hypochondrium in an abdominal radiography, and computed tomography revealed a mass 8 cm in diameter at the upper pole of the left kidney. She then was admitted to our hospital. Physical examination and laboratory screening showed hypertension, diabetes mellitus and slight hemoconcentration. Endocrine examination showed normal serum adrenal hormone concentrations. Magnetic resonance imaging again demonstrated the mass, which showed enhancement along its margins after intravenous contrast administration. With a preoperative diagnosis of adrenal tumor, we performed total resection. The pediculated tumor, arising from the stomach, showed c-kit immunohistochemical staining permitting a histopathological diagnosis of gastrointestinal stromal tumor.     

Pancreatic gastrointestinal stromal tumor: A case report

IntroductionGastrointestinal stromal tumors (GISTs) are the most common gastrointestinal tract (GIT) tumors of mesenchymal origin. GISTs tend to arise with a higher frequency in the stomach and the small intestine. GISTs that originate from outside of the GIT are defined as extra-gastrointestinal stromal tumors (EGISTs). Among them pancreatic EGISTs are very rare.Case presentationA 30 years old male patient presented with abdominal pain. Triphasic abdominal computed tomography scan with contrast revealed large well defined mass at the pancreatic tail, about 12 × 11.6 cm. Laparoscopic distal pancreatectomy and splenectomy was performed. Postoperative pathological examination revealed positive CD 117 and Dog 1 confirming the diagnosis of EGISTs.DiscussionGIST is a rare mesenchymal tumor. EGISTs arising in the pancreas are extremely rare, about, 5% of EGISTs. Its origin remains controversial. Some authors believe that GISTs and EGISTs arise from the common cell origin of interstitial cells of Cajal. Others suggest that EGISTs are at the beginning, mural GISTs with extensive extramural growth, resulting in later on, loss of their connection with the GIT wall.ConclusionWe report a rare case of large pancreatic tail EGIST, which was resected, safely and effectively by laparoscopic approach.     

Perisacral gastrointestinal stromal tumor with intracranial metastasis. Case report

A 68-year-old woman presented with an extremely rare intracranial metastasis from a gastrointestinal stromal tumor (GIST) manifesting as left hemiparesis 2 years after resection of a sacral tumor adjacent to the coccygeal bone. Magnetic resonance imaging revealed an intracranial tumor in the right parietal lobe. Craniotomy was performed to completely remove the tumor. Although the tumor was located extra-axially, only internal carotid angiography showed mass staining. Seven months after surgery, the tumor recurred. Repeat craniotomy was performed to remove the recurrent tumor. Immunohistochemical analysis showed that the tumor cells were positive for c-kit and CD34, and the tumors were identified as intracranial metastasis of GIST. Following the second intracranial surgery, the patient developed severe lower back pain caused by metastatic tumor invading the lumbar spine and ureter. To avoid surgical complications and to reduce tumor volume, imatinib mesylate (Gleevec) was administered. The severe pain was relieved, although the tumor was not reduced. In this case, the extra-axial tumor was fed only by the internal carotid artery.     

Laparoscopic total gastrectomy for multiple sporadic gastric gastrointestinal stromal tumors: report of a case

A 64-year-old man was admitted to our hospital with hematemesis. Emergency upper gastrointestinal endoscopy revealed bleeding from a submucosal tumor (SMT) in the antrum of the stomach, with two other SMTs at different sites. Based on his family history, we diagnosed familial multiple gastric gastrointestinal stromal tumors (GISTs) and performed laparoscopic total gastrectomy. Three distinct tumors were found: one in the fornix, one in the lesser curvature of the angle, and one in the antrum of the stomach. Microscopic examination of the resected specimens revealed different cytomorphologies, of the spindle and epithelioid type, as well as immunophenotypes in the tumors. Mutation analysis revealed different sites of mutation in c-kit and PDGFRA. No mutation was detected in the normal tissue of the stomach. These findings confirmed a diagnosis of multiple sporadic gastric GISTs. Thus, investigating germline mutation might assist in the preoperative diagnosis of multiple gastric GISTs.     

Acute bleeding in gastrointestinal stromal tumor: case report

A.A. refer a case report on a patient observed in emergency condition for acute bleeding from digiunal bowel by a GIST. Starting from clinical case, describe a brief profile of clinical, histogenetic, diagnostic and prognostic characteristics of the GIST also delineated by recent reports from literature; agree with other A.A. about treatment procedure represented always by resection of affected intestinal tract and never by enucleation for inconstant and unforeseeable biologic comportment by this tumours.     

Pulmonary metastasis fifteen years after hysterectomy for uterine leiomyosarcoma; report of a case

A 75-year-old woman who had undergone a hysterectomy for uterine leiomyosarcoma 15 years before was noted to have a lung tumor on chest radiography. Chest computed tomography (CT) showed a tumor mass, 3.5 cm in size, in her left lung (S10). CT-needle aspiration biopsy revealed sarcoma We performed a left lower lobectomy, as there was no distant metastasis. The histopathological diagnosis was a metastasis of uterine leiomyosarcoma. The disease-free interval for this case was 15 years, which was. to our knowledge, the longest among previous reports of pulmonary metastasis of uterine leiomyosarcoma.     

Mucinous cystadenocarcinoma of pancreas mimicking gastrointestinal stromal tumor of stomach: Case report

IntroductionPancreatic mucinous cysadenocarcinoma is a rare neoplasm of pancreas which rarely presents as upper gastrointestinal bleed.Case reportA 45-year-old woman presented with history of repeated episodes of melena and abdominal pain. Upper gastrointestinal endoscopy revealed a growth in the body of the stomach likely to be a gastrointestinal stromal tumor (GIST). Endoscopic biopsy was inconclusive for GIST or malignancy. Computed tomography scan of the abdomen showed a well-defined multiloculated cystic lesion (11.8 × 11.1 × 6.4 cm) in the body and tail of the pancreas with involvement of the stomach. Preoperative diagnosis was a cystic neoplasm of the pancreas with tumor ingrowth into the stomach. The patient underwent enbloc resection of the stomach with distal pancreatectomy and splenectomy. Histopathological examination revealed low grade mucinous cystadenocarcinoma of the pancreas.DiscussionUpper gastrointestinal bleed as a manifestation of cystic neoplasms of pancreas are rarely reported. Although some cases of hemoperitoneum were reported due to rupture of tumor; luminal gastrointestinal bleed is even rarer. It may be due to involvement of porto-mesenteric axis with portal hypertension, direct invasion of the gastric wall with ulceration of the gastric mucosa, communication between the tumor and the main pancreatic duct, and from the infiltrating tumor.ConclusionOur case highlights the fact that mucinous cystadenocarcinoma of pancreas rarely can present with upper gastrointestinal hemorrhage, Moreover, if it is large enough to compress or invade the stomach, endoscopy may misdiagnose it as GIST.     

A gastrointestinal stromal tumor discovered in a resected hemorrhoidal donut after stapled hemorrhoidopexy: report of a case

We report a case of a 47-year-old woman found to have a rectal gastrointestinal stromal tumor discovered on routine pathological examination of the resected hemorrhoidal donut after a stapled hemorrhoidopexy. There was no evidence of metastatic spread. No further therapy will be instituted.     

Robot-assisted thoracoscopic esophagectomy for gastrointestinal stromal tumor of the esophagus: A case report

IntroductionA gastrointestinal stromal tumor (GIST) often arises in the stomach and small intestine, while esophageal GIST is rare. The first-choice treatment is surgical resection, but there is no standard technique. Herein, we describe our experience in the treatment of esophageal GIST and discuss the usefulness of robotic esophagectomy.Presentation of caseThe patient was a 60-year-old woman, who was diagnosed with a 30 mm GIST in the middle thoracic esophagus. We underwent robot-assisted thoracoscopic esophagectomy in the prone position. The duration of the thoracoscopic part was 69 min and the total operation time was 319 min. Total blood loss was 135 ml. The patient's postoperative course was uneventful after surgery and the patient was discharged home in good condition on the 18th postoperative day.DiscussionThe prognosis of esophageal GIST was less favorable compared with gastric GIST, and due to the anatomical peculiarities of the esophagus, which surgical procedure should be performed is still under debate. Robotic surgery has several technological advantages as it provides a three-dimensional view, ten times magnification, tremor control, and ambidexterity. Therefore, Robotic-assisted minimally invasive esophagectomy (RAMIE) allows achieving for safe R0 resection of esophageal GIST.ConclusionRAMIE may be useful for esophageal GIST because it facilitates safe and minimally invasive surgery in a limited space of the thoracic cavity.     

Complete extragastric growth in a giant gastrointestinal stromal tumor: report of a case

Gastrointestinal stromal tumors (GISTs) are characterized by remarkable variability in their differentiation potential, but most of these lesions do not display convincing smooth muscle or neuronal differentiation. Here we report the case of a 65-year-old woman who underwent a perfect resection of a large submucosal tumor that displayed extragastric growth. The specimen was revealed to be an elastic soft tumor, 18 x 25 x 11 cm in size. Histologically, the tumor consisted of spindle-shaped cells, with a mitotic rate of 12 per 10 high-power fields. Immunohistochemically, the tumor showed positive staining for CD34 and c-kit but negative staining for alpha-smooth muscle actin, Desmin, and s-100 protein. From these findings, the tumor was diagnosed as an uncommitted type of GIST with high-grade malignancy. This case needs careful and long-term follow-up to monitor for signs of local recurrence or distant metastasis.     

巨大十二指肠间质瘤并穿孔1例

十二指肠间质瘤是胃肠道间质瘤(gastrointestinal stromal tumor,GIST)中罕见部位的肿瘤,因其发生于十二指肠,毗邻肝脏、胰腺等重要器官,故在诊断和治疗上有特殊性.我院2006年收治1例,报告如下.