Epithelioid gastrointestinal stromal tumor of the stomach mimicking extragastrointestinal origin
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Abstract:
We report a case of gastrointestinal stromal tumor (GIST) of the stomach mimicking extragastrointestinal origin. The tumor presented as a large isolated mass in the transverse mesocolon with a minor adhesion to the stomach. Microscopic examination revealed c‐kit gene protein product (KIT)‐positive tumor cells with epithelioid features. The tumor pseudocapsule close to the adhesion site included a small smooth muscle tissue component, indicating a gastric origin. Furthermore, tumor cells at the adhesion site showed prominent hyalinization and calcification. The tumor was diagnosed as a gastric GIST showing extensive extramural growth. Thus, GIST of the stomach and other parts of the gastrointestinal tract can present as tumors localized in the soft tissues of the abdomen mimicking extragastrointestinal origin.Keywords:
Stromal tumor
Hyaline
症例は66歳の男性. 胃内視鏡検査とCTで, 胃体上部後壁に最大径4 cmの壁外発育型胃粘膜下腫瘍を認めた. EUS-FNA (endoscopic ultrasonography fine needle aspiration) で胃GIST (gastrointestinal stromal tumor) と診断され, 腫瘍径から手術適応と判断された. 臍に4 cmの皮膚切開を置き, ラッププロテクターと手袋を用いて単孔式腹腔鏡下手術とした. 腫瘍は体上部後壁から壁外に発育する円形の腫瘍で, 偽被膜に覆われており周囲への癒着は認めなかった. 自動縫合器を用いて胃壁を切除して腫瘍を摘出した. 術後合併症は認めず4日目に退院した. 病理結果は胃原発GISTで低リスク群であり, 切除断端は陰性であった.一般的に単孔式腹腔鏡手術は通常の腹腔鏡手術より手技が煩雑になるが, 通常とほとんど同様に手術が施行できた. 腫瘍摘出のために元々必要である小開腹創以外に傷跡が残らないため, 単孔式腹腔鏡下手術はGISTに対する整容性と患者の満足度の高い治療法の1つと考えられた.
Stromal tumor
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Gastrointestinal stromal tumor [GIST] is commonest mesenchymal tumor, mainly affects adults. But, 1.5% to 2% GISTs were reported in pediatrics and adolescents. The treatment of GIST is managed as in adult because of lack of information about pediatric GIST.
Stromal tumor
Mesenchymal Tumor
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Stromal tumor
Imatinib Mesylate
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The gastrointestnal stromal tumor (GIST) is a gastrointestnal tract tumor, previously known as the group of smooth muscle tumors. By using medical technology improvement, GIST is shown as nonepitelial tumor that can arise along gastrointestnal tract. A patent with gastric disorder had been hospitalized multple tmes is reported. Defnitve diagnosis was delayed due to inappropriate applicaton of imaging diagnostic modalites, and the best treatment for the patent could not be done earlier.
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Introduction: Gastrointestinal stromal tumours (GISTs) are mesenchímal tumours of the digestive tract. These tumours represent 0.1–3% of all gastrointestinal neoplasms. These tumors can arise anywhere in the gastrointestinal tract, but most often in the stomach (70%). They are diagnosed sometimes as accidentally findings, but in the other cases they occour as urgent problems in the gastroenterology such as abdominal pain and bleeding. 10–30% of the newly diagnosed GIST are malignant. The imaging methods can predict the answer for these questions and help the managment of the following strategies in this type of the gastrointestinal tumours.
Gastrointestinal bleeding
Gastrointestinal pathology
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症例は51歳の男性. タール便を主訴に来院し, 精査の結果, 十二指腸水平脚に潰瘍を伴う隆起性病変を認め, 当科に紹介となった. 術前の上部消化管内視鏡検査の生検結果から, 十二指腸原発のgastrointestinal stromal tumor (GIST) と診断され, 十二指腸部分切除術を施行した. 摘出標本は38×37×30mmの境界明瞭な粘膜下腫瘍で, 中心部が粘膜面に露出し潰瘍を形成していた. 組織学的には, 紡錘形の腫瘍細胞が束状に増殖し, 核分裂像を2～4個/10HPF認めた. 免疫組織学的にはvimentin, CD34のみが陽性を示し, desmin, α-smooth muscle actin, HHF-35, S-100蛋白は陰性で, gastrointestinal stromal tumor, uncommitted type, malignantと診断した. 十二指腸原発のGISTはまれであるが, ほかの部位の消化管原発のGISTと比較して悪性度は高いといわれ, 厳重な経過観察が必要と考えられた.
Stromal tumor
Desmin
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Objective:To explore the clinical character of gastrointestinal stromal tumor(GIST)examined by prostate needlebiopsy.Methods:A case of GIST on prostate needle biopsy was reported and some questions about this disease was discussed with reviewing related literatures.Results:The biopsy specimen was proved to be GIST through immuno-enzymohistochemistry,the tumor was too huge to be resected.Imatinib was used to treat with this tumor and in 12 months the patient was still alive.Conclusion:GIST proved by prostate needle biopsy may be in prostate or rectum,which can only be determined through resection sample.GIST should be differentiated from other stromal tumor of prostate,immuno-enzymohistochemistry is very useful.Complete resection of the tumor and imatinib are effective in treating GIST.
Stromal tumor
Prostate biopsy
Needle biopsy
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Imatinib is a standard treatment for unresectable gastrointestinal stromal tumor (GIST). We described the case of a 66- year-old woman with bulky GIST of which a diameter was 25 cm. Therefore, we decided the tumor was unresectable. After 2-year administration of imatinib, the diameter of tumor was reduced to 6 cm. After 3-year administration of imatinib, the diameter of tumor was increased to 8 cm. The patient did not have any distant metastasis. He underwent a resection of the tumor. The historical examination showed that c-kit and CD34 were positive. The number of mitosis was 12/50 HPF. Conversion chemotherapy for bulky GIST may contribute to a curative resection.
Stromal tumor
Imatinib Mesylate
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Mesenchymal tumors originating from the wall of the gastrointestinal tract have contributed to fascinating literature worldwide regarding their controversial histogenesis.Most common mesenchymal tumor arising in the gastrointestinal tract is gastrointestinal stromal tumor (GIST). [1,2]Apart from gastrointestinal tract, GISTs that involve omentum, mesentery and retroperitoneum are commonly known as extra gastrointestinal stromal tumors (EGISTs) Though there are many studies regarding various aspects of GISTs, yet primary EGISTs literature are limited.EGISTs are often included in large studies of stromal tumors, in which they account for less than 10% of overall cases.In most cases a preoperative diagnosis is not possible, and the patient undergoes a surgical operation for the generic diagnosis of "abdominal mass".Here were report two rare presentations in the form of non exophytic intraluminal GIST and huge EGIST.
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Objective To analyze the CT manifestation features of gastrointestinal stromal tumor(GIST) and explore the CT diagnosis value for the tumor.Methods 25 cases with GIST confirmed by surgical pathology were retrospectively analyzed.The patients were done preoperative CT scan and/or enhanced checks.Results There were 16 cases that the tumor exited in the stomach,4 cases exited in jejunum,1 case exited in esophagus,3 cases exited in ileum,1 case exited in rectum,and the lesion showed rounded or quasi-circular.There were 18 cases with uniform density by the scan and 7 cases with uneven density by the scan.There were 4 cases with uniform strengthening by the enhanced checks and 17 cases with uneven strengthening by the enhanced checks.In 25 patients with GIST,11 cases were benign,and had the tumor diameter less than 5 cm,the clear border,and were uniform strengthening;15 cases were malignant,and had the tumor diameter more than 5 cm,the unclear border,and were uneven strengthening,of all 2 cases happened metastases.Conclusion CT examination for GIST has accuracy position and the value for the determinations on benign and malignant tumor.
Stromal tumor
Jejunum
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