TUMOR DO ESTROMA GASTROINTESTINAL (GIST) GIGANTE ASSINTOMÁTICO: REVISÃO DE TEMA A PROPÓSITO DE UM CASO CLÍNICO

Sofia Valente; Carlos Miranda; João Coutinho

doi:10.34635/rpc.686

Sofia Valente Interna de Cirurgia Geral; Departamento de Cirurgia; Centro Hospitalar Lisboa Norte, EPE – Hospital de Santa Maria, Portugal http://orcid.org/0000-0002-7917-565X
Carlos Miranda Assistente Graduado de Cirurgia Geral – Unidade de Cirurgia Hepato-bilio-pancreática; Departamento de Cirurgia; Centro Hospitalar Lisboa Norte, EPE – Hospital de Santa Maria, Portugal http://orcid.org/0000-0001-9627-8573
João Coutinho Assistente Graduado Sénior de Cirurgia Geral – Diretor do Departamento de Cirurgia do Hospital de Santa Maria; Centro Hospitalar Lisboa Norte, EPE, Portugal http://orcid.org/0000-0002-4888-3944

Resumo

Os GIST são tumores mesenquimatosos raros que podem apresentar-se como lesões milimétricas ou massas volumosas. Habitualmente são clinicamente silenciosos até atingirem um tamanho significativo, pelo que a sua identificação é muitas vezes incidental. Apresentamos o caso de uma doente de 92 anos admitida no Serviço de Urgência por dor no hipocôndrio direito (HD), náuseas e vómitos, com horas de evolução. O exame objetivo revelou dor à palpação no HD e uma massa palpável no quadrante superior esquerdo, indolor, de 10 x 10 cm. As análises e ecografia abdominal confirmaram a hipótese diagnóstica de coledocolitíase e revelaram uma massa sólida, heterogénea, com áreas quísticas, de 14 x 8 x 9 cm, com planos de clivagem. Realizada colangiopancreatografia retrógrada endoscópica (CPRE) com esfinterotomia transendoscópica (ETE) e coledocolitotomia, sem intercorrências. A doente foi operada no decurso do internamento, tendo realizado, por laparotomia mediana supraumbilical, resseção de tumor gástrico, com gastrectomia em cunha e colecistectomia. A análise histológica e imuno-histoquímica da lesão mostrou um GIST de alto risco de malignidade. Pela idade avançada da doente e pelas comorbilidades existentes, optou-se por não realizar terapêutica adjuvante com imatinib, como normalmente indicado. A revisão da literatura mostrou que os GIST gigantes do estômago são raros, sendo habitualmente sintomáticos, contrariamente à nossa doente. A ressecção cirúrgica completa é o tratamento de escolha nos GIST localmente ressecáveis, estando a terapêutica adjuvante indicada nos tumores de alto risco.

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