ASSYMTPOMATIC GIANT GASTROINTESTINAL STROMAL TUMOR (GIST): CLINICAL CASE REPORT
Abstract
GISTs are rare mesenchymal tumors, which may present as millimetric lesions or bulky masses. They are usually clinically silent until they reach a significant size, so their finding is often incidental. We report the case of a 92 – year – old female patient admitted to the Emergency Department due to clinical symptoms of right hypochondrium (RH) pain, nausea and vomiting, developing within a few hours. Clinical examination revealed tenderness in the RH and a palpable painless mass in the epigastric/left upper quadrants, of 10 x 10 cm. Blood tests and ultrasonography confirmed the diagnostic hypothesis of choledocholithiasis and also revealed a solid, heterogeneous mass of 14 x 8 x 9 cm, with cystic areas and cleavage planes. Endoscopic retrograde cholangiopancreatography (ERCP) was performed with endoscopic sphincterotomy (EST) and removal of calculi with no complications. The patient had open surgery so as to approach the gallblader and the mass at the same surgical time. Gastric wedge resection and cholecystectomy were performed. The histological and immunohistochemical analysis of the lesion showed a high-risk GIST. Due to the advanced age of the patient and the existing co-morbidities, it was decided not to perform adjuvant therapy with imatinib, as usually indicated. Review of literature show that giant GISTs of the stomach are rare and usually symptomatic. Complete surgical resection is the standard treatment in locally resectable GISTs, with adjuvant therapy being indicated for high-risk tumors.
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References
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7 M. Miettinen e J. Lasota, “Gastrointestinal Stromal Tumors,” Gastroenterol Clin North Am, vol. 42 (2), pp. 399-415, June 2013.
8 S. Hirota et al, “Gain-of-function of c-kit in human gastrointestinal stromal tumors,” Science, vol. 258, pp. 577-580, 1998.
9 L. Kindblom et al, “Gastrointestinal pacemaker cell tumor (GIPACT). Gastrointestinal stromal tumors show phenotypic caractheristics of the interstitial cells of Cajal,” American Journal of Pathology, vol. 153, pp. 1259-1269, 1998.
10 S. Hirota e k. Isozaki, “Pathology of gastrointestinal stromal tumors.,” Pathology International, vol. 56(1), pp. 1-9, Jan 2006.
11 C. Serrano e S. George, “Recent advances in the treatment of gastrointestinal stromal tumors,” Therapeutic Advances in Medical
Oncology, vol. 6 (3), pp. 115-127, 2014.
12 ESMO/European Sarcoma Network Working Group, “Gastrointestinal stromal tumours: ESMO clinical Practice Guidelines for diagnosis, treatment and follow-up,” Annals of Oncology, vol. 25(3), pp. iii21-iii26, 2014.
13 J. Lopes, M. Soares et al, “Recomendações para Análise Mutacional em Tumores do Estroma Gastrointestinal (GISTs). Grupo de
Trabalho Português GIST– Proposta de Condeixa,” Revista Portuguesa Cirurgia , vol. 23, pp. 61-68, 2012.
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International Scholary Research Network, Mar 2011.
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Cirurgiões, vol. 39(5), pp. 408-413, 2012.
18 Y.-M. Lin et al, “Unusual gastric tumors and tumor-like lesions: Radiological with pathological correlation and literature review,”
World Journal of Gastroenterology, vol. 23(14), pp. 2493-2504, April 2017.
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Risk Factors and Tumor Recurrence,” Journal of the American College of Surgeons, vol. 215, p. 53–59, Jul 2012.
27 J. Nishimura, K. Nakajima et al, “Surgical strategy for gastric gastrointestinal stromal tumors: laparoscopic vs. open resection,”
Surgical Endoscopy, vol. 21(6), p. 875–878, 2007.
28 G. Karakousis et al “Laparoscopic versus open gastric resections for primary gastrointestinal stromal tumors (GISTs): a size-matched comparison,” Annals of Surgical Oncology, vol. 18(6), p. 1599–1605, 2011.
29 M. Ortenzi, R. Ghiselli, L. Cardinali e M. Guerrieri, “Surgical treatment of gastric stromal tumors: laparoscopic versus open
approach,” Ann Ital Chir, vol. 88, 2017.
30 R. DeMatteo, et al e ACOSOG Intergroup Adjuvant GIST Study Team, “Adjuvant imatinib mesylate after resection of localised,
primary gastrointestinal stromal tumour: a randomised, double-blind, placebo-controlled trial,” Lancet, vol. 373(9669), pp. 1097-
1104, 2009.
31 H. Joensuu, M. Eriksson et al, “One vs three years of adjuvant imatinib for operable gastrointestinal stromal tumor: a randomized
trial,” JAMA, vol. 307(12), pp. 1265-1272, 2012.
32 P. Hohenberger, U. Ronellenfitsch et al, “Pattern of recurrence in patients with ruptured primary gastrointestinal stromal tumour,” British Journal of Surgery, vol. 97(12), pp. 1854-1859, 2010.
33 M. McCarter, et al e ACOSOG Intergroup Adjuvant GIST Study Team, “Microscopically positive margins for primary gastrointestinal stromal tumors: analysis of risk factors and tumor recurrence.,” Journal of the American College of Surgeons, vol. 215(1), pp. 53-59, 2012.
34 F. Haller, S. Detken et al, “Surgical management after neoadjuvant imatinib therapy in gastrointestinal stromal tumours (GISTs)
with respect to imatinib resistance caused by secondary KIT mutations,” Annals of Surgical Oncology, vol. 14(2), pp. 526-532, 2007.
35 A. Le Cesne et al, “Discontinuation of imatinib in patients with advanced gastrointestinal stromal tumours after 3 years of treatment: an open-label multicentre randomised phase 3 trial,” Lancet Oncol, vol. 11(10), pp. 942-949, 2010.
36 C. Mussi et al, “Post-imatinib surgery in advanced/metastatic GIST: is it worthwhile in all patients?,” Annals of Oncology, vol. 21(2), pp. 403-8, 2010.
37 C. Raut et al, “Surgical management of advanced gastrointestinal stromal tumors after treatment with targeted systemic therapy
using kinase inhibitors,” Journal of Clinical Oncology, vol. 24(15), pp. 2325-2331, 2006.
38 H. Choi, “Response Evaluation of Gastrointestinal Stromal Tumors,” Oncologist, vol. 13(2), pp. 4-7, 2008.
39 H. Joensuu et al, “Follow-up strategies for patients with gastrointestinal stromal tumour treated with or without adjuvant imatinib after surgery,” European Journal of Cancer, vol. 51, pp. 1611-1617, 2015.
40 Y. Kang YK, M. Ryu et al, “Resumption of imatinib to control metastatic or unresectable gastrointestinal stromal tumours after
failure of imatinib and sunitinib (RIGHT): a randomised, placebo-controlled, phase 3 trial,” Lancet Oncology, vol. 14(12), pp. 1175--1182, 2013.
41 M. Miettinen e J. Lasota, “Gastrointestinal stromal tumors: pathology and prognosis at different sites,” Seminars in Diagnostic
Pathology, vol. 23(2), pp. 70-83, 2006.
42 H. Joensuu, A. Vehtari et al, “Risk of recurrence of gastrointestinal stromal tumour after surgery: an analysis of pooled populationbased cohort,” Lancet Oncology, vol. 13(3), pp. 265-274, 2012.
2 K. Søreide et al, “Global epidemiology of gastrointestinal stromal tumours (GIST): A systematic review of population-based cohort studies.,” Cancer Epidemiol, vol. 40, pp. 39-46, Feb 2016.
3 A. Koyuncer, L. Gönlusen e A. V. Kutsal, “A rare case of giant gastrointestinal stromal tumor of the stomach involving the serosal surface,” Int J Surgery Case Rep, vol. 12, pp. 90-94, May 2015.
4 Y. Wang, J. Peng e H. Jinbai, “Giant and high-risk gastrointestinal stromal tumor in the abdomino-pelvic cavity: A case report,” Oncology Letters, vol. 11, pp. 2035-2038, 2016.
5 L. Zhou et al, “A rare giant gastrointestinal stromal tumor of the stomach traversing the upper abdomen: a case report and literature review,” Worl Journal of Surgical Oncology, vol. 10, p. 66, 2012.
6 A. Cappellani et al, “Giant gastrointestinal stromal tumor (GIST) of the stomach cause of high bowel obstruction: surgical management,” World Journal Of Surgical Oncology, vol. 11, p. 172, 2013.
7 M. Miettinen e J. Lasota, “Gastrointestinal Stromal Tumors,” Gastroenterol Clin North Am, vol. 42 (2), pp. 399-415, June 2013.
8 S. Hirota et al, “Gain-of-function of c-kit in human gastrointestinal stromal tumors,” Science, vol. 258, pp. 577-580, 1998.
9 L. Kindblom et al, “Gastrointestinal pacemaker cell tumor (GIPACT). Gastrointestinal stromal tumors show phenotypic caractheristics of the interstitial cells of Cajal,” American Journal of Pathology, vol. 153, pp. 1259-1269, 1998.
10 S. Hirota e k. Isozaki, “Pathology of gastrointestinal stromal tumors.,” Pathology International, vol. 56(1), pp. 1-9, Jan 2006.
11 C. Serrano e S. George, “Recent advances in the treatment of gastrointestinal stromal tumors,” Therapeutic Advances in Medical
Oncology, vol. 6 (3), pp. 115-127, 2014.
12 ESMO/European Sarcoma Network Working Group, “Gastrointestinal stromal tumours: ESMO clinical Practice Guidelines for diagnosis, treatment and follow-up,” Annals of Oncology, vol. 25(3), pp. iii21-iii26, 2014.
13 J. Lopes, M. Soares et al, “Recomendações para Análise Mutacional em Tumores do Estroma Gastrointestinal (GISTs). Grupo de
Trabalho Português GIST– Proposta de Condeixa,” Revista Portuguesa Cirurgia , vol. 23, pp. 61-68, 2012.
14 J. Lasota e M. Mietten, “Clinical significance of oncogenic KIT and PDGFRA mutations in gastrointestinal stromal tumours.,”
Histopathology, vol. 53(3), pp. 245-266, Sep 2008.
15 S. Patil et al, “Giant Gastrointestinal Stromal Tumor Presenting as a Palpable Abdominal Mass: An Unusual Presentation,”
International Scholary Research Network, Mar 2011.
16 D. M. King, “The radiology of gastrointestinal stromal tumours (GIST),” Cancer Imaging, vol. 5, pp. 150-156, 2005.
17 F. Almeida et al, “Ecoendoscopia nas lesões subepiteliais do trato digestório – artigo de revisão,” Revista do Colégio Brasileiro de
Cirurgiões, vol. 39(5), pp. 408-413, 2012.
18 Y.-M. Lin et al, “Unusual gastric tumors and tumor-like lesions: Radiological with pathological correlation and literature review,”
World Journal of Gastroenterology, vol. 23(14), pp. 2493-2504, April 2017.
19 A. Rader et al, “Fine-needle aspiration biopsy diagnosis of gastrointestinal stromal tumors using morphology, immunocytochemistry, and mutational analysis of c-kit,” Cancer, vol. 93(4), pp. 269-275., 2001.
20 J. DeWitt, R. Emerson et al, “Endoscopic ultrasound-guided trucut biopsy of gastrointestinal mesenchymal tumor,” Surgical
Endoscopic, vol. 25, pp. 192-202, 2011.
21 W. Swalchick, R. Shamekh e M. Bui, ““IS s DOG1 Immunoreactivity Specific to Gastrointestinal Stromal Tumor?”,” Cancer Control,
vol. 22(4), pp. 498-504., Oct; 2015 .
22 L. Lopes et al, ““DOG1 for the diagnosis of gastrointestinal stromal tumor (GIST): Comparison between 2 different antibodies”,”
Appl Immunohistochem Mol Morphol, vol. 18(4):, pp. 333-7., Jul 2010.
23 U. Chaudhry e R. DeMatteo, “Advances in the surgical management of gastrointestinal stromal tumor,” Advances in Surgery,
vol. 45, pp. 197-209, 2011.
24 S.-H. Kong e H.-K. Yang, “Surgical Treatment of Gastric Gastrointestinal Stromal Tumor,” J Gastric Cancer, vol. 13 (1), pp. 3-18, 2013.
25 R. DeMatteo et al, “Two Hundred Gastrointestinal Stromal Tumors: Recurrence Patterns and Prognostic Factors for Survival,”
Annals of Surgery, vol. 231, pp. 51-58, 2000.
26 M. McCarter, C. Antonescu et al l, “Microscopically Positive Margins for Primary Gastrointestinal Stromal Tumors: Analysis of
Risk Factors and Tumor Recurrence,” Journal of the American College of Surgeons, vol. 215, p. 53–59, Jul 2012.
27 J. Nishimura, K. Nakajima et al, “Surgical strategy for gastric gastrointestinal stromal tumors: laparoscopic vs. open resection,”
Surgical Endoscopy, vol. 21(6), p. 875–878, 2007.
28 G. Karakousis et al “Laparoscopic versus open gastric resections for primary gastrointestinal stromal tumors (GISTs): a size-matched comparison,” Annals of Surgical Oncology, vol. 18(6), p. 1599–1605, 2011.
29 M. Ortenzi, R. Ghiselli, L. Cardinali e M. Guerrieri, “Surgical treatment of gastric stromal tumors: laparoscopic versus open
approach,” Ann Ital Chir, vol. 88, 2017.
30 R. DeMatteo, et al e ACOSOG Intergroup Adjuvant GIST Study Team, “Adjuvant imatinib mesylate after resection of localised,
primary gastrointestinal stromal tumour: a randomised, double-blind, placebo-controlled trial,” Lancet, vol. 373(9669), pp. 1097-
1104, 2009.
31 H. Joensuu, M. Eriksson et al, “One vs three years of adjuvant imatinib for operable gastrointestinal stromal tumor: a randomized
trial,” JAMA, vol. 307(12), pp. 1265-1272, 2012.
32 P. Hohenberger, U. Ronellenfitsch et al, “Pattern of recurrence in patients with ruptured primary gastrointestinal stromal tumour,” British Journal of Surgery, vol. 97(12), pp. 1854-1859, 2010.
33 M. McCarter, et al e ACOSOG Intergroup Adjuvant GIST Study Team, “Microscopically positive margins for primary gastrointestinal stromal tumors: analysis of risk factors and tumor recurrence.,” Journal of the American College of Surgeons, vol. 215(1), pp. 53-59, 2012.
34 F. Haller, S. Detken et al, “Surgical management after neoadjuvant imatinib therapy in gastrointestinal stromal tumours (GISTs)
with respect to imatinib resistance caused by secondary KIT mutations,” Annals of Surgical Oncology, vol. 14(2), pp. 526-532, 2007.
35 A. Le Cesne et al, “Discontinuation of imatinib in patients with advanced gastrointestinal stromal tumours after 3 years of treatment: an open-label multicentre randomised phase 3 trial,” Lancet Oncol, vol. 11(10), pp. 942-949, 2010.
36 C. Mussi et al, “Post-imatinib surgery in advanced/metastatic GIST: is it worthwhile in all patients?,” Annals of Oncology, vol. 21(2), pp. 403-8, 2010.
37 C. Raut et al, “Surgical management of advanced gastrointestinal stromal tumors after treatment with targeted systemic therapy
using kinase inhibitors,” Journal of Clinical Oncology, vol. 24(15), pp. 2325-2331, 2006.
38 H. Choi, “Response Evaluation of Gastrointestinal Stromal Tumors,” Oncologist, vol. 13(2), pp. 4-7, 2008.
39 H. Joensuu et al, “Follow-up strategies for patients with gastrointestinal stromal tumour treated with or without adjuvant imatinib after surgery,” European Journal of Cancer, vol. 51, pp. 1611-1617, 2015.
40 Y. Kang YK, M. Ryu et al, “Resumption of imatinib to control metastatic or unresectable gastrointestinal stromal tumours after
failure of imatinib and sunitinib (RIGHT): a randomised, placebo-controlled, phase 3 trial,” Lancet Oncology, vol. 14(12), pp. 1175--1182, 2013.
41 M. Miettinen e J. Lasota, “Gastrointestinal stromal tumors: pathology and prognosis at different sites,” Seminars in Diagnostic
Pathology, vol. 23(2), pp. 70-83, 2006.
42 H. Joensuu, A. Vehtari et al, “Risk of recurrence of gastrointestinal stromal tumour after surgery: an analysis of pooled populationbased cohort,” Lancet Oncology, vol. 13(3), pp. 265-274, 2012.
Published
2021-08-09
How to Cite
VALENTE, Sofia; MIRANDA, Carlos; COUTINHO, João.
ASSYMTPOMATIC GIANT GASTROINTESTINAL STROMAL TUMOR (GIST): CLINICAL CASE REPORT.
Revista Portuguesa de Cirurgia, [S.l.], n. 50, p. 57-68, aug. 2021.
ISSN 2183-1165.
Available at: <https://revista.spcir.com/index.php/spcir/article/view/686>. Date accessed: 26 apr. 2024.
doi: https://doi.org/10.34635/rpc.686.
Section
Clinical Case
