Laparoscopic surgery for double gastrointestinal stromal tumor of the stomach: a report of two cases
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WORLD JOURNAL OF SURGICAL ONCOLOGY
CASE REPORT
Open Access
Laparoscopic surgery for double gastrointestinal stromal tumor of the stomach: a report of two cases Nicola de’Angelis1*, Riccardo Memeo1, Valeria Zuddas1, Dalila Mehdaoui2, Daniel Azoulay1 and Francesco Brunetti1
Abstract Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors that originate from interstitial cells of Cajal or their stem cell-like precursors. Generally, GISTs have specific c-KIT gene mutations. The incidence of GISTs is estimated to be 10 to 20 cases/one million individuals, and GISTs typically affect people over 50 years of age. The majority of GISTs are solitary. However, multifocal GISTs have been observed, especially in children. We report on two unusual adult cases of double GISTs that were treated by laparoscopic surgery. The first patient presented a polypoid mass of the fundus and a second isolated smaller tumor in the posterior wall of the lesser curvature of the stomach. A histopathological examination confirmed that both tumors were GISTs and were c-KIT-positive. A total laparoscopic gastrectomy was performed. In the second patient, GISTs were identified at the level of the fundus and the greater curvature of the stomach. A laparoscopic partial sleeve gastrectomy was performed. Both surgeries were successful with no complications or relapses at three to five years following surgery. Keywords: Gastrointestinal stromal tumors, Laparoscopic surgery, Gastrectomy
Background Gastrointestinal stromal tumors (GISTs) are mesenchymal neoplasms of the gastrointestinal tract that account for approximately 0.1% to 3% of all gastrointestinal malignancies [1]. GISTs occur more frequently in the stomach (60% to 70%), followed by the small intestine (20% to 30%), the colon and the rectum (5%), and the esophagus (less than 5%) [1,2]. In most cases, GISTs originate from interstitial cells of Cajal, a complex cellular network that regulates gastrointestinal motility, or mesenchymal stem cells of the mesentery or omentum, which transform into the malignant phenotype that expresses the proto-oncogene c-Kit (CD 117) and less frequently the platelet-derived growth factor receptor-α (PDGFRA) [3,4]. Small GISTs (less than 2 cm in diameter) are usually asymptomatic and are detected during investigations performed for other unrelated diseases. Conversely, GISTs * Correspondence: [email protected] 1 Digestive and Liver Transplant Surgery Unit, Henri-Mondor Hospital, Université Paris Est, 51 avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France Full list of author information is available at the end of the article
that are greater than 2 cm are generally associated with clinical signs and symptoms, such as nausea, vomiting, abdominal pain, obstruction, abdominal mass, anemia and melena [2,3]. Diagnosis and staging are usually based on abdominal ultrasonography, computed tomography (CT) scanning, and/or magnetic resonance imaging (MRI). Clinically, GISTs vary from virtually benign diseases to aggressive tumors (20% to 30% of cases) w
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