A Ruptured Gastrointestinal Stromal Tumour of the Transverse Mesocolon: a Case Report

Abstract

We discuss the long history of a patient still alive with a primary gastrointestinal stromal tumour (GIST) of the transverse mesocolon: initially it presented as an acute complication, namely a haemorrhagic shock caused by rupture of the tumour and it recurred twice locally in the years following primary resection. Each time, a macroscopically complete resection could be achieved. Six years after the resection of the primary tumour, a liver metastasis was discovered, which was removed by radio frequency ablation (RFA). Eight months later, the patient developed a new liver metastasis and a retropancreatic mass deemed unresectable. He is treated with imatinib mesylate (Glyvec, Novartis, Vilvoorde, Belgium) since and has had a stable disease for 6 months. Gastrointestinal stromal tumours outside the gastrointestinal tract are rare. Until a few years ago the only possible therapy was surgical resection. Nowadays radio frequency ablation can be a solution for irresectable liver metastases, and imatinib mesylate can bring improvement for advanced and metastasized tumours. Whether this could also be useful as an adjuvant therapy has not yet been investigated, but it could be important knowing that 38% of the tumours recur locally and 15% metastasize. The most important prognostic factors for gastrointestinal stromal tumours are grading and complete resection.

Primary extragastrointestinal stromal tumor of the transverse mesocolon without c-kit mutations but with PDGFRA mutations

“…eGISTs of the mesocolon have been reported in the literature only twice by Jakobs et al [12] and Paparelli et al [13]. However, they did not perform a genetic analysis.…”

“…Miettinen et al [11] reported 13 cases of eGISTs in the omentum and 10 cases of eGISTs in the mesentery. However, eGIST of the mesocolon has been rarely reported [12,13]. The author herein reports a case of eGIST of the transverse mesocolon with a point mutation of the PDG-FRA gene but without mutations of the c-kit gene.…”

Spontaneous rupture of a sigmoid colon gastrointestinal stromal tumor manifesting as pneumoretroperitoneum with localized peritonitis: Report of a case

“…Seven GISTs arose from the stomach 10,11,13,15,19,21 and four from the small intestine. [12][13][14]20 One case each originated from the mesocolon, 16 esophagus, 17 and greater omentum. 18 Depending on the location of the GIST, it may rupture into the abdominal cavity, resulting in ascites, hemoperitoneum, peritonitis, or features mimicking appendicitis if it originates in the small bowel.…”

“…Our review of the literature and a Medline search on spontaneously ruptured GISTs identifi ed only 15 cases. [10][11][12][13][14][15][16][17][18][19][20][21] In all cases, the tumor size was >5 cm, 12 of the 15 patients were older than 60 years, and the male-tofemale ratio was 2 : 1. Seven GISTs arose from the stomach 10,11,13,15,19,21 and four from the small intestine.…”

Atypical Presentation of Gastrointestinal Stromal Tumours With Pneumoperitoneum: A Case Report

“…7 To our knowledge, a ruptured GIST with pneumoperitoneum has not been previously reported. We describe surgical correction, and histopathologic findings of a ruptured primary GIST 8 . In our patient, the operation was successful, and he did well after surgery.…”