Perforated gastrointestinal stromal tumor in the small intestine: A rare case of Torricelli-Bernoulli sign

Tajima, Takayuki; Nishi, Takayuki; Tomioku, Mifuji; Ogimi, Takashi; Chan, Lin Fung; Okazaki, Takashi; Myoujin, Kazunori; Sasaki, Hideo

doi:10.3892/mco.2018.1699

Cited by 5 publications

(3 citation statements)

References 28 publications

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“…A typical bull's-eye appearance is seen because of the central area of necrosis seen in larger GISTs. Deep ulceration or central necrosis with an elevated air-fluid level gives rise to the typical Torricelli-Bernoulli sign on CT or MRI [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

Radiological Evaluation of a Malignant Gastrointestinal Stromal Tumor in a Female Patient With Co-incidental Detection of Primary Breast Cancer: A Case Report

Ghanta¹,

Dhande²,

Mishra³

et al. 2023

Cureus

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Gastrointestinal stromal tumors (GIST) are a rare and unique group of mesenchymal tumors arising from the gastrointestinal tract, omentum, mesentery, and retroperitoneum. Though they have certain typical radiological features that can differentiate them from epithelial tumors, it is often difficult to differentiate them from other non-epithelial tumors. Their features also vary depending on their size, site of origin, etc. When differentiation from other mesenchymal tumors on histopathology is difficult, receptor tyrosine kinase (C-KIT proto-oncogene/CD117) and gastrointestinal stromal tumor (GIST-1) discovered on GIST1 (DOG-1) expression are confirmatory. The concurrent presence of other primary cancers with GISTs has been described in the literature, among which most have been of gastrointestinal origin. Few cases of primary breast cancer in GIST have been described. Lymph nodal metastasis is rarely encountered in GIST, and metastasis to the breast is even rarer. We present a case of a 39-year-old female with non-specific symptoms who was referred for ultrasonography (USG) and computed tomography (CT) that showed a small intestinal GIST along with a breast lump and axillary lymphadenopathy that were labeled as metastases from the GIST on frozen sections; however, they were later diagnosed as primary breast cancer with axillary metastases on the histopathology and immunohistochemistry of the excision biopsy specimens postsurgery. The patient underwent surgical resection and chemotherapy.

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Section: Discussionmentioning

confidence: 99%

Radiological Evaluation of a Malignant Gastrointestinal Stromal Tumor in a Female Patient With Co-incidental Detection of Primary Breast Cancer: A Case Report

Ghanta¹,

Dhande²,

Mishra³

et al. 2023

Cureus

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“…It is worth noting that in our study, the pressure of a necrotic cavity may be equal to that of the intestinal tract in some GIST cases, making the liquid unable to flow out or flow into the necrotic cavity of GIST ( S4 Fig ). This condition was first described and interpreted by Fortman [ 6 ] and termed as the “Torricelli-Bernoulli sign (T-B sign).” Since 1999, the T-B sign has been reported in patients with GISTs [ 5 , 11 – 13 ]. Regarding the occurrence of air-fluid levels or bubbles in GISTs (Figs 2 , 3 and S5 – S7 ), there is a divergence of findings in previous studies.…”

Section: Discussionmentioning

confidence: 99%

“…Regarding the occurrence of air-fluid levels or bubbles in GISTs (Figs 2 , 3 and S5 – S7 ), there is a divergence of findings in previous studies. Some clinicians consider the T-B sign a manifestation [ 13 – 18 ], while others consider it a common risk factor adversely affecting prognosis in association with recurrence of GIST [ 7 , 19 – 26 ]. Moreover, rupture, perforation, or fistula formation in GISTs have not been well defined, and their definitions remain vague and controversial [ 27 – 29 ].…”

Section: Discussionmentioning

confidence: 99%

Clinicopathological characteristics and prognosis of gastrointestinal stromal tumors containing air-fluid levels

Liu¹,

Gao

Peng

et al. 2021

PLoS ONE

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An air-fluid level within a gastrointestinal stromal tumor (GIST) is unusual and indicates the presence of a fistula within the lumen of the GI tract. Until recently, the optimal management of such patients was not clear-cut. This retrospective study investigated the clinicopathological characteristics, surgical procedures, pre-and post-operative management, and prognosis of patients with GIST containing an air-fluid level. Data of GIST patients, spanning 5 years, including 17 GIST patients with air-fluid levels in the experimental group and 34 GIST patients without air-fluid levels in the control group, were retrieved from two hospitals in China. The clinicopathological characteristics, types of surgery, management, and clinical outcomes of GIST patients were compared between the two groups. GISTs containing air-fluid levels were significantly different from GISTs without air-fluid levels regarding tumor morphology, NIH risk category, invasion of adjacent organs, and necrosis or ulceration. Most GIST patients with air-fluid levels (14/17, 82.4%) received open surgery, significantly higher than the 20.6% in the control group. Targeted therapy with Imatinib mesylate (IM) was implemented in all GIST patients in the experimental group (17/17, 100%); markedly higher than those (3/34, 8.8%) in the control group. During follow-up, recurrence and death rates (5.9% and 5.9%) in the experimental group were higher than those (2.9% and 0%) in the control group. Open surgery is commonly performed in GIST patients with air-fluid levels who also require targeted therapy with IM. The Torricelli-Bernoulli sign could be a risk factor, adversely affecting the patient’s prognosis.

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Ruptured gastro-intestinal stromal tumor as a surgical emergency: A case report and literature review

Abdelgawad

Kamel

Issa

et al. 2022

Journal of Surgical Case Reports

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Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. GISTs of the small bowel are rare, and often present with an abdominal mass and/or bleeding. Chemotherapy and surgery are the mainstay of therapy. Here, we discuss an unusual case of a ruptured jejunal GIST with hemoperitoneum and recurrence despite surgical excision followed by Imatinib treatment. Forty-five cases of ruptured small intestinal GISTs were identified in the literature. Most cases were in males and were found to be at the site of the jejunum.

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Perforated gastrointestinal stromal tumor in the small intestine: A rare case of Torricelli-Bernoulli sign

Cited by 5 publications

References 28 publications

Radiological Evaluation of a Malignant Gastrointestinal Stromal Tumor in a Female Patient With Co-incidental Detection of Primary Breast Cancer: A Case Report

Radiological Evaluation of a Malignant Gastrointestinal Stromal Tumor in a Female Patient With Co-incidental Detection of Primary Breast Cancer: A Case Report

Clinicopathological characteristics and prognosis of gastrointestinal stromal tumors containing air-fluid levels

Ruptured gastro-intestinal stromal tumor as a surgical emergency: A case report and literature review

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