Small Bowel GIST: Clinical Presentation as Intussusception and Obscure Bleeding

Giestas, Sílvia; Almeida, Nuno; Martins, Ricardo; Canhoto, Ana Isabel; Oliveira, Pedro Paulo Martins de; Figueiredo, Pedro; Sofia, Carlos

doi:10.1016/j.jpge.2015.12.007

Cited by 11 publications

(13 citation statements)

References 5 publications

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“…There was also one case (male, 55 years of age) who presented with acute appendicitis, which is a rare observation, to date, only 9 cases being previously mentioned in the literature ( 15 ). Two other types of acute presentations, rarely mentioned previously in the literature, were 3 cases (5.26%) of spontaneous rupture of GIST with subsequent peritonitis ( 16 ), an ileal intussusception (female, 59 years) ( 17 ) and a case with retroperitoneal invasion ( 18 , 19 ). Other peculiar complications included jaundice and pyloric or cardial stenosis ( Table III ).…”

Section: Resultsmentioning

confidence: 92%

A multidisciplinary approach in the diagnostic challenge of GIST

et al. 2021

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Gastrointestinal stromal tumors (GISTs) are the most common malignant mesenchymal lesions of the gastrointestinal tract. They originate from the interstitial cells of Cajal and are characterized by overexpression of the tyrosine kinase receptor, protein product of c-KIT gene (KIT). In this retrospective study, conducted over a period of 10 years, we retrieved from our database, a total number of 57 patients, admitted and operated in the surgical department of 'Sf. Pantelimon' Emergency Clinical Hospital, Bucharest, for digestive tumors, histopathologically confirmed as GISTs. More than half of the cases presented as surgical emergencies and the tumors found during the surgical procedures, which proved to be GISTs, were sometimes difficult to differentiate from other mesenchymal tumors, both for the clinician and the pathologist. The diagnosis of GIST relies mostly on pathology and immunohistochemistry, but also on clinical and imagistic data. The most common emergencies were digestive hemorrhage (associated with gastric location), followed by intestinal obstruction (especially for the ileal localization). The largest dimensions corresponded to gastric location. For selected indications (upper digestive sites), upper digestive endoscopy approaches 100% sensitivity. This study focuses on diagnosis of GISTs sustained by both clinical and imagistic methods, along with histopathology and immunohistochemistry techniques, according to the World Health Organization 2019 criteria. Even though the differential diagnosis of these tumors is challenging, an interdisciplinary cooperation with a multiple approach increases the odds of a correct positive diagnosis.

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Section: Resultsmentioning

confidence: 92%

A multidisciplinary approach in the diagnostic challenge of GIST

et al. 2021

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“…It causes various symptoms such as a palpable abdominal mass, fullness, nausea, vomiting, and abdominal pain [6]. Although uncommon, small intestinal GISTs may cause gastrointestinal bleeding, which manifests as hematemesis, anemia, and acute abdomen due to intestinal obstruction, perforation of the tumor, or intussusception [17][18][19][20][21]. In addition, small intestinal volvulus caused by GIST manifests as acute abdomen.…”

Section: Discussionmentioning

confidence: 99%

Gastrointestinal Stromal Tumor of the Small Bowel Complicated by Torsion: A Case Report

Yoshizawa¹,

Shimizu²,

Ikehara³

et al. 2021

Preprint

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Background: Gastrointestinal stromal tumor (GIST) is a mesenchymal tumor originating in the wall of the gastrointestinal tract, and 20-30% of these tumors originate from the small intestine. The clinical manifestations of GIST of the small intestine generally include a palpable mass, distention, and abdominal pain and sometimes include acute abdomen due to ileus, bleeding, perforation, and intussusception at onset. Here, we describe a rare case of a pedunculated GIST of the small intestine complicated by torsion.Case presentation: A 69-year-old woman was referred for lower abdominal pain. Abdominal contrast-enhanced computed tomography showed a 73×62×57-mm tumor in the pelvic cavity with an enhanced margin and reduced contrast effect inside of it. T2-weighted magnetic resonance imaging showed a hyperintense, demarcated, lobulated tumor. The diffusion-weighted image showed hyperintensity, and the apparent diffusion coefficient value revealed diffusion restriction, indicating malignancy. T1-weighted images showed a low intensity tumor; contrast-enhanced images showed hypointensity inside of the tumor and slight hyperintensity around its edges. It was presumed that the tumor had caused hemorrhagic infarction. Emergency laparotomy was performed, and the pedunculated tumor was found to be twisted 360 degrees clockwise at the pedicle with hemorrhage and necrosis due to torsion. We performed partial resection of the small intestine including the tumor. Histopathology revealed tightly arranged spindle-shaped cells with hemorrhage, congestion, and inflammatory cell infiltration. Immunohistochemical staining showed positivity for CD34, CD117, and DOG1.Conclusions: The present report describes a very rare case in which pedicle torsion of an extra luminal expanding GIST of small intestine, although there were some reports of small intestine volvulus caused by GIST of small intestine as a rare condition. The torsion of pedunculated GIST of small intestine should be recognized as an emergency condition of GIST, and we report that characteristic findings of this condition were acquired with CT and MRI which was possibility useful for the diagnosis.

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“…19 While ileo-ileal intussusception due to GIST was recorded by Fersahoglu et al, whereas Giestas et al, recorded jejuno-jejunal intussusception. 20,21 Jameel et al and Zhou et al, recorded Gastro-duodenal Intussusception caused by gastric GISTs. 22,23 In this study; the small bowel was the most common site of GISTs (20 patients followed by the stomach (13 patients).…”

Section: Discussionmentioning

confidence: 99%

Outcome and prognostic factors of primary gastrointestinal stromal tumours following complete surgical resection

et al. 2019

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Background: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms. Surgical excision is the definitive treatment for primary localized GISTs. Targeted therapy represented by tyrosine kinase inhibitors has clearly improved the survival rates in patients with GISTs. The aim of this study was to identify prognostic factors influencing tumor recurrence and survival after curative resection of primary GISTs.Methods: This study was conducted on thirty seven patients with localized primary GIST who were operated on in the Department of General Surgery. Then completed adjuvant therapy in the medical Oncology Department, Faculty of Medicine; Tanta University Hospital, from March 2016 to August 2017. All patients’ data, clinical presentations, radiological and endoscopic data, surgical procedures, complications, and survival data were collected, reviewed and analyzed.Results: The mean age of the studied cases was 53.62 years. 14 patients were males and 23 patients were females. Eleven patients had performance status 2. Abdominal pain was the most common complaint. 4 patients presented with acute intestinal obstruction. Ileum was the most common site (14 cases) followed by stomach (13 cases). We reported four cases of extra-gastrointestinal stromal tumors (EGISTs). According to the mitotic index in studied cases; sixteen patients had mitotic count ˃5/50 HPF. Surgical excision was done in all cases with histopathologically negative resection margins. Thirty three cases showed good complete response without local recurrence or distant metastasis.Conclusions:Performance status of patients, tumor size and mitotic index were independent prognostic predictors for tumor recurrence or metastasis.

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Small Bowel GIST: Clinical Presentation as Intussusception and Obscure Bleeding

Cited by 11 publications

References 5 publications

A multidisciplinary approach in the diagnostic challenge of GIST

A multidisciplinary approach in the diagnostic challenge of GIST

Gastrointestinal Stromal Tumor of the Small Bowel Complicated by Torsion: A Case Report

Outcome and prognostic factors of primary gastrointestinal stromal tumours following complete surgical resection

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