Mide Fundus Kaynaklı ve Pankreas Kuyruk İnvazyonu Olan Dev Gastrointestinal Stromal Tümör Olgu Sunumu

Yıl 2020, Cilt: 12 Sayı: 4, 131 - 138, 24.04.2021

Sezai Kantar

Öz

Gastrointestinal stromal tümörler (GIST) Cajal’ın intersitisyel hücrelerinden köken alırlar. GIST’ler tüm gastrointestinal maligniteler arasında %0,1-3 oranında rastlanır ve en sık mide kaynaklıdır (%50-70). İnsidansı %0,002’dir. Sıklıkla 4. dekat sonrası görülür ve ortalama tanı yaşı 60’tır. Erkeklerde biraz daha sık görülmekle beraber kadın-erkek oranları arasında istatistiksel olarak anlamlı bir fark yoktur. Asemptomatik ve rastlantısal olarak yakalanan tümörlerden; çok hızlı ilerleyen, agresif tümörlere kadar uzanan geniş bir klinik spektrumda yer alabilirler. Bu sunumda mide kaynaklı, pankreasın gövde ve kuyruk kısmına invaze, yaklaşık 18 cm çapında, dev gastrointestinal stromal tümör olgusu tartışılmıştır. Hastaya total gastrektomi, distal pankreatektomi, splenektomi ve çöliak lenf nodu diseksiyonu ameliyatı yapılmıştır. Post-op 10. günde hasta şifa ile taburcu edilmiştir.

Anahtar Kelimeler

Mide, stromal tümör, tedavi

Giant Gastrointestinal Stromal Tumor with Stomach Fundus Origin and Pancreatic Tail Invasion Case Report

Öz

Gastrointestinal stromal tumors originate from the interstitial cells of Cajal. GISTs are found in 0,1%-3% of all gastrointestinal malignancies and are most frequently gastric origin. Its incidence is 2 in 100000. It is frequently seen after the 4th decade and the average age of diagnosis is 60. Although it is a little more common in men, there is no statistically significant difference between female-male ratios. They can be captured asymptomatically and accidentally, but they can be located in a wide clinical spectrum that progresses very rapidly and extends to aggressive tumors.
In this presentation, a case of giant gastrointestinal stromal tumor originating from the stomach, invading the body and tail of the pancreas, with a diameter of 18 cm was discussed. The patient underwent total gastrectomy, distal pancreatectomy, splenectomy, and celiac lymph node dissection surgery. On the post op 10th day, the patient was discharged with healing.

Anahtar Kelimeler

Stomach, tumour, treatmet

Kaynakça

• 1. Mazur MT, Clark HB. Gastric stromal tumors: reappraisal of histogenesis. Am J Surg Pathol. 1983;7:507-519.
• 2. Gold JS, DeMatteo RP. Combined surgical and moleculer therapy: The Gastrointestinal stromal tumor model. Ann Sur 2006;244:176-184.
• 3. Robin BP, Heinrich MC, Corless CL. Gastrointestinal stromal tumour. Lancet. 2007;369:1731-1741.
• 4. Miettinen M, Majidi M, Lasora J. Pathology and diagnostic criteria ofgastrointestinal stromal tumours (GISTs): a review. Eur J Cancer. 2002;38:39-51.
• 5. Sturgeon C, Chejfec G, Espat N. Gastrointestinal stromal tumors: a spectrum of diseases. Surg Oncol. 2003;12:21-26.
• 6. Brunicardi F, Andersen D, Billier T, ve ark. Schwartz’s Principles of Surgery, Onuncu baskı. 2016;26:1084-5.
• 7. Naguib SF, Zaghloul AS, El Marakby H. Gastrointestinal stromal tumors (GIST) of the stomach: retrospective experience with surgical resection at the National Cancer Institute. J Egypt Natl Canc Inst. 2008;20:80-89.
• 8. Fletcher CD. Diagnosis of gastrointestinal stromal tumors: a consensus approach. Hum Pathology. 2002;33:459-65.
• 9. Nowain A, Bhakta H, Pais S. Gastrointestinal stromal tumors: clinical profile, pathogenesis, treatment strategies and prognosis. J Gastroenterol Hepatol. 2005;20:18-24.
• 10. De Matteo RP, Lewis JJ, Leung D, et al. Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival. Ann Sur. 2000;231:51-8.
• 11. Joensuu H, Roberts PJ, Sarlomo-Rikala M. Effect of the tyrosine kinase inhibitör. STI571 in a patient with a metastatic gastrointestinal stromal tumor. N Engl J Med. 2001; 344:1052-6.
• 12. Demetri GD, Benjamin RS, Blanke CD, et al. NCCN Task Force Report: Optimal management of patients with gastrointestinal stromal tumor (GIST)-Update of the NCCN Clinical Practice Guidelines. JNCCN. 2007;5:1-29.
• 13. Langer C, Gunawan B, Schuler P, et al. Prognostic factors influencing surgical management and outcome of gastrointestinal stromal tumours. Br J Surg. 2003;90:332-9.
• 14. Verweij J, Casali PG, Zalcberg J, et al. Progression-free survival in gastrointestinal stromal tumours with high-dose imatinib: randomised trial. Lancet. 2004;364:1127-34.