Incidentally detected gastrointestinal stromal tumor: A case report

Yıl 2017, , 81 - 83, 01.12.2017

Tolga Canbak Aylin Acar , Ethem Unal

https://doi.org/10.25000/acem.300715

Öz

Gastrointestinal stromal tumors (GIST) are mesenchymal tumors located primarily in the gastrointestinal tract. We aimed to present a case report of GIST incidentally detected during laparoscopic cholecystectomy.

A 60-year-old woman was admitted to the emergency room due to abdominal pain for one day. The physical examination revealed sensitivity on the right upper quadrant. In the laboratory examinations, white blood cell count 6,490 k/uL, hemoglobin 12 g/dL, hematocrit 35% and other biochemical tests were normal. Abdominal ultrasound revealed hydropic gallbladder, several gallstones with a maximum diameter of 15 mm and pericholecystic fluid collection was present. Laparoscopic cholecystectomy was planned due to acute cholecystitis. In exploration, beside the presence of acute cholecystitis, a mass of approximately 5 cm, located 15 cm distal to the ligament of Treitz was detected. Laparoscopic cholecystectomy was performed. Conversion to open laparotomy was done; small intestine resection with end-to-end anastomosis was performed. Gastrointestinal stromal tumor with CD117, CD34 and S100 positivity was detected on histopathologic examination.

It is thought that GISTs are mesenchymal tumors originating from precursors of Kajal cells. GISTs are usually detected in their 60s. The first option for treatment is surgical resection.

Anahtar Kelimeler

Gastrointestinal stromal tumor, Jejunum, Surgery

Rastlantısal olarak saptanan gastrointestinal stromal tümör: Olgu sunumu

Öz

Gastrointestinal stromal tümörler (GİST), primer olarak gastrointestinal sistemde yerleşen mezenkimal tümörlerdir. Laparoskopik kolesistektomi esnasında rastlantısal olarak saptanan bir GİST olgusunun sunumu amaçlandı.

Altmış yaşında kadın hasta bir gün önce başlayan karın ağrısı nedeniyle acil servise başvurdu. Fizik muayenede sağ üst kadranda hassasiyeti mevcuttu. Laboratuar incelemelerinde, WBC: 6.490 K/uL, hemoglobin 12 gr/dL, hematokrit %35, diğer biyokimyasal tetkikleri normaldi. Karın ultrasonografisinde safra kesesi hidropik, intraluminal en büyüğü 15 mm birkaç kalkül ve perikolesistik sıvı mevcuttu. Akut kolesistit nedeniyle laparoskopik kolesistektomi planlandı. Eksplorasyonda akut kolesistite ek olarak Treitz Ligamenti’nden 15 cm distalde yaklaşık 5 cm’lik bir kitle tespit edildi. Laparoskopik kolesistektomi yapıldı. Konversiyon laparotomiye geçilerek segmenter ince barsak rezeksiyonu ve uç uca anastomoz yapıldı. Spesmenin histopatolojik incelemesinde CD117, CD34 ve S100 pozitifliği olan gastrointestinal stromal tümör saptandı.

GİST’lerin Kajal hücrelerinin öncüllerinden kaynaklanan mezenkimal tümörler olduğu düşünülmektedir. GİST’ler genellikle 60’lı yaşlarda tespit edilirler. Tedavide ilk seçenek cerrahi rezeksiyondur.

Anahtar Kelimeler

insidental, gastrointestinal stromal tümör, CD 117

Kaynakça

• 1. Connolly EM, Gaffney E, Reynolds JV. Gastrointestinal stromal tumors. British Journal of Surgery 2003; 90: 1178-86.
• 2. Duffaud F, Blay JY. Gastrointestinal stromal tumors: biology and treatment. Oncology 2003; 65: 187-97.
• 3. Gold JS, Dematteo RP. Combined surgical and molecular therapy: the gastrointestinal stromal tumor model. Ann Surg 2006;244:176-84.
• 4. Bolukbasi H, Nazli O, Tansug T, et al. Gastrointestinal stromal tumors (GISTs): analysis of 20 cases. Hepatogastroenterology 2006;53:385-8.
• 5. Kindblom LG, Remotti HE, Aldenborg F, Meis-Kindblom JM. Gastrointestinal pacemaker cell tumour (GIPACT): gastrointestinal stromal tumours show phenotypic characteristics of the interstitial cells of Cajal. Am J Pathol 1998;152:1259-69.
• 6. Duffaud F, Blay JY. Gastrointestinal stromal tumors: biology and treatment. Oncology 2003; 65: 187-97.
• 7. 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(Suppl 2):1-29.
• 8. Crosby JA, Catton CN, Davis A, et al. Malignant gastrointestinal stromal tumours of the small intestine: a review of 50 cases from a prospective database. Ann Surg Oncol 2001;8:50-
• 9. Catena F, Di Battista M, Fusaroli P, et al. Laparoscopic treatment of gastric GIST: report of 21 cases and literature's review. J Gastrointest Surg 2008;12:561-8.