Kolonik obstruksiyona neden olan dev mide stromal tümörü

Öz

Gastrointestinalstromal tümörler, sindirim sisteminin en sık karşılaşılan mezenkimal tümörleri olmakla birlikte tüm gastrointestinal sistem tümörlerinin %1'den azını oluşturmaktadır. Genellikle 4. dekad sonrası görülmekle birlikte ortalama tanı yaşı 60'tır. En sık yerleştiği bölge mide olup genellikle karın ağrısı, kanama, karında ele gelen kitle gibi semptomlara neden olarak erken dönemde tanı alabilmektedir. Bununla birlikte, nadiren de olsa asemptomatik seyredip dev boyutlara ula-şabilmektedir. Bunun sonucunda, intestinal obstrüksiyon, perforasyon gibi morbiditesi yüksek gastrointestinal sistem komplikasyonlarına yol açabilmektedir. Kitlenin temiz cerrahi sınır ile birlikte en blok rezeksiyonu esas tedavi yöntemidir. Histopatolojik incelemeye göre adjuvan tedavi en kısa sürede planlanmalıdır. Bu çalışmada, dev mide stromal tümörüne bağlı ileus tablosu gelişen bir hastamızın cerrahi tedavi ve takip sonuçlarını literatür eşliğinde tartışarak sunmak amaçlanmıştır.

Anahtar Kelimeler

• Dev, gastrointestinal stromal tümör, obstrüksiyon, cerrahi

Colonic obstruction related to a giant gastric stromal tumor

Öz

Gastrointestinal stromal tumor is the most common mesenchymal tumor of the alimentary tract, whereas it represents less than 1% of all gastrointestinal system tumors. The diagnosis is generally made after the 4th decade, at a mean age of 60 years. The stomach is the most common site of gastrointestinal stromal tumor, and the tumor usually causes symptoms such as abdominal pain, bleeding, and a palpable mass; hence, an early diagnosis can be made. However, it rarely remains asymptomatic and reaches giant sizes that lead to gastrointestinal system complications with high morbidity, including intestinal obstruction and perforation. The essential treatment method is en bloc resection of the mass with free surgical margin. Adjuvant therapy should be planned as soon as possible according to the histopathological examination. In this study, we aimed to present the clinical and postoperative outcomes of a patient with ileus related to a giant gastric stromal tumor.

Anahtar Kelimeler

• Giant, gastrointestinal stromal tumor, obstruction, surgery

Kaynakça

1. Mazur MT, Clark HB. Gastric stromal tumors: Reappraisal of histo- genesis. Am J Surg Pathol 1983;7:507-19.
2. Kindblom LG, Remotti HE, Aldenborg F, Meis-Kindblom JM. Gastro- intestinal pacemaker cell tumor (GIPACT): gastrointestinal stromal tumors show phenotypic characteristics of the interstitial cells of Cajal. Am J Pathol 1998;152:1259-69.
3. Fletcher CDM, Berman JJ, Corless C, et al. Diagnosis of gastrointes- tinal stromal tumors: a consensus approach. Hum Pathol 2002; 33: 459-65.
4. Naguib SF, Zaghloul AS, El Marakby H. Gastrointestinal stromal tu- mors (GIST) of the stomach: retrospective experience with surgical resection at the National Cancer Institute. J Egypt Natl Canc Inst 2008;20:80-9.
5. Bulus H, Morkavuk B, Koyuncu A, et al. Stomach located giant GIST which obstructed the intestinal segment. Doi: 10.4328/JCAM.755
6. Sezer A,Yagci MA, Hatipoglu AR, ve ark. A rare cause of intestinal obstruction due to an exophytic gastrointestinal stromal tumor of thesmall bowel. SignaVitae 2009;4:32-4.
7. Kimura H, Yoshida T, Kinoshita S, Takahashi I. Pedunculated giant gastrointestinal stromal tumor of the stomach showing extragas- tric growth: report of a case. Surg Today 2004;34:159-62.
8. Büyükaşık O, Hasdemir OA, Dirican A, Çöl C. Gastrointestinal stro- mal tümörler. İnönü Üniversitesi Tıp Fakültesi Dergisi 2009;16:227- 32.

9. Sturgeon C, Cheifec G, Espat NJ. Gastrointestinal stromal tumors: a spectrum of disease. Surg Oncol 2003;12:21-6.
10. Nilsson B, Bümming P, Meis-Kindblom JM, et al. Gastrointestinal stromal tumors: the incidence, prevalence, clinical course and prognosticationin the pre-imatinib mesylate era-a population based study in western Sweden. Cancer 2005;103:821-9.
11. Miettinen M, Sobin LH, Lasota J. Gastrointestinal stromal tumors of the stomach: A clinicopathologic, immunohistochemical and mo- lecular genetic study of 1765 cases with long-term follow-up. Am J Surg Pathol 2005;29:52-68.
12. Gupta S, Punia R, Kaushik R. Gastrointestinal stromal tumor of the colon presenting with intestinal obstruction. Indian J Cancer 2004;41:175-7.
13. Bucher P, Egger JF, Gervaz P, et al. An audit of surgical manage- ment of gastrointestinal stromal tumors (GIST). Eur J Surg Oncol 2006;32:310-4.
14. DeMatteo RP, Lewis JJ, Leung D, et al. Two hundred gastrointesti- nal stromal tumors: recurrence patterns and prognostic factors for survival. Ann Surg 2000;231:51-8.
15. Duffaud F, Blay JY. Gastrointestinal stromal tumors: biology and treatment. Oncology 2003;65:187-97.