Jejunal Gastrointestinal Stromal Tumor Mimicking Leiomyoma in Premenopausal Period

Yıl 2019, Cilt: 16 Sayı: 1, 55 - 59, 01.01.2019

Güler İsrafilova Şahin Kaan Baydemir Yavuz Emre Şükür Can Konca Cem Somer Atabekoğlu

Öz

Aim: Approximately 90% of adnexal masses are benign and located in the upper ranks among gynecologic hospitalizations. Gastrointestinal system adnexal masses are less common when compared with gynecological causes. Gastrointestinal stromal tumors GIST are responsible for less than 1% of all gastrointestinal tumors. Clinical symptoms may include bleeding, pain, anorexia, swallowing difficulty, jaundice due to tumor size and localization.Case: 48 years old, G3 P3, female patient presented to our clinic with complaints of menstrual irregularity and left groin pain. On the gynecologic examination on the left adnexal area moving and rigid mass was palpable. 7×6 cm solid, heterogeneous mass in the upper-anterior region of the uterus and bladder was observed. The mass was evaluated as subserous pedunculated fibroid. In the tomography report adnexial mass and myom couldn’t be distinguished. Abdominal exploration was through a Pfannensteil incision. A 6x6.5 cm well-circumscribed mass in jejunum was identifed on observation. The mass was excised with segmental resection and the bowel was repaired by end to end anastomosis. The specimen was sent to paraffin evaluation. Pathology result was reported as GIST. On the postoperative third day, the patient was discharged without complications.Discussion: In case of differential diagnosis of adnexal masses, especially which are mobile, small intestinal masses should also be considered. While gastrointestinal stromal tumors are usually benign, the exact treatment is surgical resection. However, it’s necessary to evalaute all prognostic factors to consider medical treatment.

Anahtar Kelimeler

Adnexal mass, surgery, gastrointestinal stromal tumor, imatinib

Premenapozal Dönemde Leiomyomu Taklit Eden Jejunal Gastrointestinal Stromal Tümör

Öz

Giriş: Adneksiyel kitlelerin %90’ı benign karakterli olup, jinekolojik nedenli hastane başvuruları arasında üst sırada yer almaktadır. Gastrointestinal sistemden kaynaklanan adneksiyel kitleler jinekolojik nedenlerle kıyaslandığında daha az görülür. Gastrointestinal stromal tümörler GİST tüm gastrointestinal tümörlerin %1’ inden azından sorumludurlar. Klinik semptomlar tümör boyutuna ve lokalizasyonuna bağlı olarak kanama, ağrı, iştahsızlık, yutma güçlüğü, sarılık ve akut batına kadar değişmektedir.Olgu: 48 yaşında, G3 P3, kadın hasta menstrüel düzensizlik ve sol kasık ağrısı şikâyeti ile kliniğimize başvurdu. Jinekolojik muayenesinde sol adneksiyel alanda hareketli ve sert bir kitle palpe edildi. USGdeuterus ve mesane üst-ön komşuluğunda 7×6 cm’lik solid, heterojen kitle izlendi. Subseröz saplı myom olarak değerlendirildi. Tomografi raporunda da adneksiyel kitle ve myom ayrıcı tanısı yapılamadı. Pfannensteil kesi ile batına girildi. Gözlemde jejunumdan kaynaklanan 6×6.5 cm çapında düzgün kenarlı kitle izlendi. Kitle segmenter rezeksiyon ile çıkarıldı ve uç-uca anastomoz yapıldı. Kesin sonuç paraffin incelemeye bırakıldı. Patoloji raporu GİST olarak raporlandı. Postoperatif üçüncü günde hasta komplikasyonsuz olarak taburcu edildi.Tartışma: Adneksiyel kitle ayırıcı tanısında, özellikle hareketli kitlelerde, ince bağırsak kaynaklı kitleler de göz önünde bulundurulmalıdır. Gastrointestinal stromal tümörler çoğunlukla benign karakterli olduğundan esas tedavi cerrahi rezeksiyondur, ancak prognostik faktörlerin tümü birlikte değerlendirilerek tıbbi tedaviye karar verilmelidir.

Anahtar Kelimeler

Adneksiyel kitle, cerrahi, gastrointestinal stromal tümör, imatinib

Kaynakça

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