Gebelikte gastrik stromal tümör: Olgu sunumu

Yıl 2018, , 164 - 167, 01.05.2018

Anas Belhaj , Karim Ibn Majdoub Hassani İmane Toughrai Khalid Mazaz

https://doi.org/10.28982/josam.401335

Öz

Gastrointestinal stromal tümörler (GIST) gastrointestinal sistemi duvarında gelişen nadir mezenkimal tümörlerdir. Gebelikte GIST ile ilgili literatürde az miktarda bilgi bulunmaktadır. Biz burada gebelik ikinci trimesterde tespit edilen bir GIST olgusunu rapor ediyoruz. Olgu 44 yaşında ve hamileliğin beşinci ayındaydı. Biliyer kolik ağrısı ile başvurdu. Abdominal muayenede 15 cm'lik rahim yüksekliği ve sağ hypochondrium 15 cm kitle tespit edildi. Abdominal ultrasonografi ve manyetik rezonans görüntüleme ile sağ hypochondrium bölgesinde büyük bir lezyon gösterildi. Endoskopi ile midenin önünde dışsal bası görüldü. Hasta ameliyata alındı ve orta hat kesi yapıldı. Eksplorasyonda neredeyse tüm sağ hypochondrium işgal eden, karaciğeri yukarı ve rahimi aşağı iten, küçük kurvatür düzeyinde mideye yapışan, yaklaşık 3 cm'lik bir implantasyon tabanı olan 25 cm kitle tespit edildi. Histolojik ve immun histokimyasal çalışmalar, yüksek malignite riskli GIST gösterdi. Literatürde gebelik sırasında sadece olgu sunumu olarak bildirilen GIST, multidisipliner bakım gerektiren nadir bir patolojidir.

Anahtar Kelimeler

Hamilelik, Gestasyon, Imatinib, Gastrointestinal stromal tümör

Gastric stromal tumor with pregnancy: A case report

Öz

Gastrointestinal stromal tumors (GISTs) are rare mesenchymal tumors that develop in the wall of the gastrointestinal tract. There is few given information throughout literature concerning gestation associated with GIST. We report here the case of a patient who was admitted in our hospital for GIST discovered during the second trimester of pregnancy. She was 44 years old, in the fifth months of pregnancy. She was admitted for biliary colic pain. An abdominal examination objectified a distended abdomen with uterine height of 15 cm and right hypochondrium mass of 15 cm. Abdominal ultrasound and magnetic resonance imaging showed a large lesion process in the right hypochondrium region. Endoscopy objectified an aspect of extrinsic compression at the front of the stomach. The patient was operated and an umbilical median incision was performed, exploration showed the presence of a hug mass measuring 25 cm occupying almost all of the right hypochondrium, pushing the liver up and the uterus down, adheres to the stomach at the level of the small curvature with an implantation base of about 3 cm. Histological and immune histochemical study of hepatic process showed a GIST of high risk of malignancy. Only some cases have been reported in the literature on GIST during pregnancy showing the rarity of the pathology that requires multidisciplinary care.

Anahtar Kelimeler

Pregnancy, Gestation, Imatinib, Gastrointestinal stromal tumor

Kaynakça

• 1. Charif I, Khalil N, Ousadden A, Benjelloun EB, Slimani O, Alaoui FZF, et al. (2014) Pregnancy with Gastric Stromal Tumor. Case Reports in Clinical Medicine 2014;3:571-6.
• 2. Cuerva-Gonzalez MJ, Lacoponi S, de la Calle-Fernandez M, Pozo-Krielinger J. Gastrointestinal Stromal Tumor in Pregnancy and Control. Case Report. Ginecol Obstet Mex. 2010 Dec;78(12):697-702.
• 3. Abbas M, Farouk Y, Nasr MM, Elsebae MM, Farag A, Akl MM, et al. Gastrointestinal stromal tumors (GISTs): clinical presentation, diagnosis, surgical treatment and its outcome. J Egypt Soc Parasitol. 2008 Dec;38(3):883-94.
• 4. Lanteri R, Aliotta I, Racalbuto A, Licata A. Anal GIST in Older Old Patient: A Case Report. G Chir. 2005 Apr;26(4):135-7.
• 5. Du CY, Shi YQ, Zhou Y, Fu H, Zhao G. The Analysis of Status and Clinical Implication of KIT and PDGFRA Mutations in Gastrointestinal Stromal Tumor (GIST). J Surg Oncol. 2008 Sep 1;98(3):175-8.
• 6. Emma T, Igras A, Susan J, Neuhaus C. Maternal GIST in Twin Pregnancy: Case Report of a Rare and Complex Management Challenge. Gynecol Oncol Case Rep. 2012 Aug 19;2(4):133-5.
• 7. Chaudhry UI, DeMatteo RP. Management of Resectable Gastrointestinal Stromal Tumor. Hematol Oncol Clin North Am. 2009 Feb;23(1):79-96.
• 8. Neagu S, Zarnescu NO, Costea R, Stamatoiu A, Badea V, Dumitrescu C, et al. Gastric stromal tumors--Clinical and histopathological analysis of four cases. Chirurgia (Bucur). 2003 Sep-Oct;98(5):443-51.
• 9. Folgado Alberto S, Sanchez P, Oliveira M, Cuesta L, Gomes F, Figueiredo A, et al. Gastrointestinal stromal tumors - a retrospective study of 43 cases. Rev Esp Enferm Dig. 2008 Nov;100(11):696-700.
• 10. Emile JF, Theou N, Tabone S, Cortez A, Terrier P, Chaumette MT, et al. Clinicopathologic, Phenotypic, and Genotypic Characteristics of Gastrointestinal Mesenchymal Tumors. Clin Gastroenterol Hepatol. 2004 Jul;2(7):597-605.
• 11. Zarkavelis G, Petrakis D, Pavlidis N. Gastrointestinal stromal tumors during pregnancy: a systematic review of an uncommon but treatable malignancy. Clin Transl Oncol. 2015 Oct;17(10):757-62.
• 12. Goel N, Malik R, Rathi B, Bhaskaran S, Rajaram S, Mehta S, et al. Pregnancy with metastatic gastrointestinal stromal tumor (GIST) on imatinib chemotherapy: an oncologist’s nightmare and obstetrician’s dilemma. J Gastrointest Cancer. 2013;44(1):115–7.
• 13. Pavlidis N. Coexistence of pregnancy and malignancy. Oncologist. 2002;7(4):279–87.
• 14. Blay JY, Von Mehren M, Blackstein ME. Perspective on updated treatment guidelines for patients with gastrointestinal stromal tumors. Cancer. 2010;116:5126–372.
• 15. Hohenberger P, Ronellenfitsch U, Oladeji O, Pink D, Stro¨bel P, Wardelmann E, et al. Pattern of recurrence in patients with ruptured primary gastrointestinal stromal tumor. J Clin Oncol. 2003;21:4342–9.
• 16. Eisenberg BL, Harris J, Blanke CD, Demetri GD, Heinrich MC, Watson JC, et al. Phase II trial of neoadjuvant/adjuvant imatinib mesylate (IM) for advanced primary and metastatic/recurrent operable Gastrointestinal stromal tumor (GIST): early results of RTOG 0132/ACRIN 6665. J Surg Oncol. 2009;99:42–7.
• 17. Bauer S, Rutkowski P, Hohenberger P, Miceli R, Fumagalli E, Siedlecki JA, et al. Long term follow-up of patients with GIST undergoing metastasectomyin the era of imatinib- analysis of prognostic factors (EORTC-STBSG collaborative study). Eur J Surg Oncol. 2014;40:412–9.
• 18. Novartis Pharmaceuticals Corporation [Internet]. www.pharma.us.novartis.com/ product/pi/pdf/gleevec.tabs.pdf
• 19. Lambertini M, Peccatori FA, Azim HA Jr. Targeted agents for cancer treatment during pregnancy. Cancer Treat Rev. 2015;41(4):301–9.
• 20. Pye SM, Cortes J, Ault P, Hatfield A, Kanarjian H, Pilot R, et al. The effects of imatinib therapy on pregnancy outcome. Blood. 2008;111:5505–8.
• 21. Ali R, Ozkalemkas F, Kimya Y, Koksai N, Ozkocaman V, Gulten T, et al. Imatinib use during pregnancy and breast feeding: a case report and review of the literature. Arch Gynecol Obstet. 2009;280(2):169–75.