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. 2013 Aug 5:11:172.
doi: 10.1186/1477-7819-11-172.

Giant gastrointestinal stromal tumor (GIST) of the stomach cause of high bowel obstruction: surgical management

Alessandro Cappellani, Gaetano Piccolo, Francesco Cardì, Andrea Cavallaro, Emanuele Lo Menzo, Vincenzo Cavallaro, Antonio Zanghì, Maria Di Vita, Massimiliano Berretta

Giant gastrointestinal stromal tumor (GIST) of the stomach cause of high bowel obstruction: surgical management

Alessandro Cappellani et al. World J Surg Oncol. .

Abstract

Background: Gastrointestinal stromal tumors (GISTs) represent 85% of all mesenchymal neoplasms that affect the gastrointestinal (GI) tract. These GISTs range in size from small lesions to large masses. Often they are clinically silent until they reach a significant size, so their discovery is usually incidental.

Case presentation: A 67-year-old man was admitted at our general surgery department with a persistent abdominal pain in the left hypochondrium, associated with nausea and vomiting. Clinical examination revealed a palpable mass in the epigastrium and in the left hypochondrium, which was approximately 40 cm long. Ultrasonography and computed tomography of the abdomen showed a large mass of 40 × 25 cm, which extended from the posterior wall of the stomach to the spleen, involving the body and the tail of the pancreas. The patient underwent en-block resection of the mass, sleeve resection of the stomach, and distal pancreatectomy-splenectomy. The histopathology of the resected specimen was consistent with a gastrointestinal stromal tumor of the stomach (positive for CD 117) with a high risk of malignancy (mitotic count >5/50 high-power fieldand Ki67/Mib1 >10%). The postoperative course was uneventful and treatment with imatinib mesylate began immediately. The patient appears to be disease free after four years.

Conclusions: Giant GISTs of the stomach are rare. Surgical resection with curative intent is feasible. The combination of surgical resection and imatinib can provide long-termdisease-free survival. An R0 resection is the best achievable treatment, therefore the patient should be evaluated over time for potential resectability.

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Figures

Figure 1
Figure 1
Sagittal computed tomogram, showing the extent of tumor and the compression of the left colonic flexure.
Figure 2
Figure 2
Coronal computed tomogram, showing a large mass of 40 × 25 cm, which extended from the posterior wall of the stomach to the spleen, enveloping the body and the tail of the pancreas.
Figure 3
Figure 3
The removed tumor.
See this image and copyright information in PMC

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