Laparoscopic surgery for double gastrointestinal stromal tumor of the stomach: a report of two cases

Abstract

Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors that originate from interstitial cells of Cajal or their stem cell-like precursors. Generally, GISTs have specific c-KIT gene mutations. The incidence of GISTs is estimated to be 10 to 20 cases/one million individuals, and GISTs typically affect people over 50 years of age. The majority of GISTs are solitary. However, multifocal GISTs have been observed, especially in children. We report on two unusual adult cases of double GISTs that were treated by laparoscopic surgery. The first patient presented a polypoid mass of the fundus and a second isolated smaller tumor in the posterior wall of the lesser curvature of the stomach. A histopathological examination confirmed that both tumors were GISTs and were c-KIT-positive. A total laparoscopic gastrectomy was performed. In the second patient, GISTs were identified at the level of the fundus and the greater curvature of the stomach. A laparoscopic partial sleeve gastrectomy was performed. Both surgeries were successful with no complications or relapses at three to five years following surgery.

Figure 1

Imaging and schematic representation of double GIST in case report 1. a. Case report 1. Esophagogastroscopy: a polypoid lesion of the fundus, which was suggestive of a GIST. b. Case report 1. CT scan imaging: a tumoral mass under the cardia region was 8 × 7 × 6 cm without sites of distant metastasis. c. Case report 1. Echoendoscopy with fine needle aspiration (EUS-FNA) imaging. Visualization of the gastric tumor. d. Case report 1. A schematic representation of the locations of the double GISTs. Tumor 1 was 7 × 6 × 6 cm and was observed to be a polypoid lesion on the fundus of the stomach. Tumor 2 was discovered intra-operatively, was 2.5 × 1 × 1 cm and was located in the posterior wall of the lesser curvature.

Figure 2

Imaging and schematic representation of double GIST in case report 2. a. Case Report 2. CT scan imaging: the tumoral lesions (the red arrows) were 6 × 5 × 2.5 cm and 2.5 × 1.5 × 1 cm. b. Case report 2. A schematic representation of the location of the double GISTs. Tumor 1 was an intramural lesion at the level of the fundus of the stomach (6 × 5 × 2.5 cm), whereas tumor 2 was an extraluminal gastric mass located in the middle of the greater curvature (2.5 × 1.5 × 1 cm).