Pancreatic gastrointestinal stromal tumor: A case report

Abstract

Introduction: Gastrointestinal stromal tumors (GISTs) are the most common gastrointestinal tract (GIT) tumors of mesenchymal origin. GISTs tend to arise with a higher frequency in the stomach and the small intestine. GISTs that originate from outside of the GIT are defined as extra-gastrointestinal stromal tumors (EGISTs). Among them pancreatic EGISTs are very rare.

Case presentation: A 30 years old male patient presented with abdominal pain. Triphasic abdominal computed tomography scan with contrast revealed large well defined mass at the pancreatic tail, about 12×11.6cm. Laparoscopic distal pancreatectomy and splenectomy was performed. Postoperative pathological examination revealed positive CD 117 and Dog 1 confirming the diagnosis of EGISTs.

Discussion: GIST is a rare mesenchymal tumor. EGISTs arising in the pancreas are extremely rare, about, 5% of EGISTs. Its origin remains controversial. Some authors believe that GISTs and EGISTs arise from the common cell origin of interstitial cells of Cajal. Others suggest that EGISTs are at the beginning, mural GISTs with extensive extramural growth, resulting in later on, loss of their connection with the GIT wall.

Conclusion: We report a rare case of large pancreatic tail EGIST, which was resected, safely and effectively by laparoscopic approach.

Fig. 1

Triphasic abdominal CT with contrast, (coronal and axial view) revealed large well defined, partially solid/cystic mass at pancreatic tail.

Fig. 2

Opening of the lesser sac and exposure of the pancreatic EGIST mass.

Fig. 3

Ligation and clipping of the splenic artery.

Fig. 4

Transection of the pancreas using laparoscopic Endo GIA stapler.

Fig. 5

Histomicrographs of GIST. A, The neoplastic proliferation and the adjacent panreaticacini (blue arrow) can be seen (H&E x200). B, The tumor is formed of spindle cell proliferation in fasicular pattern with oval shaped nuclei (H&E x200). C, The neoplastic cells showed positive cytoplasmic staining for CD117 (IHCx200). D, The tumor cells showed positive cytoplasmic staining for DOG1 (IHC x400). (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)