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Case Reports
. 2024 Jan:114:109155.
doi: 10.1016/j.ijscr.2023.109155. Epub 2023 Dec 12.

Surgical management of a locally advanced jejunal stromal tumor: A case report of a challenging condition

Anis Hasnaoui  1 , Racem Trigui  2 , Nizar Khedhiri  3 , Imen Helal  4 , Haithem Zaafouri  5 , Anis Ben Maamer  5
Affiliations
Case Reports

Surgical management of a locally advanced jejunal stromal tumor: A case report of a challenging condition

Anis Hasnaoui et al. Int J Surg Case Rep. 2024 Jan.

Abstract

Introduction and importance: Locally advanced jejunal stromal tumors stand as a captivating and relatively rare entity, garnering attention for several reasons. Their inaccessible location by conventional endoscopy poses a diagnostic challenge. Further, treatment decisions necessitate a multidisciplinary approach, compounded by the absence of high-level evidence studies.

Case presentation: A 54-year-old patient was admitted to our surgical department with abdominal pain and chronic anemia. Abdominal CT imaging confirmed the presence of a non-metastatic sizable jejunal tumor. The patient underwent laparotomy, revealing a locally advanced jejunal tumor contracting the ileum and the ascending colon. A monobloc oncological resection was performed, followed by the restoration of digestive continuity. Anatomopathological analysis delineated a locally advanced Stromal Tumor with a high risk of recurrence. The patient underwent a course of tyrosine kinase inhibitors for 3 years, with no reported recurrence during the subsequent 3-year follow-up.

Discussion: Locally advanced jejunal stromal tumors are rare. Most patients present with unspecific symptoms. Diagnosis remains challenging due to their intricate anatomical location. Decisions regarding management must be deliberated within a multidisciplinary framework, tailored to each patient's unique characteristics. While combined therapeutic modalities have demonstrated efficacy in recent studies, prudence is advised given the heightened incidence of both short and long-term complications.

Conclusion: In the absence of randomized controlled trials, the management of locally advanced jejunal stromal tumors underscores the imperative of multidisciplinary collaboration in treatment deliberations. A wide, sometimes mutilating excision is only permissible if it is complete.

Keywords: Case report; Gastrointestinal stromal tumors; Jejunal neoplasms; Locally advanced; Protein kinase inhibitors.

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Conflict of interest statement

Conflict of interest statement Nothing to declare.

Figures

Fig. 1
Fig. 1
Preoperative computed tomography findings. (a), (b) axial views and (c) coronal view, showing a small bowel tumor (Black star in (b)), encompassing a necrotic region, and exerting pressure on the inferior vena cava (Black arrow in (b)) and the adjacent ascending colon (White circle in (b)).
Fig. 2
Fig. 2
Intraoperative findings. (a) Illustration of the intraoperative findings. A locally advanced jejunal tumor contracting anr ileal loop positioned 2.5 m distal to the duodeno-jejunal flexure, and the ascending colon (Black transparent polygon). Surgical resection limits are highlighted with dashed lines. (b) Anterior view of the surgical specimen with the tumor highlighted with a white star. (c) Posterior view of the surgical specimen showing the tumor (White star) emerging from a jejunal loop (White arrow) and contracting an ileal loop (Yellow arrowhead) and the ascending colon. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
Fig. 3
Fig. 3
Histopathological findings of the jejunal stromal tumor. (a) Spindle cell GIST with closely packed elongated cells arranged in short intersecting fascicles (HEx200). (b) Elongated cells with blunt-ended cigar-shaped nuclei (HEx400). (c) CD117 (c-Kit) immunohistochemistry shows diffuse positivity. (d) Dog1 immunohistochemistry shows diffuse positivity.
See this image and copyright information in PMC

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