Synchronic gastric tumors: a case report

Beatriz Moraghi Dias Da Silva,Diego Ito,Nagamassa Yamaguchi,Arlem Cesar Damasceno Perez,José Eduardo Gonçalves,Larissa Barros Bezerra Cunha,Helena Vecchia D’Elia,Fernando Bray Beraldo,Rachel Bonavita Soriano

doi:10.11606/issn.2176-7262.v50i6p382-389

Abstract

Objective: The aim of this report is to describe a case of a patient with synchronous gastric tumors and demonstrate the importance of identifying this coexistence before surgery, considering that synchronicity is generally detected only after the surgery. Methods: The medical records of patients from Servidor Público Estadual Hospital of São Paulo were analyzed. Results: We identified a case of a 69-year-old male patient who presented with symptoms of dyspepsia, weight loss, and asthenia. The patient underwent serum laboratory tests, abdominal computed tomography, and upper digestive endoscopy. Analysis of the results revealed that the symptomatology was related to the association of two different gastric lesions, gastric adenocarcinoma and a nearby gastrointestinal stromal tumor (GIST), although without collision. Conclusion: The patient was submitted to a total gastrectomy with a Y-en-Roux reconstruction. Importance of the problem: Gastric cancer is the major cause of mortality of neoplastic nature, considering its high frequency and presentation of few symptoms. Although gastric adenocarcinoma and GIST are extremely different in their histopathological aspects, they can occur synchronously in the stomach. Preoperative identification of the synchronicity of these tumors is significantly important to improve surgical planning. Comments: Currently, there is a lack of a specific examination for screening GISTs, which explains the difficulty in diagnosing this tumor before the surgical procedure. In the present case, the diagnosis of adenocarcinoma was made despite the fact that two distinct gastric lesions were detected in the radiological imaging examination, and the final diagnosis of GIST was made only through anatomopathological analysis.

Highlights

Analysis of the results revealed that the symptomatology was related to the association of two different gastric lesions, gastric adenocarcinoma and a nearby gastrointestinal stromal tumor (GIST), without collision
B) lesão nodular (Figura 3B): representada por tumor estromal gastrointestinal (GIST) de células fusiformes grau 1 com dimensão de 5,0 cm, ausência de embolia angiolinfática, invasão perineural e necrose, observando-se índice mitótico com 4 mitoses em 50cga e margens cirúrgicas, omento e linfonodos livres de comprometimento neoplásico (0/19)
Quanto à etiologia dos tumores sincrônicos, especialmente a ocorrência de gastrointestinal stromal tumor (GIST) e adenocarcinoma gástricos, ainda não há evidências de um agente carcinogênico comum atuando em seres humanos

Summary

Introduction

B) lesão nodular (Figura 3B): representada por tumor estromal gastrointestinal (GIST) de células fusiformes grau 1 (baixo grau) com dimensão de 5,0 cm, ausência de embolia angiolinfática, invasão perineural e necrose, observando-se índice mitótico com 4 mitoses em 50cga e margens cirúrgicas, omento e linfonodos livres de comprometimento neoplásico (0/19). Pode-se observar o estudo de Agaimy onde está descrito que foi observado tumores microscópicos em 22,5% dos pacientes com 50 anos ou mais, sendo os dados obtidos através de inúmeras autópsias.[15] Já Kawanowa et al relatou que os GISTs microscópicos coexistem em 35% com os carcinomas gástricos ressecados.[16] Devido ao progressivo ganho de conhecimento, bem como a maior preocupação na sua identificação durante o exame endoscópico do trato gastrointestinal superior, o encontro de lesões subepiteliais tem aumentado significativamente.

Results

Conclusion