Cases Of Gastrointestinal Stromal Tumors Research Articles

Gastric GIST with 13 kg in Asymptomatic Patient: A Rare Case of Giant GIST and Literature Review

Gastrointestinal stromal tumors (GIST) account for 85% of all mesenchymal neoplasms of the digestive tract. Of these, two thirds are found in the stomach. GISTs usually present as small lesions, often incidentally discovered. On the other hand, the presence of an abdominal mass, a very infrequent finding, can produce symptoms: Abdominal pain, digestive bleeding, nausea, vomiting, in addition to weight loss and intestinal constipation.

Cytopathology of rare gastric mesenchymal neoplasms: A series of 25 cases and review of literature.

Gastrointestinal stromal tumour (GIST) is the most common mesenchymal neoplasm arising in the stomach. However, a number of other rare mesenchymal neoplasms do occur at this anatomic site, which often presents a diagnostic challenge for cytopathologists on endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). Our study aims to selectively present the clinico-radiological and cytopathological characteristics of these rare "non-GIST" neoplasms, as well as their differential diagnoses. We performed a 20 year retrospective search in the cytopathology database of our two large medical institutions for non-GIST mesenchymal neoplasms arising in the stomach and diagnosed on EUS-FNA. Data regarding the patients' demographics and radiological findings were analysed. All available cytopathology specimens were reviewed. The cytomorphological characteristics and the accompanying immunohistochemical stains, when available, were subsequently analysed. Twenty-five cases of gastric mesenchymal tumours were selectively included in the study after excluding all cases of GIST (n=113) diagnosed on FNA. These cases included 10 leiomyomas (40%), eight schwannomas (32%), five glomus tumours (20%), one perivascular epithelioid cell neoplasm, and one desmoid tumour. The specimen cellularity was variable and ranged from hypocellular to highly cellular. Most smears were composed of spindle cells with a few showing epithelioid morphology. Cell blocks were available in 20 cases and a range of immunohistochemical ancillary studies were performed. DOG-1, c-KIT, smooth muscle actin (SMA), and S100-protein were the most common immunomarkers done. Our study highlights important cytomorphological characteristics of rare mesenchymal neoplasms arising in the stomach. In the appropriate clinical setting and with the help of immunohistochemistry, an accurate diagnosis of these neoplasms can be achieved.

104P A multi-institutional epidemiological and oncological profile of gastrointestinal stromal tumors in the Lebanese population

Gastrointestinal stromal tumor (GIST) is a rare type of soft tissue sarcoma that most commonly arises from gastric mesenchymal cells. This study represents the first-ever form of GIST registry or database in Lebanon. The aim of this study is to describe and compare the Lebanese cohort of GIST cases and their management to the findings of international reports and gold standards.

SUCCINATE DEHYDROGENASE SUBUNIT B DEFICIENT PEDIATRIC GIST

Case report Gastrointestinal stromal tumors (GISTs) occur exceedingly rare in children and adolescents. Eighty five percent of pediatric GISTs and 15 % of adult GISTs lack oncogenic mutations in KIT and PDGFRA. The results of tyrosine kinase inhibitor therapy in GIST cases with SDH deficiency are limited and controversial. Here, we would like to present a pediatric SDH deficient GIST case treated with surgery and Imatinib Mesylate. We obtained a good response with Imatinib Mesylate.

S2436 A Rare Case of a Large Esophageal Gastrointestinal Stromal Tumor

Introduction: Gastrointestinal stromal tumors (GISTs) are rare mesenchymal neoplasms, accounting for approximately 1 to 2 percent of primary gastrointestinal (GI) cancers. Presenting symptoms include abdominal pain, nausea, vomiting, early satiety, bleeding, and dysphagia, but vary depending on primary tumor location. Most tumors are discovered incidentally with the majority found in the stomach (40 to 60 percent) followed by small bowel (25-30 percent), colon and rectum (5-15 percent). We present a case of an elderly patient diagnosed with esophageal GIST after he was found to have an incidental esophageal mass on imaging. Case Description/Methods: 80-year-old male with PMH of HTN, HLD, DM2, CKD Stage III, COPD, former tobacco user was referred for an upper endoscopy for evaluation of an incidental finding on CT scan. CT demonstrated a mass arising from the distal esophagus, measuring 6.5 x 7.5 cm. Patient denied any dysphagia, abdominal pain, nausea, vomiting, weight loss, hematemesis, or melena. Endoscopy showed submucosal mass in the distal esophagus (Figure). Biopsy was inconclusive and subsequent EUS-guided fine needle biopsy was performed. Upper endoscopic ultrasound (EUS) showed an intramural lesion in the distal esophagus arising from the muscularis propria. Pathology results confirmed GIST, positive for CD117 and DOG-1. Further testing revealed a mutation in the KIT gene exon 11. Patient is currently undergoing neoadjuvant therapy with imatinib mesylate with anticipated surgical resection. Discussion: This is a rare case of a large esophageal GIST. Most mesenchymal esophageal tumors are leiomyomas, and GIST only accounts for 0.7% of them. EUS with fine need aspiration biopsy is the most accurate method for diagnosis and definite diagnosis is made histologically. Majority of GISTs, expresses the CD117 antigen, a KIT receptor tyrosine kinase. Another commonly found mutation is the platelet derived growth factor (PDGFRA) tyrosine kinase gene. Tumor size and mitotic rate are used for prognostication, with increased malignancy risk seen in tumor size > 3 cm with irregular margins. Tumor location is also a key factor in risk stratification; non gastric primary location has higher rates of metastases. Liver and peritoneum are the most common sites of metastatic GISTs. Treatment focuses on surgical resection and neoadjuvant therapy with imatinib. Given significant implication for its management, esophageal GIST should be considered in differential diagnosis and distinguished from more common esophageal leiomyomas.Figure 1.: Submucosal mass in distal esophagus.

S3455 Unusual Presentation of a Young Male Diagnosed With a Perforated Gastrointestinal Stromal Tumor (GIST) in the Jejunum With a Previous History of Multiple Myeloma (MM)

Introduction: Studies suggest an increase in the frequency of additional malignancies in patients with GIST. This relationship remains unclear and needs further exploration. We present a case of GIST in a patient with Multiple Myeloma. Case Description/Methods: A previously healthy 38 years old male presented in 2016 complaining of weakness, fatigue, and back pain; he was diagnosed with Multiple Myeloma. Remission was achieved using chemotherapy and autologous bone marrow transplantation. He had a relapse of Multiple Myeloma on a bone marrow biopsy in 2020. Since then, he has been receiving chemotherapy. In March 2022, he presented to the ER complaining of abdominal distension, severe pain, and vomiting, based on a physical exam and CT. Scan, he was diagnosed with small bowel obstruction and peritonitis. Surgical exploration revealed a large abdominal perforated mass originated from the proximal jejunum, with adhesions to the root of the mesentery, urinary bladder, small bowel, transverse, descending, and sigmoid colons. Excision of the mass with resection of about 30 cm and re-anastomosis of the jejunum was performed. Postoperatively, the patient was admitted to the ICU for three days to control cardiac arrhythmia. He was discharged from the hospital ten days later. Pathology confirmed the diagnosis of GIST. Currently, the patient is receiving chemotherapy and doing well (Figure). Discussion: Despite being the most common mesenchymal neoplasms of the gastrointestinal tract, GIST are still rare tumors that account for less than 1% of all GI tumors; they occur mostly in the stomach or small intestines. The average age of diagnosis is 50-70 years and is considered non-hereditary or sporadic. There are reports of co-existing GIST with adenocarcinomas within the GI tract or distant organs. In a single case series of 43 patients with GIST, 6 (14%) had an additional primary tumor, five within the GI tract. In a larger population-based study with 6,112 GIST patients, 1,047 (17.1) had additional cancers. Despite that, so far, only one case of (MM) was reported in a patient with GIST in 2007 in Greece, which ended with the patient’s death six months after the diagnosis of (MM). This case highlights the relationship between GIST and other primary neoplasms at a young age. It is unclear whether the GIST was due to genetic association, environmental exposure, or chemotherapy. Clinicians should look for tumors within or outside the GI tract, which could significantly affect the prognosis.Figure 1.: Resected GIST from with 30 Cm of the jejunum.

CASE REPORT ON RARE OUTCOME OF A RETROPERITONEAL MASS: MANAGEMENT CHALLENGES AND LESSONS LEARNT

Background. Gastrointestinal stromal tumours (GIST) are non-epithelial mesenchymal solid neoplasm with varied presentation. The study reports the case of a retroperitoneal GIST in a 21‑year‑old male presented with an abdominal lump for six months. The lesion was initially thought to be a retroperitoneal sarcoma. Exploratory laparotomy revealed an abdominopelvic mass covering the entire right side of abdomen and pelvis. The tumour was adherent to the terminal ileum and ascending colon. There were dense adhesions between the retroperitoneum with involvement of the middle third of the right ureter. The tumour was resected with right hemicolectomy with ileotransverse anastomosis. Post-operative histopathology revealed it as high-grade spindle cell type GIST. The patient is presently on post-operative chemotherapy with Imatinib mesylate. Objective. Atypical presentations of GIST are seldom discussed but frequently encountered in clinical practice. This article depicts different challenges the surgeon has to face while diagnosing such atypical entity. Methods. Case report of atypical GIST presenting as retroperitoneal lump. Results. The patient underwent surgical resection and is presently on post-operative chemotherapy with good overall outcome for a one year follow up. Conclusions. GISTs presenting as retroperitoneal lumps are very rare, they should be considered in their differential diagnosis of an atypical retroperitoneal mass.

Associations of CD34, Ki67, layer of invasion and clinical pathological characteristics, prognosis outcomes in gastrointestinal stromal tumors-a retrospective cohort study.

BackgroundGastrointestinal stromal tumors (GIST) is the most common interstitial tumor of the digestive tract. GIST, like other malignancies, can recur, metastasize, and even metastasize to the brain, leading to death. Therefore, the prevention and treatment of GIST is very important. The clinical features of GIST are uniquely different to those of other common malignancies. Therefore, it is of great significance to explore the relationship between the pathological features and prognosis of GIST to strengthen the prevention and treatment of GIST. The objectives of this study were to study the clinical features of Ki67, Cluster Differentiation 34 (CD34), and their correlations in the Jianghuai region of China in recent years, and to analyze their relationship with prognosis.MethodsA total of 423 cases of GIST in Northern Jiangsu People’s Hospital in Yangzhou from 2013 to 2020 were retrospectively analyzed. The data of CD34, Ki67 and layer of invasion was collected, and their associations with the clinical pathological characteristics, prognosis outcomes of GIST were studied. CD34 and Ki67 were tested by immunohistochemistry (IHC) And data was analyzed by chi-square test, t-test, Kaplan-Meier (KM) method survival curve, Log-rank test, and Cox regression.ResultsThe results showed that CD34 was associated with the clinical features of primary site, tumor size, risk, recurrence, and progression-free survival (PFS) (P<0.001, =0.01, <0.001, =0.039 and =0.018), but not with nuclear division or overall survival (OS) (P>0.05). Further, Ki67 was associated with nuclear division, tumor size, risk, recurrence, and PFS (P<0.001, <0.001, <0.001, <0.001 and <0.001), but there was no significant correlation with the primary site and CD34 (P>0.05), and Ki67 was associated with OS, but there was no statistical significance (P=0.0507). The layer of invasion was associated with the primary site, nuclear division, tumor size, risk, CD34, smooth muscle actin (SMA), recurrence, Ki67, and PFS (P<0.001, <0.001, <0.001, <0.001, <0.001, <0.001, <0.001, <0.001 and =0.0025), but not with OS (P=0.6680).ConclusionsCD34, Ki67, and layer of invasion may play important roles in the occurrence and development of GIST, affecting the prognosis of GIST.

Ki-67 index assessment on FNA specimens of gastrointestinal stromal tumor: Correlation with mitotic rate and potential predictive value for risk stratification.

Risk assessment of gastrointestinal stromal tumor (GIST) is challenging on cytology specimens. This study aims to determine whether Ki-67 index evaluated on fine-needle aspiration (FNA) specimens can correlate with the mitotic rate of GIST in surgical specimens and provide further risk assessment. Cases with cell blocks containing adequate tumor cells and surgical resections were included. Ki-67 immunostain was retrospectively performed on cell block sections, and Ki-67 index was calculated on the "hot spot" areas. This study included 50 GIST cases from stomach (n=45; 90%), duodenum (n=4; 8%), and distal esophagus (n=1; 2%). The tumor size ranged from 1.5 cm to 21 cm (mean, 5.4 cm). Based on the mitotic count, 37 GISTs (74%) had low mitotic rate (LMR) and 13 GISTs (26%) had high mitotic rate (HMR). The spindle cell, epithelioid, and mixed types accounted for 60%, 14%, and 26%of GIST, respectively. Ki-67 index counted on cell block sections correlated well with mitotic count evaluated in surgical specimens (r=0.8031). Mean Ki-67 index was higher in HMR than LMR groups (3.5% vs. 1%, p < .001). The receiver operating characteristic curve using Ki-67 index to predict mitotic rate was further analyzed, and area under the curve was 0.839. Using a cutoff of 2.5% yielded a sensitivity of 70% at 92% specificity. This study demonstrates good correlations between Ki-67 index and mitotic count or risk stratification, suggesting that Ki-67 index evaluated on cytology specimens may offer a promising approach to preoperatively predict the mitotic rate and risk of GIST.

Gastrointestinal Stromal Tümörlerin Klinikopatolojik Özellikleri ve Literatürün Gözden Geçirilmesi: Tek Merkez Deneyimi

Objective: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasias of the gastrointestinal system (GIS). The malignancy potential of GISTs may vary ranging from indolent tumors to progressive malignant tumors. This study aims to define clinicopathological and immunohistochemical features of GISTs diagnosed in our institute with a review of the literature.&#x0D; Method: A total of 28 GIST cases were included in the study. The Hematoxylin&amp;Eosin stained slides of surgical resection materials and cell blocks and immunohistochemistry performed slides were reviewed by a pathologist. The immunohistochemical expression with CD117, DOG-1, CD34, SMA, and S100 was scored between 0 and 3 points according to staining intensity. Descriptive statistics were used in the study. The demographic data, prognostic histopathological, and immunohistochemical findings are evaluated with the literature indications.&#x0D; Result: Eleven of the cases were male and seventeen were female. The age range was 18-88. The most common site of GISTs was the stomach, followed by the small intestine, colorectal region, and, esophagus. Twenty of the tumors were resected surgically, four were endoscopic biopsy material and four were fine-needle aspiration biopsies. The tumor size in measurable materials ranged from 0,2 to 22 cm. The mitotic count in 50 HPF ranges from 0 to 10. Seven of the GISTs were high grade and the remaining 21 were low grade. The majority of the cases were composed of spindle cells, 3 were epithelioid and 3 were the mixed type with spindle and epitheloid cells.&#x0D; Conclusion: A variety of criteria has been proposed to estimate the malignancy potential of GISTs and predict prognosis but definite prognostic criteria remain uncertain. Further studies with larger series of GISTs consisting of different types of biopsy materials may help define criteria to predict prognosis precisely.

Gastrointestinal Stromal Tumors Mimicking Gynecologic Disease: Clinicopathological Analysis of 20 Cases.

Diagnosis of pelvic gastrointestinal stromal tumors (GISTs) can be challenging because of their nonspecific presentation and similarity to gynecological neoplasms. In this series, we describe the clinicopathological features of 20 GIST cases: 18 patients presented with pelvic mass and/or abdominal pain concerning gynecological disease; 2 patients presented with a posterior rectovaginal mass or an anorectal mass. Total abdominal hysterectomy and/or salpingo-oophorectomy (unilateral or bilateral) were performed in 13 cases. Gross and histological examination revealed that the ovary/ovaries were involved in three cases, the uterus in two cases, the vagina in two cases and the broad ligament in one case. Immunohistochemically, all tumors (20/20, 100%) were diffusely immunoreactive for c-KIT. The tumor cells were also diffusely positive for DOG-1 (10/10, 100%) and displayed focal to diffuse positivity for CD34 (11/12, 92%). Desmin was focally and weakly expressed in 1 of the 14 tested tumors (1/14, 7%), whereas 2 of 8 tumors (2/8, 25%) showed focal SMA positivity. At the molecular level, 7 of 8 (87.5%) GISTs with molecular analysis contained c-KIT mutations with the second and third c-KIT mutations detected in some recurrent tumors. In addition to c-KIT mutation, a pathogenic RB1 mutation was detected in two cases. We extensively discussed these cases focusing on their differential diagnosis described by the submitting pathologists during consultation. Our study emphasizes the importance of precision diagnosis of GISTs. Alertness to this entity in unusual locations, in combination with clinical history, morphological features as well as immunophenotype, is crucial in leading to a definitive classification.

Rare c-KIT c.1926delA and c.1936T>G Mutations in Exon 13 Define Imatinib Resistance in Gastrointestinal Stromal Tumors and Melanoma Patients: Case Reports and Cell Experiments.

Background: Target therapies play more and more important roles in gastrointestinal stromal tumors (GISTs) and melanoma with the advancement of clinical drugs that overcome the resistance caused by gene mutations. c-KIT gene mutations account for a large portion of GIST patients, which are known to be sensitive or resistant to tyrosine kinase inhibitors. However, the role rare mutations play in drug efficacy and progression-free duration remains elusive. Methods: Two rare mutations were identified using Sanger sequencing from the GIST and melanoma cases. Cell experiments were further carried out to demonstrate their role in the imatinib resistance. Results: c-KIT c.1926delA p.K642S*FS mutation in primary and recurrent GIST patients and c-KIT c.1936T>G p.Y646D point mutation in melanoma patients in exon 13 were first demonstrated to be novel targets resistant to imatinib agent. Conclusion: c-KIT mutations c.1926delA and c.1936T>G in exon 13 are clinically significant targets that exhibit resistance to imatinib. This study provides guidance to GIST and melanoma treatments.

Бариатрическая хирургия: описание клинического случая лапароскопической продольной резекции желудка у пациента с морбидным ожирением и гастроинтестинальной стромальной опухолью желудка

Gastrointestinal stromal tumor (GIST) is the most common tumor of the submucosal layer of the gastrointestinal tract. With the development of diagnostic methods, the incidence of GIST cases has increased significantly. Similarly, the prevalence of morbid obesity has increased significantly in the last decade. It is known from the literature that the incidence of GIST in obese patients is higher than in the general population. Although marginal and sparing resection is the first treatment for GIST, depending on the size and location of the tumor, broader surgery should also be considered. Laparoscopic sleeve gastrectomy is one of the most popular bariatric procedures. It can also be an option for concomitant treatment of both morbid obesity and gastric GIST when the tumor is within the range of sleeve resection.

Tropomyosin-Related Kinase Fusions in Gastrointestinal Stromal Tumors.

Simple SummaryThe canonical mutations in gastrointestinal stromal tumors (GISTs) are typically activating mutations in KIT and platelet-derived growth factor receptor alpha (PDGFRA). Imatinib, the treatment of choice for GISTs, shows a lower response in KIT/PDGFRA wild-type GISTs. Neurotrophic tyrosine receptor kinase (NTRK) fusion, which can be treated with an NTRK target agent, has been reported in KIT/PDGFRA wild-type GISTs, and, therefore, the Yonsei Cancer Center analyzed NTRK fusion incidence in KIT/PDGFRA wild-type GISTs. At the Yonsei Cancer Center, NTRK fusion was confirmed in 16% of cases. Confirmation of NTRK fusion in KIT/PDGFRA wild-type GISTs provides important information for improving therapeutic outcomes. NTRK fusion was confirmed in 16% of KIT/PDGFRA wild-type GIST cases at the Yonsei Cancer Center. Confirmation of NTRK fusion in KIT/PDGFRA wild-type GISTs will improve therapeutic outcomes.The canonical mutations in gastrointestinal stromal tumors (GISTs) are typically activating mutations in KIT and platelet-derived growth factor receptor alpha (PDGFRA). GISTs with non-canonical mutations are a heterogeneous group. Here, we examined tropomyosin-related kinase (TRK) fusion in GIST cases without KIT/PDGFRA mutations (KIT/PDGFRA wild-type (WT) GISTs). We retrospectively analyzed patients who were diagnosed with GISTs at the Yonsei Cancer Center, Severance Hospital, between January 1998 and December 2016. Thirty-one patients with KIT/PDGFRA WT GISTs were included in the analysis. TRK expression in tumor samples was assessed by pan-TRK immunohistochemistry (IHC), and the neurotrophic tyrosine receptor kinase (NTRK: the gene encoding TRK) rearrangement was analyzed by fluorescence in situ hybridization (FISH). IHC analyses revealed that five cases in this cohort exhibited a weak to moderate TRK expression. NTRK1 fusions were detected in three tumor samples, and two samples harbored NTRK3 fusions. The remaining 26 samples did not harbor NTRK fusions. Two types of NTRK fusions were detected, and the overall NTRK fusion frequency in KIT/PDGFRA WT GIST cases was 16% (5/31). Our data provide insights into the molecular alterations underpinning KIT/PDGFRA WT GISTs. More effort should be devoted to improve methods to identify this distinct disease subtype within the KIT/PDGFRA WT GIST group.

A case of jejunal GIST revealed by hematemesis: Unusual situation.

IntroductionGastrointestinal stromal tumors (GISTs) are rare tumors of the gastrointestinal (GI) tract, which can occur in majorly stomach, and rarely in the small intestine, rectum, and large intestine. We report a jejunal GIST presented with massive hematemesis in the current study.Case presentationA 39-years-old male, without any underlying history, was presented to our center with the complaint of massive hematemesis. Given the unstable hemodynamics of the patient, an upper GI endoscopy was requested, associated with a large amount of blood in the duodenal bulb without any sign of bleeding. The patient was sent to the operation room, and after laparotomy, a mass was seen in the jejunum, revealed as GIST after pathological study.DiscussionSmall-intestine-related etiologies are rare conditions related to upper GI bleeding (UGIB). Jejunal GIST usually manifests as asymptomatic subepithelial mass and is associated with abdominal discomfort or GI bleeding. Sudden unset bleeding is a rare manifestation of jejunal GIST, but it can be associated with the emergency outcome and may need emergency intervention.ConclusionUGIB can occur in jejunal GIST, which should be considered in the management of UGIB.

Challenges in the management of metastatic gastrointestinal stromal tumor in a patient with neurofibromatosis type 1: a case report

BackgroundNeurofibromatosis type 1 is an inherited cancer predisposition syndrome that is caused by a mutation in the NF1 gene that encodes neurofibromin. Patients with neurofibromatosis type 1 have a higher risk of gastrointestinal stromal tumor. This study reports the case of a patient with gastrointestinal stromal tumor who was later diagnosed to have neurofibromatosis type 1 and, unlike usual features, had some uncommon features such as occurrence at an early age and unusual site of origin.CaseWe report the case of a 29-year-old Indian female diagnosed to have gastrointestinal stromal tumor originating from the greater curvature of the stomach. Gastrointestinal stromal tumor was wild type, negative for c-kit and platelet-derived growth factor receptor, and had an aggressive clinical course not responding to oral tyrosine kinase inhibitors. On later evaluation, we found that the patient had germline mutation in NF1. This case has some unusual features compared with gastrointestinal stromal tumor cases reported in neurofibromatosis type 1. Firstly, the age of onset for gastrointestinal stromal tumor in neurofibromatosis type 1 is earlier in our case compared with previous cases reported in literature. Secondly, the site of occurrence is in the stomach, without involving other parts of the intestine. Gastrointestinal stromal tumor in neurofibromatosis type 1 is usually multifocal, and small intestine is the common site of occurrence. When occurring in the stomach, it is usually associated with other lesions in the small intestine. Lastly, the clinical course is aggressive compared with previous case reports and series.ConclusionOur patient had germline NF1 mutation and cutaneous stigmata of neurofibromatosis. Our patient had unicentric gastrointestinal stromal tumor occurring at younger age and involving greater curvature of the stomach, with spindle cell type histology and high-risk features. If gastrointestinal stromal tumor occurs at young age, we should look into neurocutaneous markers.

Intestinal Preserving Giant Mesenteric GIST Excision – A Rare Case

Gastrointestinal Stromal Tumors (GISTs) were originally believed to have originated from the mesenchymal cells of the gastrointestinal tract. These tumors actually originate from the intestinal cells of Cajal. A 26-year-old female came with complaints of mass per abdomen since 3 months which was insidious in onset, slowly progressive, complaining of vomiting,3-4 episodes since the last 4 days, non-blood tinged,non-projectile,non-bilious,non-foul smelling containing food particles associated with pain in the upper abdomen dull aching type,non-radiating, and non-migrating. On per abdominal examination — There was an oval-shaped mass that was firm in consistency, measuring about 15x10cm in size located in the left lumbar extending into the umbilical area which was mobile horizontally but vertical mobility was restricted. Routine investigations, USG, and CECT abdomen &amp; pelvis were done which was pointing the diagnosis towards mesenteric GIST. Exploratory laparotomy and resection of GIST were scheduled. The resected tumor was sent for histopathological examination and a CD-117(IHC) marker was sent, which confirmed the mass as a mesenteric GIST. Literature shows that only a few cases of mesenteric GIST have been reported to date. Incidence of such giant mesenteric GISTs is very rare and intestinal preserving giant mesenteric gist excision is one of the firsts. Keywords: Mass per abdomen, Mesenteric GIST

Clinical outcomes of endoscopic treatment for gastric gastrointestinal stromal tumors: a single-center study of 240 cases in China

Background and aims Endoscopic resection (ER) gradually becomes an important treatment method for gastrointestinal stromal tumors (GISTs). The aim of this study is to evaluate the efficacy and safety of ER of gastric GISTs. Methods This retrospective study included 240 patients with gastric GISTs who underwent ER at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2010 to December 2019. The clinicopathologic, endoscopic and follow-up data of the patients were collected and analyzed. Results The mean maximum tumor diameter was 1.67 ± 1.00 cm (range 0.2–6.5 cm), of which 156 cases (65.00%) were small gastric GISTs (tumor diameter < 2 cm). A total of 43 patients (17.92%) had perioperative bleeding, including 40 cases (16.67%) of minor bleeding and three cases (1.25%) of major bleeding. Perioperative perforation occurred in 101 patients (42.08%), of which 51 patients (21.25%) were active perforation and 50 patients (20.83%) were passive perforation. The en bloc resection rate was 97.08% (233/240), and seven cases (2.92%) had piecemeal resection. There were three cases (1.92%) of small gastric GISTs at intermediate risk and one case (0.64%) at high risk. A total of 193 patients were followed up, and no tumor residual, recurrence or metastasis occurred within a median follow-up time of 30 months (range 1–127 months). Conclusions Endoscopic treatment for gastric GISTs is safe and effective. Piecemeal resection does not seem to be related to the patient's prognosis. Endoscopic resection can be performed if patients are willing to remove small gastric GISTs.

GIST in Third Part of Duodenum Causing Partial Obstruction – Laparoscopic Management

Background: Gastrointestinal Stromal Tumor (GIST) arises from the interstitial cells of Cajal. Stomach is the most common site of GIST. The usual presentations of GIST are gastrointestinal bleeding and abdominal pain. GISTs in the duodenum are uncommon. Duodenal obstruction due to GIST is even more uncommon. Duodenal GISTs are usually detected on endoscopy, however they can be missed on routine endoscopy if they are located in the third part of duodenum. Computed Tomography (CT) of abdomen is useful in determining the exact size, location and extent of tumor. In the absence of metastases, surgical excision is the mainstay of treatment. Case Presentation: We present a case of a duodenal GIST in the 3rd part of duodenum, causing partial obstruction to the duodenal lumen and causing recurrent abdominal pain and vomiting. Although technically challenging, we successfully excised this lesion laparoscopically. Furthermore, as it was a pedunculated tumor arising from the posterior wall of the duodenum, we performed a novel technique of laparoscopic duodenotomy and stapling of pedunculated tumor at the base and primary closure, rather than the conventional technique of wedge or segmental resection. Conclusion: Third part of the duodenum is a difficult location to access surgically and excision of tumors in this location is usually performed by the open method because of the technical difficulties of laparoscopic surgery in this location. However, with adequate expertise and advanced laparoscopic skills, laparoscopic excision of tumors in the third part of duodenum can be accomplished with good post-operative outcomes.

Jejunal GIST, a clinical case report

Background: Gastrointestinal stromal tumors (GISTs) are rare mesenchymal tumors, comprising 0.2% of all gastrointestinal tumors. Jejunal GISTs are the rarest subtype. Its clinical presentation can be acute or chronic and symptoms are generally nonspecific and vary according to size, location and aggressiveness of the tumor. Here we present a rare case of jejunal GIST.