Morris Sasson, MD, Fernando Dip, MD, Emanuele Lo Menzo, MD, PhD, FACS, Samuel Szomstein, MD, FACS, Raul Rosenthal, MD, FACS. Cleveland Clinic Florida
Gastrointestinal stromal tumor (GIST) are mesenchymal tumors that account for approximately 0.1-3% of GI neoplasm. GISTs are most commonly found in the stomach, small intestine, colon and rectum. Two-thirds of patients may have overt or occult GI bleeding, 40 percent have an abdominal mass, and 20 percent abdominal pain. We present the case of a massive GIST treated with partial gastrectomy.
An 86 year old male with multiple comorbidities and a history of epigastric pain was admitted due to shortness of breath and melena. The patient was anemic with a hemoglobin of 7.9 mg/dl. CT scan showed a mass in the gastric fundus and an upper endoscopy revealed a large fungating oval mass located near the greater curvature. The mass was located 2 cm from the gastroesophageal junction and measured 10 cm by 10 cm in maximal cross-sectional diameter. Laparoscopic wedge resection of the gastric fundus and closure of hiatal hernia was performed.
There were no postoperative complications. No evidence of leak or obstruction was noted on gastrografin fluoroscopic study performed on postoperative day 1. The final pathology was consistent with GIST, spindle cell type. Tumor cells were positive for CD34 and Ckit (CD117). The number of mitotic figures reached 2 per 50 HPF. The patient was discharged on postoperative day 4.
The standard of care for patients with a primarily resectable GIST is surgery. Both Laparoscopic and open techniques have proven to be safe and efficacious in GIST resections.