A case of gastrointestinal stromal tumor of the lesser omentum, which was successfully resected by laparoscopic surgery

Hirotsugu Ohara. Fujieda heisei Memorial Hospital

GIST ( gastrointestinal stromal tumor ) of the lesser omentum is rare. Furthermore, in many cases, the size were more 5cm in diameter on finding of tumor. So the report of laparoscopic surgery for lesser omentum GIST is extremely rare . We resected the GIST of the lesser omentum by laparoscopic surgery. We report the rare case together reviews of the literatures including the indication and the procedure.

A 71 – year – old woman visited to our hospital with a chief complain of abdominal distension. The computed tomography revealed that 4cm mass located between the stomach and the pancreas. The upper gastrointestinal endoscopy revealed that the submucosal tumor located on the upper stomach body. PET ( positron emission tomogrphy ) – CT revealed no abnormal uptake of FDG on the region. We diagnosed the low malignancy tumor, so we selected laparoscopic resection.

The laparoscopic surgery was performed with the preoperative diagnosis of 1 ) the pedunculated growth gastric GIST, 2 ) lesser GIST adhere to vessels, or 3 ) GIST no adhere to vessels. In operative findings, the tumor adhered to left gastric artery and vein. It was easier to remove the tumor with together left gastric vessels than to preserve them. However we preserved them with the consideration of ischemic of stomach after the operation. The tumor was isolated from left gastric vessels by using LCS. We thought that if tumor size was more 5cm in diameter, or it had positive uptake of PET, we should remove the tumor with together left gastric vessels.

The tumor was a well circumscribed mass with solid and partially cystic surface. The post operative course was uneventful.

Histologically, it consisted of spindle cells and with mitotic counts of less than 5 per 50 high – power fields. Immunohistochemically, it was negative for alpha – smooth muscle actin and S – 100 protein, but positive for C – kit and CD 34. The pathological diagnosis was low malignancy GIST of lesser omentum ( The tumor was kept intact from the stomach wall ).

The laparoscopic surgery is a minimally invasive and useful method for GIST of lesser omentum.

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