Paul R Clark, MD. Florida State University college of medicine
Introduction: The aim of this manuscript is to present a case of gastrointestinal stromal tumor in severely anemic Jahovah’s witness patient and to discuss management options. Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the GI tract and represent ~ 0.1-3% of all GI tumors. A review of the current literature is also presented.
Case Presentation: The authors present the case of a 66-year-old female who is a practicing Jahovah’s witness presenting with headache and dark tarry stools. Patient was found to be severely anemic; Hb of 5.4. Endoscopy showed a prolapsed nodular lesion in the cardia roughly 2.5 cm with superficial ulceration and active bleeding, this was treated with epi injection and APC ablation. Patient was taken to the operating room and underwent a laparoscopic partial gastrectomy, hiatal hernia repair and intraoperative EGD. Blood loss was minimal and post op Hb was stable at 5.4. Pathology revealed clear margins with 5.7 cm greatest diameter, mitotic count 1 per 50 HPF. The tumor was therefore intermediate risk, requiring no adjuvant Imantinib therapy and surveillance with CT q 3-6 months for 1st 3-5 years providing a estimated recurrence free survival 2-5 yrs > 90 % and 10 yrs 80-87 %. Patient was discharged on erythropoietin post operative day 3.
Conslusion: Gastrointestinal stromal tumors (GISTs) rare neoplasms representing ~ 0.1-3% of all GI malignancies. GISTs are most commonly found in the stomach and present with bleeding. CT with IV contrast is recommended imaging modality and preoperative biopsy is not routinely necessary for a primary resectable neoplasm suspicious for GIST and may increase risk of rupture w/ dissemination or bleeding. However if metastatic disease suspected or differential includes other malignancies such as lymphoma a biopsy is warranted. In 2008 Imantinib (antineoplastic tyrosine kinase inhibitor) was approved for daily dose of 400mg by FDA for adjuvant therapy for high risk patients following complete resection and is recommended for adjuvant therapy depending on an estimation of the risk of recurrence, which is based on tumor size, mitotic index, location in GI tract, and the presence or absence of tumor rupture (either spontaneously or during surgery). Minimally invasive laparoscopic resection of primary GISTs can be preformed following basic oncologic principles and is particularly appealing in patients with bleeding with contraindications to transfusion.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79577
Program Number: P602
Presentation Session: Poster (Non CME)
Presentation Type: Poster
