Gastrointestinal Stromal Tumor in Cardia and Small Stomach Curvature: A Case Report
Gastrointestinal Stromal Tumors (GISTs) are the most common gastrointestinal mesenchymal tumors and in 80% of the cases are associated with KIT activating mutations. The incidence of GISTs is generally 10-20 cases per million population, which turn out to be malignant in 20-30% of cases. GISTs can be large and present with dysphagia, even though they are usually small and asymptomatic. A 67-year-old woman was referred to the hospital complaining of pain and burning in epigastric area and left flank; the patient had experienced a weight loss within one month before the admission. Primary investigations upon upper endoscopy revealed a submucosal mass in distal part of esophagus, and nodularity and erythema in stomach. But through more examinations by MDCT of Abdomen and Pelvis, a mass measuring 20*33 mm in cardiac and lesser curvature submucosa, without lymphadenopathy was reported, that could suggest GIST. This mass was excised with normal margins via wide local excision, bilayer cardiplasty and funduplication. The patient was hospitalized for 10 days after surgery, and was discharged with good general condition. In follow-up, there wasn’t any sign of dysphagia and dyspepsia within 24 months. In the patients suffering from GIST, the tumor location appears to have the most important role on deciding whether to perform local excision or not. Treatment of GISTs locating near gastroesophageal junction (GE junction) is still challenging. Using an appropriate therapeutic method is crucial in improving the patient’s quality of life. Therefore, wide local excision followed by bilayer cardiplasty and funduplication, could be considered as the appropriate therapeutic protocol in such same situations due to elimination of post total gastrectomy adverse effects and the tumor relapse.
Shinagare A, Zukotynski K, Krajewski K, Jagannathan J, Butrynski J, Hornick J, et al. Esophageal gastrointestinal stromal tumor: report of 7 patients. Cancer Imaging. 2012;12(1):100-
Bagheri R, Gh M, Tavasoli A. Esophagogastricmesenchymal tumors: analysis of 24 patients. Tehran University of Medical Sciences. 2011;69(7).
Kafeel M, Cheedella N, Wang J. Esophageal gastrointestinal stromal tumors presenting as mediastinal mass. Case reports in oncology. 2013;6(3):579-84.
Sjogren PP, Banerji N, Batts KP, Graczyk MJ, Dunn DH. Rare presentation of a gastrointestinal stromal tumor with spontaneous esophageal perforation: a case report. International journal of surgery case reports. 2013;4(7):636-9.
Gh M. Esophageal leiomyomatosis in a 70-year-old man: a case report. Tehran University Medical Journal TUMS Publications. 2008;66(6):437-40.
Simoglou C, Mikroulis D, Konstantinou F, Bougioukas G. Giant 10 cm Diameter Esophageal Gastrointestinal Stromal Tumor (GIST). World Journal of Cardiovascular Surgery. 2014;4(11):177.
Vicente E, Quijano Y, Ielpo B, Duran H, Diaz E, Fabra I, et al. Robot‐assisted resection of gastrointestinal stromal tumors (GIST): a single center case series and literature review. The International Journal of Medical Robotics and Computer Assisted Surgery. 2015.
Kang HC, Menias CO, Gaballah AH, Shroff S, Taggart MW, Garg N, et al. Beyond the GIST: mesenchymal tumors of the stomach. Radiographics. 2013;33(6):1673-90.
Lott S, Schmieder M, Mayer B, Henne-Bruns D, Knippschild U, Agaimy A, et al. Gastrointestinal stromal tumors of the esophagus: evaluation of a pooled case series regarding clinicopathological features and clinical outcome. American journal of cancer research. 2015;5(1):333.