Giant gastrointestinal stromal tumor of the proximal ileum

ABSTRACT

The gastrointestinal stromal tumors (GIST) are rare and consist in mesenchymal neoplasms of the gastrointestinal tract, which may affect any part of the gastrointestinal tract, and is more frequent in stomach. We report a case of a 65-years-old male patient who presented a mass in the proximal ileum found by exploratory laparotomy. The patient underwent a segmental enterectomy with total resection of the tumor and free surgical margins with the pathological diagnosis of GIST, confirmed by immunohistochemistry (CD117).

Key words:
ileum; gastrointestinal stromal tumor; small intestine tumor

RESUMEN

Los tumores del estroma gastrointestinal (GIST) son raros, consisten en neoplasias de origen mesodérmico del tracto gastrointestinal y pueden acometer cualquier parte del tracto gastrointestinal, siendo más frecuentes en el estómago. Reportamos el caso de un paciente varón, de 65 años de edad, con una masa en el íleon proximal, descubierta mediante laparotomía exploratoria. Se ha realizado una enterectomía segmentaria, con la resección total del tumor y márgenes quirúrgicos libres. El diagnóstico anatomopatológico de GIST fue confirmado por inmunohistoquímica (CD117).

Palabras clave:
íleon; tumor del estroma gastrointestinal; tumor del intestino delgado

RESUMO

Os tumores estromais gastrointestinais (GISTs) são raros, consistem em neoplasias mesenquimais do trato gastrointestinal e podem acometer qualquer parte do trato gastrointestinal, sendo mais frequentes no estômago. Relatamos o caso de um paciente do sexo masculino, 65 anos de idade, com uma massa em íleo proximal, descoberta em uma laparotomia exploradora. Foi realizada enterectomia segmentar com ressecção total do tumor e margens cirúrgicas livres, com o diagnóstico anatomopatológico de GIST confirmado por imuno-histoquímica (CD117).

Unitermos:
íleo; tumor estromal gastrointestinal; tumor de intestino delgado

INTRODUCTION

Gastrointestinal stromal tumors (GIST) are rare and account for about 1% of gastrointestinal tumors⁽¹⁾, which can affect any part of the gastrointestinal tract, and are more frequent in the stomach⁽²⁾, predominantly in the age group 50-60 years⁽³⁾, with no prevalence between men and women⁽²⁾. Such tumors present mesenchymal origin in the interstitial cells of Cajal^{(2, 4)}.

CASE REPORT

A 65-year-old male patient presented a mass in the proximal ileum found during exploratory laparotomy. Tumor resection was performed with free surgical margins; the material was submitted to pathological anatomy examination whose macroscopy revealed a tumor lesion measuring 13.5 × 13 × 8.5 cm, and sections showed a cystic lesion with a white solid area and a necrotic component in the wall, draining hemorrhagic fluid (Figure 1). Microscopy revealed a tumor with spindle cells, elongate nuclei, abundant cytoplasm, marked congestion and necrosis (Figure 2). The anatomopathological diagnosis was GIST, confirmed by immunohistochemistry (CD117).

FIGURE 1
Macroscopy: cystic lesion with solid white area and hemorrhagic walls near the ileum

FIGURE 2
Microscopy, 400×, HE: spindle cells, with elongated nuclei and abundant cytoplasm

HE: hematoxylin and eosin.

DISCUSSION

GISTs are considered rare tumors when compared to other gastrointestinal tumors. However, they are the most common type among mesenchymal tumors of the gastrointestinal tract. Immunohistochemistry by CD117 confirms the diagnosis. Complete surgical resection of the lesion with safety margin is the main curative approach for patients with primary tumors; however, Imatinib chemotherapy is also used depending on patient’s clinical conditions^(1,5).

REFERENCES

• ¹
  Barchi LC, Gama-Rodrigues J, Carvalho FAPM, Barchi MC, Oliveira OCG, Carneiro MF. Tumor estromal gástrico cístico C-kit negativo. ABCD Arq Bras Cir Dig. 2012; 25(4): 300-2. Available at: http://dx.doi.org/10.1590/S0102-67202012000400018
  » http://dx.doi.org/10.1590/S0102-67202012000400018
• ²
  Silva FE, Ascoly MH, Scofano V, Arakaki JRN, Reis O, Mags SA. Tumores estromais gastrointestinais - Gist: relato de um caso. Rev Bras Coloproct [Internet]. 2004; 24(2): 159-64. Available at: http://www.jcol.org.br/revista/nbr242.php#datatopo
  » http://www.jcol.org.br/revista/nbr242.php#datatopo
• ³
  Yamamoto FZ, Fernandes da Costa GGR, Ururahy RR, et al. Tumor estromal gastrointestinal gigante em ângulo de Treitz - relato de caso e revisão de literatura. Arq Med Hosp Fac Cienc Med Santa Casa São Paulo [Internet]. 2017; 62(2): 110-4. Available at: http://arquivosmedicos.fcmsantacasasp.edu.br/index.php/AMSCSP/article/view/54/40
  » http://arquivosmedicos.fcmsantacasasp.edu.br/index.php/AMSCSP/article/view/54/40
• ⁴
  Rubini P, Tartamella F. Primary gastrointestinal stromal tumour of the ileum pre-operatively diagnosed as an abdominal abscess. Mol Clin Oncol. 2016; 5(5): 596-8. PubMed PMID: 27900093.
• ⁵
  Ray MS, Deepak BS. Giant gastrointestinal stromal tumor of ileum: the gist of GIST: a case report. Int Surg J [Internet]. 2017; 4(3): 1096-100. Available at: http://dx.doi.org/10.18203/2349-2902.isj20170868
  » http://dx.doi.org/10.18203/2349-2902.isj20170868

Publication Dates

• Publication in this collection
  02 Sept 2019
• Date of issue
  Jul-Aug 2019

History

• Received
  29 Mar 2019
• Reviewed
  03 Apr 2019
• Accepted
  03 Apr 2019
• Published
  20 Aug 2019