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      Robot-assisted resection of GIST in the proximal jejunum

      case-report
      Author(s): ,
      Publication date (Electronic):
      Journal: Journal of Surgical Case Reports
      Publisher: Oxford University Press

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          Abstract

          Gastrointestinal stromal tumors (GISTs) are rare. Although most commonly found in the stomach, GISTs in the jejunum are among the rarest subtypes. A 46-year-old woman presented to the surgical department with proximal jejunal mass found in the examinations after abdominal pain and melena. Computed tomography imaging showed a 2.3 cm sized well-defined heterogenous enhancing mass in the proximal jejunum, and GIST was strongly suspected. The jejunal mass was identified 5 cm below the ligament of Treitz intraoperatively. She underwent robotic-assisted jejunal resection with intracorporeal robot-sewn anastomosis. The patient’s postoperative course was uneventful, and she was discharged on the seventh postoperative day. A robotic approach for GIST in the proximal jejunum is a safe and feasible procedure with good surgical outcomes.

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          Gastrointestinal stromal tumors of the jejunum and ileum: a clinicopathologic, immunohistochemical, and molecular genetic study of 906 cases before imatinib with long-term follow-up.

          Markku Miettinen, Hala Makhlouf, Leslie Sobin … (2006)
          Gastrointestinal (GI) stromal tumors (GISTs), the specific KIT- or PDFGRA-signaling driven mesenchymal tumors, are the most common mesenchymal tumors of the GI tract. This study analyzed 1091 tumors originally classified as smooth muscle tumors of the small intestine (including jejunum or ileum and excluding duodenum), and found that 906 (83%) of these were GISTs. The GIST patients had 55:45 male-to-female ratio with a median age of 59 years (range, 13-94 years). Only 0.6% of tumors occurred before the age of 21 years and 13.6% before the age of 40 years. The tumors varied from 0.3 to 40 cm (median, 7.0 cm) and most commonly presented with GI bleeding or acute abdomen; 18% were incidentally detected. Histologically, the tumors were relatively monotypic with spindle cell (86%), epithelioid (5%), or mixed patterns (9%). Skeinoid fibers were present in 44% of cases, and their presence was associated with a favorable course. Most epithelioid tumors were malignant, and this morphology sometimes emerged from less cellular and less mitotically active spindle cell tumors, suggesting that it represented a transformation. KIT was immunohistochemically detected in 98%, CD34 in 40%, smooth muscle actin in 34%, desmin in 0.2%, and S-100 protein in 14% of the tumors tested. Outcome was strongly dependent on tumor size and mitotic activity, with an overall 39% tumor-related mortality, twice that for gastric GISTs. Only 10 cm and >5 mitoses/50 HPF metastasized. In stark contrast to corresponding gastric tumors, tumors >10 cm with mitotic activity 5/50 HPF had a high metastatic rate (>50%); tumors >5 cm < or = 10 cm with low mitotic rate had a 24% metastatic rate. The median survival times of patients with low mitotic rate tumors who died of disease decreased by increasing tumor size. KIT exon 11 mutations were detected in 90 cases, exon 9 mutation in 17 cases, and exon 17 mutation in 1 case; the presence of mutation or mutation type was not prognostically significant. There were no PDGFRA exon 12 or 8 mutations. Systematic data on prognosis of small intestinal GISTs of various size and mitotic activity categories can be helpful in management and surveillance of patients with these tumors.
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            Gastrointestinal stromal tumor: 5 years later.

            Ronald DeMatteo, Marike van der Schaaf (2005)
            There is now considerable interest in gastrointestinal stromal tumor (GIST) because it can be treated effectively with a targeted molecular agent. The majority of GISTs contain an activating mutation in the KIT protooncogene or, occasionally, in the platelet-derived growth factor-alpha (PDGFRA) gene. Five years ago, imatinib mesylate, a specific molecular inhibitor of the protein products of these 2 genes, was applied to metastatic GIST. Approximately 80% of patients with metastatic GIST benefit from imatinib, although acquired resistance to the agent may develop. For patients with primary GIST, surgery remains the treatment of choice, and whether outcome is improved by adjuvant imatinib is currently under broad investigation. A combination of imatinib therapy and surgery also may be effective in a subset of patients with metastatic or unresectable primary GIST. In this review, the authors summarize the new multimodality approach to GIST. The integration of surgery and molecular therapy in GIST will serve as a prototype for the management of other solid tumors for which targeted agents become available. (c) 2005 American Cancer Society.
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              Current management of gastrointestinal stromal tumors--a comprehensive review.

              Eric Lai, Stephanie Lau, Wan Lau (2012)
              Gastrointestinal stromal tumors (GISTs) comprise < 1% of all gastrointestinal (GI) tumors, but GISTs are the most common mesenchymal tumors of the GI tract. Dramatic changes in clinical practice have been observed in the last decade. This review highlights the overall management of GIST and its recent developments. We identified literature by searching Medline and PubMed from January 1995 to December 2011 using the keywords "gastrointestinal stromal tumors", "GIST", "imatinib" and "tyrosine kinase inhibitor". Additional papers were identified by a manual search of the references from the key articles. There were no exclusion criteria for published information to the topics. For localized primary GISTs, surgical resection is the mainstay of therapy. The 5-year survival rate after complete resection of GISTs is approximately 50%-65%. Many factors including tumor size, mitotic rate, tumor location, kinase mutational status and occurrence of tumor rupture have been extensively studied and proposed to be predictors of survival outcomes. Adjuvant imatinib is proposed as an option for those patients with a substantial risk of relapse. Unresectable metastatic or recurrent GIST can be treated with a tyrosine kinase inhibitor, imatinib, with a remarkable response (50%-70%) and prolonged survival (median progression-free survival: 18-20 months; median overall survival: 51-57 months). The standard approach in the case of tumor progression on 400 mg once per day is to increase the imatinib dose to 400 mg twice per day as permitted by toxicity. Use of a second-line targeted agent, sunitinib, in patients with advanced GIST who fail (or are intolerant of) imatinib therapy is advised. Treatment for GISTs has become increasingly complex because of the growing understanding of its biology. A multidisciplinary team that includes radiologists, medical oncologists, pathologists, and surgeons is paramount for the effective treatment of GIST. Copyright © 2012 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.
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                Author and article information

                Contributors
                Myeong Hun Oh
                Byoung Chul Lee:
                ORCID: http://orcid.org/0000-0003-1468-096X
                Journal
                Journal ID (nlm-ta): J Surg Case Rep
                Journal ID (publisher-id): jscr
                Title: Journal of Surgical Case Reports
                Publisher: Oxford University Press
                ISSN (Electronic): 2042-8812
                Publication date Collection: October 2020
                Publication date (Electronic): 03 October 2020
                Publication date PMC-release: 03 October 2020
                Volume: 2020
                Issue: 10
                Electronic Location Identifier: rjaa301
                Affiliations
                Department of Surgery , Pusan National University Hospital, Busan, Korea
                Department of Surgery , Pusan National University Hospital, Busan, Korea
                Author notes
                Correspondence address. Department of Surgery, Pusan National University Hospital, 179, Gudeok-ro, Seo-gu, Busan 49241, Korea. Tel: +82-51-240-7238; Fax: +82-51-247-1365; E-mail: gsbc3927@ 123456gmail.com
                Author information
                http://orcid.org/0000-0003-1468-096X
                Article
                Publisher ID: rjaa301
                DOI: 10.1093/jscr/rjaa301
                PMC ID: 7532830
                SO-VID: 46580a2a-90c8-485c-8bda-b55c0c702c24
                Copyright © Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. © The Author(s) 2020.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

                History
                Date received : 22 May 2020
                Date revision received : 12 July 2020
                Date accepted : 15 July 2020
                Page count
                Pages: 3
                Categories
                Subject: AcademicSubjects/MED00910
                Subject: jscrep/0160
                Subject: Case Report

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