1/119. Pedunculated exogastric leiomyosarcoma: case report and brief literature review.A case report and review of the literature on pedunculated exogastric leiomyosarcomas are presented. Although about one-fourth of the stromal tumors (common leiomyomas and leiomyosarcomas) of the stomach grow in an exogastric configuration, pedunculated exogastric leiomyosarcomas are extremely rare. At present there is no evidence of intraperitoneal seeding from exogastric leiomyosarcomas. Consequently, a local resection with an adequate margin is sufficient when no invasion to the adjacent structures, is observed.- - - - - - - - - - ranking = 1keywords = stromal (Clic here for more details about this article) |
2/119. hemoperitoneum due to a ruptured gastric stromal tumor.BACKGROUND/AIMS: gastrointestinal stromal tumors form a group of uncommon neoplasms originated from pluripotential mesenchymal cells. Many patients are asymptomatic and the tumor is discovered during an abdominal operation. Massive intraperitoneal bleeding is an exceptional complication associated with high mortality rates. Our aim is to report a case of a gastric stromal tumor in an 83-year-old patient presenting with intraperitoneal hemorrhage and hypovolemic shock, successfully operated. methods: Emergency laparotomy showed a hemoperitoneum caused by rupture of a large exogastric tumor attached to the greater curvature. Total gastrectomy and esophagojejunostomy was performed. RESULTS: Histological examination revealed proliferation of spindle-shaped cells but immunocytochemistry failed to identify specific markers of smooth muscle and neural cells. diagnosis of a gastric stromal tumor was made. Postoperative evolution was uncomplicated. CONCLUSION: Gastric stromal tumor is a relatively rare neoplasm of mesenchymal origin whose nature and prognosis is unclear.- - - - - - - - - - ranking = 8keywords = stromal (Clic here for more details about this article) |
3/119. Gastric malignant stromal tumor with long stalk impacted into duodenum.Most GIST have traditionally been classified as submucosal origin by upper gastrointestinal series (UGIS) or endoscopy. However, we experienced a gastrointestinal mesenchymal origin tumor expressed by polypoid mass with a long stalk. The gastric outlet was obstructed by the polypoid mass on the duodenum. The microscopic findings of the resected mass showed a stromal cell component by immunohistochemical stain. We experienced gastric stromal tumor found as a polypoid mass with long stalk which was easily detected by endoscopy. It would not have been suspected as a stromal tumor as a result of endoscopic findings only.- - - - - - - - - - ranking = 7keywords = stromal (Clic here for more details about this article) |
4/119. Gastric leiomyosarcoma presenting as a sentinel hemorrhage.A 43-year-old Asian woman who was initially seen because of hematemesis later had a gastric leiomyosarcoma diagnosed. Epigastric palpation, computed tomography, and magnetic resonance imaging assisted in determining the size, borders, and location of the tumor while a second esophagogastroduodenoscopy revealed friable gastric mucosa with erosions. biopsy specimens taken for frozen section during surgical abdominal exploration revealed a malignant gastric stromal tumor. An en bloc excision of the mass then followed, with the final pathologic diagnosis a gastric leiomyosarcoma. Metastases were later found in the liver, peritoneum, and mesentery. Differentiation of gastric leiomyosarcoma from other stromal tumors is difficult and requires standardized nuclear and cellular evaluation of atypia, necrosis, mitosis, and tumor doubling time. The most common symptoms at initial presentation are abdominal pain and gastrointestinal bleeding. Abdominal computed tomography remains more specific in suggesting gastric stromal tumors than esophagogastroduodenoscopy and upper gastrointestinal barium series. lymph node involvement in gastric leiomyosarcoma is rare and affords the first-line therapy of laparoscopic wedge gastrectomy with a good prognosis in tumors less than 6 cm in diameter. The prognostic factors include metastasis, size of the tumor, histologic grade, dna ploidy of the tumor, and ulceration of overlying gastric mucosa.- - - - - - - - - - ranking = 3keywords = stromal (Clic here for more details about this article) |
5/119. Synovial sarcoma of the upper digestive tract: a report of two cases with demonstration of the X;18 translocation by fluorescence in situ hybridization.Two cases of synovial sarcoma that arose in the upper digestive tract are reported. One case was a polypoid mass that arose at the gastroesophageal junction; the other was a large intramural mass that arose in the wall of the stomach. Both cases had a classic biphasic pattern. In the stomach tumor, the biphasic morphology was focal and there was an abrupt transition to poorly differentiated synovial sarcoma. The tumors had immunohistochemical features that were consistent with synovial sarcoma. Ultrastructural evaluation of the gastroesophageal tumor supported the diagnosis. The diagnostic X;18 translocation was demonstrated by fluorescence in situ hybridization on sections from paraffin-embedded tissue in 86% and 50% of interphase nuclei from the gastroesophageal and gastric tumor, respectively. The translocation was present in equal frequency in the epithelial and spindle cells in the biphasic areas and the poorly differentiated areas of the gastric tumor, indicating that the development of the more aggressive subclone was probably due to genetic mutations not encompassing the SYT-SSX gene fusion product. We are aware of only five reported cases of synovial sarcoma arising in the digestive tract, all in the proximal esophagus. These cases are the first reported arising in the gastroesophageal junction and stomach and the only cases of synovial sarcoma of the digestive tract in which the diagnostic translocation was demonstrated. Sarcomatoid carcinoma (carcinosarcoma) and gastrointestinal stromal tumor are the main differential diagnoses for synovial sarcoma in this site. Synovial sarcoma of the digestive tract may be underdiagnosed, and its recognition may have important clinical implications. fluorescence in situ hybridization is helpful in making this distinction.- - - - - - - - - - ranking = 118.54361743177keywords = gastrointestinal stromal, stromal (Clic here for more details about this article) |
6/119. Synchronous occurrence of epithelial and stromal tumors in the stomach: a report of 6 cases.OBJECTIVE: The synchronous development of epithelial and stromal tumors in the stomach has been reported rarely in the literature. A series of 6 such cases is described in this article. methods: Clinical and pathologic data were recorded and the literature was reviewed. RESULTS: Five cases featured the simultaneous occurrence of stromal tumors (1 benign, 3 borderline, 1 malignant) and adenocarcinomas, whereas the stromal tumor in the sixth case was found in association with a carcinoid. No collision tumors were observed. In 2 cases, tumors arose from the same site and were closely juxtaposed, but in 4 patients they developed from different areas of the stomach. A preoperative histologic diagnosis of both tumors was not achieved in any case. Two patients harbored occult infiltrative epithelial lesions (1 diffuse-type adenocarcinoma, 1 carcinoid), which were detected only at pathologic examination of the gastric mucosa adjacent to the stromal tumor. CONCLUSIONS: The simultaneous occurrence of epithelial and stromal tumors in the stomach can be less rare than usually expected. Coincidence alone could account for such an association, particularly in areas with high incidence rates of gastric cancer. The hypothesis that a single carcinogenic agent might interact with two neighboring tissues in the stomach inducing the development of tumors of different histotype cannot be theoretically discarded.- - - - - - - - - - ranking = 9keywords = stromal (Clic here for more details about this article) |
7/119. The mini-laparoscopic intragastric resection of a gastroesophageal stromal tumor: a novel approach.The laparoscopic wedge resection of gastric stromal tumors has been shown to be safe and effective. The removal of these tumors at the gastroesophageal junction is not amenable to a typical local resection because of anatomic inaccessibility and potential luminal restriction after resection. Also, an esophagogastrectomy is not tenable in the setting of benign disease. The recent advances in miniaturized laparoscopic instrumentation (2-mm diameter) have expanded the laparoscopic options, including intraluminal resection. The first intragastric mini-laparoscopic resection of the gastric stromal tumor at the gastroesophageal junction is reported.- - - - - - - - - - ranking = 6keywords = stromal (Clic here for more details about this article) |
8/119. Gastric stromal tumor with CD34 immunoreactivity--a case report.Gastric stromal tumors are the most common mesenchymal tumors, and such submucosal mass lesions of the upper gastrointestinal tract occur frequently. A 54-year-old woman with no major complaint was admitted to our hospital for evaluation of a mass located between the stomach and the pancreas. Abdominal ultrasonography, computed tomography and endoscopic ultrasonography demonstrated a mass lesion which was located near the lesser curvature of the stomach. Selective left gastric arterial angiography revealed a hypervascular mass, and we diagnosed it as a leiomyosarcoma of the stomach. At laparotomy, there was a large solid mass 5 cm in diameter along the minor curvature of the stomach. Tumor resection with partial gastrectomy was performed, and the histological diagnosis was a gastric stromal tumor with CD34 immunoreactivity. We report a case of stromal tumor of the stomach with extramural growth and review the literature.- - - - - - - - - - ranking = 7keywords = stromal (Clic here for more details about this article) |
9/119. A case of gastrointestinal stromal tumor of the stomach.In a 55-year-old man, a tumor about 3 cm in diameter was detected in the upper abdomen by abdominal ultrasound screening during follow-up of chronic hepatitis c discovered in 1990. There were no symptoms and no abnormalities on physical examination. Tests for tumor markers were negative. By barium meal and gastroscopy, submucosal tumor was found on the lesser curvature of the stomach, with bridging fold in the absence of central ulceration. biopsy revealed no tumor tissue. Under the diagnosis of submucosal tumor of the stomach, either a leiomyoma or leiomyosarcoma, partial resection of stomach was performed. Direct invasion of the surrounding organs, lymph node metastasis or distant metastasis was not observed grossly in the operation. Histologic examination of the resected specimen revealed proliferation of spindle cells and oval cells in an interlacing pattern. immunohistochemistry for CD34, vimentin and c-kit protein was strongly positive, while smooth muscle actin, S-100 protein, desmin and p53 protein were negative. The proliferating cell nuclear antigen index was about 50%, while the MIB-1 index was < or = 1%. From these findings, this tumor was diagnosed as a gastrointestinal stromal tumor of the uncommitted type.- - - - - - - - - - ranking = 592.71808715885keywords = gastrointestinal stromal, stromal (Clic here for more details about this article) |
10/119. Surgical management of gastrointestinal stromal tumors of the stomach.BACKGROUND: gastrointestinal stromal tumors (GISTs) are rare tumors of the GI tract with varying degree of dignity and prognosis. Intramural or extragastral growth of gastric GISTs is associated with diagnostic difficulties and uncertainty about the type and extent of surgical therapy. Based on our experience, we tried to formulate management guidelines for gastric GISTs. methods: Five patients with gastric GIST (36-85 years old) underwent subserosal excision with subsequent B-II resection (1x), full-thickness partial gastric resection (2x), gastrotomy with submucosal excision (1x), or gastrectomy for carcinoma with an incidental finding of a leiomyoma (1x). RESULTS: Tumor size ranged from 2x2x1 cm to 9x6x4 cm. These tumors were classified as epithelioid leiomyosarcoma (1x), GIST (3x), or leiomyoma (1x). The prognosis of risk ranged from no risk (leiomyoma) to low-malignancy (leiomyosarcoma) depending on tumor size and mitotic index. No recurrent disease has been noted so far during follow-up ranging from 3 months to 6 years. CONCLUSIONS: Staging of gastric disease should include the probability of gastric GIST. Surgical resection is the therapy of choice for potential malignant GISTs to ensure a local radical removal. Metachronic metastases should be resected if possible. Depending on tumor stage and prognostic parameters, an individual follow-up with endoscopic and radiologic examinations is recommended. Further studies should be undertaken to elaborate prognostic determinants and stage-adapted treatment.- - - - - - - - - - ranking = 475.17446972708keywords = gastrointestinal stromal, stromal (Clic here for more details about this article) |
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