3.12 a rare case of gist presented as leiomyoma

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Hiremath PB et al., Int J Med Res Health Sci.2013;2(2):317-320

International Journal of Medical Research

&

Health Scienceswww.ijmrhs.com Volume 2 Issue 2 April-June Coden: IJMRHS Copyright @2013 ISSN: 2319-5886

Received: 7th

Mar 2013 Revised: 28th

Mar 2013 Accepted: 31st

Mar 2013

Case Report

A RARE CASE OF GIST PRESENTED AS LEIOMYOMA

*Hiremath PB1, Nidhi Bansal2 , Meenal C3 , Thulasiraman VN 4, Arun Kumar SP5, Reshma Hiremath6

1 Associate Professor, 2 Assistant Professor, 3 Professor & Head, Dept. of Obstetrics & Gynaecology,

SVMCH & RC, Ariyur, Puducherry4

Professor, Dept. of General Surgery, SVMCH & RC, Ariyur, Puducherry5 Professor & Head , Dept. of Pathology, SVMCH & RC, Ariyur, Puducherry6 IMO Mapusa, Goa.

*Corresponding author email: [email protected]

ABSTRACT

Gastrointestinal stromal tumour (GIST) is the most commonly identified mesenchymal tumour of the

gastrointestinal tract. There is a great deal of dilemma in diagnosing GIST . Confirmation is possible

only by histopathological examination and by immunohistochemistry. Complete surgical removal

followed by long term postoperative chemotherapy is essential for the optimal cure.

Keywords: GIST, Ileum, cellular leiomyoma, Imatinib

INTRODUCTION

Gastrointestinal stromal tumor (GIST) is a most

common mesenchymal tumor of gastrointestinal

tract (G.I)tract (80%)1. The incidence of GIST is

1020 million people per year with a malignantpotential of 20-30%1,2. Presentations include

abdominal mass (5-50%), obstruction (5%),

haemorrhage and rarely perforation (0.8%)4,5.

CASE REPORT

A 50year old, post menopausal, an asymptomatic

woman came with an ultrasound report showing

uterus measuring 9x4.6x4.9cm with

heterogenous echotexture, evidence of 6x4.2cmisoechoeic lesion seen antero-superior to uterus

with internal vascularity and attached to the

uterus. Both ovaries not clearly seen. Impression

Pedunculated fibroid Right ovarian mass

Endometriotic deposit. P4L4A2. All FTND and a

known case of hypertension on regular treatment.

On examination general condition was fair, pulse

rate of 82/min, BP of 130/90mmHg. Abdominal

examination was normal, no mass palpable. On

bimanual examination, uterus was irregularly

enlarged to 14-16 weeks size, both the fornices

free, no mass palpable. Investigations: Hb-

11gms%, Blood group O+ve, RBS-142mgs%,

Blood urea - 28mg%, Serum Creatinine-

0.8mg%, HIV- negative, HbsAg- negative , chest

x ray - normal, ECG- normal. USG as mentioned

above.Patient was taken for Laparoscopy.

Intraoperative findings uterus not visualized,

317

DOI: 10.5958/j.2319-5886.2.2.003


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DISCUSSION

Gastrointestinal stromal tumour (GIST) is most

common mesenchymal tumour of gastrointestinal

tract (GI)tract (80%)1. The incidence of GIST is

1020 million people per year with a malignantpotential of 20-30%.Presentations include

abdominal mass (5-50%), obstruction (5%),

haemorrhage and rarely perforation (0.8%)1,2.

GIST tumors arise either from stem cells that

differentiate towards Interstitial Cells of Cajal or

directly from Interstitial Cells of Cajal

(ICCs)..GIST are most often characterized by

strong immunoreactivity to the KIT protein, the

CD117 antigen3. On the other hand, leiomyoma,

leiomyosarcoma , schwannoma , lipoma, ,

hemangioma, are negative for CD1174.

Risk criteria were first published in 2001 and

were amended as more was learned about the

importance of mitotic rate, anatomic primary

site, and size, in large part due to large case

series developed by Miettinen, Lasota and

colleagues5,6.

GISTs are chemotherapy and radiotherapy

resistant and there remains high risk ofrecurrence after tumor resection 7-10. All GISTs

have a potential for malignancy and the

standard therapy is complete surgical removal

with negative tumor margins 11 . 50% of patients

with GIST will have a relapse after surgery,

necessitating the need for adjuvant

chemotherapy9.

The culprit for the pathogenesis of this tumour is

the mutations of the KIT proto-oncogene and the

tumors show a immunoreactivity to the KIT

protein, the CD117 antigen 12,13. KIT tyrosine

kinase inhibitor has showed a hope of improved

outcome in advanced GIST. Imatinib mesylate is

one such tyrosine kinase blocker being

considered as the drug of choice for advanced

tumour14-16. Imatinib is also being used for

palliative therapy or in patients with recurrent

disease.

CONSENT

Consent for publication of this case report was

taken from the patient, copy of which is available

with the corresponding author.

ACKNOWLEDGEMENT

We would like to extend our heartfelt gratitude to

the head of dept, Obstetrics & Gynecology and

Professor, Dept of General surgery and Dept of

Pathology.

REFERENCES

1. Efremidou EI, Liratzopoulos N,Papageorgiou MS, Romanidis K. Perforated

GIST of the small intestine as a rare cause of

acute abdomen: surgical treatment andadjuvant therapy. Case report. J

Gastrointestin Liver Dis 2006, 15:297-99.

2. Oida Y, Motojuku M, Morikawa G, MukaiM, Shimizu K, Imaizumi T, Makuuchi H:

Laparoscopic-assisted resection of

gastrointestinal stromal tumor in small

intestine. Hepatogastroenterology 2008,

55:14649.

3. Hirota S, Isozaki K, Moriyama Y, HashimotoK, Nishida T, Ishiguro S, et al.: Gain-of-

function mutations of c-kit in human

gastrointestinal stromal tumors. Science 1998;

279(5350.):577-80.

4. Rubin BP, Fletcher JA, Fletcher CD:Molecular Insights into the Histogenesis and

Pathogenesis of Gastrointestinal Stromal

Tumors. Int J Surg Pathol 2000,8(1):510

5. Miettinen M, Makhlouf H, Sobin LH, LasotaJ: 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. Am J Surg Pathol 2006,

30:47789.

6. Miettinen M, Sobin LH, Lasota J:Gastrointestinal stromal tumors of the

stomach: a clinicopathologic, immunehisto

chemical, and molecular genetic study of

1765 cases with long-term follow-up. Am J

Surg Pathol 2005,29:5268.

319


4/4


7. Pierie JP, Choudry U, Muzikansky A, YeapBY, Souba WW, Ott MJ. The effect of

surgery and grade on outcome of

gastrointestinal stromal tumors. Arch

Surg 2001; 136(4):383-89.

8. Edmonson JH, Marks RS, Buckner JC,Mahoney MR. Contrast of response to

dacarbazine, mitomycin, doxorubicin, and

cisplatin (DMAP) plus GM-CSF between

patients with advanced malignant

gastrointestinal stromal tumors and patients

withother advanced leiomyosarcomas. Cancer

Invest 2002; 20(5):605-12.

9. DeMatteo RP, Lewis JJ, Leung D, Mudan SS,Woodruff JM, Brennan MF: Two hundredgastrointestinal stromal tumors: recurrence

patterns and prognostic factors for

survival. Ann Surg 2000; 231(1)51-58.

10.Miettinen M, Makhlouf H, Sobin LH, LasotaJ: Gastrointestinal stromal tumors of the

jejunum and ileum: a clinicopathologic,

immunohistochemical, and molecular genetic

study of 906 cases before imatinib with long-

term followup. AmJSurg Pathol. 2006;

30(4):477-89.

11.Casali PG, Jost L, Reichardt P, Schlemmer M,Blay JY: Gastrointestinal stromal tumors:

ESMO clinical recommendations for

diagnosis, treatment and follow-up. Ann

Oncol 2008; 19(2); 35-38

12.Fletcher CD, Berman JJ, Corless C, GorsteinF, Lasota J, Longley BJ, et al.: Diagnosis of

gastrointestinal stromal tumors: a consensus

approach. Int J Surg Pathol 2002; 10(2):81-89.

13.Miettinen M, Lasota J: Gastrointestinalstromal tumors--definition, clinical,

histological, immunohistochemical, and

molecular genetic features and differential

diagnosis. Virchows Arch 2001; 438(1):1-12.

14.Joensuu H, Roberts PJ, Sarlomo-Rikala M,Andersson LC, Tervahartiala P, Tuveson D, et

al.: Effect of the tyrosine kinase inhibitorSTI571 in a patient with a metastatic

gastrointestinal stromal tumor. N Engl J

Med 2001; 344(14.);1052-6.

15.Demetri GD, von Mehren M, Blanke CD, Vanden Abbeele AD, Eisenberg B, Roberts PJ, et

al.: Efficacy and safety of imatinib mesylate

in advanced gastrointestinal stromaltumors. N Engl J Med 2002; 347(7):472-80.

16.Dematteo RP, Ballman KV, Antonescu CR,Maki RG, Pisters PW, Demetri GD, et

al.:Adjuvant imatinib mesylate after resection

of localised, primary gastrointestinal stromal

tumour: a randomised, double-blind, placebo-

controlled trial. Lancet 2009;373;(9669):

1097-104.

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3.12 a rare case of gist presented as leiomyoma

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