Gastrointestinal Stromal Tumor in a roux en Y limb
Keywords:
CD 117, DOG1, Gastrointestinal Stromal Tumor, Roux-en-Y anastomosis
Abstract
Our patient, a 54 year old male came with abdomen distension and pain for 5 months with on and off constipation. Per abdominal examination revealed a midline scar with an ill-defined mass in the epigastrium and right hypochondrium. Endoscopy revealed a bulge in the posterior wall of the stomach. Contrast enhanced CT scan suggested a lesion arising from the posterior wall of stomach. But, laprotomy showed the mass to be arising from the blind end of the jejunum, post roux-en-Y anastomosis. We received a globular mass measuring 14x8x7.5 cm attached to one end of the intestine. External surface was grey tan to grey brown with multiple nodules of varying sizes. Cut surface was variegated with solid and cystic areas filled with blood. Our initial differential diagnoses were leiomyosarcoma, angiosarcoma, inflammatory fibroid polyp and GIST.Microscopy revealed spindle cells with mild to moderatepleomorphismadmixed with lymphocytes and plasma cells with mitotic count of four per 50 high power fields. By immunohistochemistry the spindle cells were CD117 and DOG1 positive which prompted a diagnosis of gastrointestinal stromal tumor. We present this case for the uncommon location of GIST in a roux en Y limb.References
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2. Liegl-Atzwanger B, Fletcher JA, Fletcher CDM. Gastrointestinal stromal tumors. Virchows Arch. 2010;456(2):111–27.
3. Jaison J, Joshi SR, Pathak S, Tekwani D, Nagare M. Gastrointestinal Stromal Tumour at An Unusual Site Jejunum: A Case Report. Int J Sci Stud 2014; 2(4):80-83.
4. Rosai Juan, Lauren V. Ackerman. Gastrointestinal Tract. Rosai and Ackerman's Surgical Pathology. Edinburgh: Mosby, 2011.p. 638-644.
5. Zhi X, Jiang B, Yu J, Røe OD, Qin J, Ni Q, et al. Prognostic role of microscopically positive margins for primary gastrointestinal stromal tumors: a systematic review and meta-analysis. Sci Rep [Internet]. 2016;6:21541.
6. Joensuu H, Hohenberger P, Corless CL. Gastrointestinal stromal tumour. Lancet (London, England) [Internet]. 2013 Sep 14 [cited 2016 Jun 2];382(9896):973–83.
7. Nishida T, Blay J-Y, Hirota S, Kitagawa Y, Kang Y-K. The standard diagnosis, treatment, and follow-up of gastrointestinal stromal tumors based on guidelines. Gastric Cancer [Internet]. 2016 Jan [cited 2016 May 16];19(1):3–14.
8. Fagkrezos D, Touloumis Z, Giannila M, Penlidis C, Papaparaskeva K, Triantopoulou C. Extra-gastrointestinal stromal tumor of the omentum: a rare case report and review of the literature. Rare Tumors [Internet]. 2012 Jun 26 [cited 2016 Jun 1];4(3):e44.
9. Behammane H, Aggouri Y, Oussaid M, et al. Stromal tumor of the lesser omentum : a case report. Pan Afr Med J [Internet]. 2014 Jan [cited 2016 Jun 1];17:236.
10. Bhatt NR, Collins D, Crotty P, Ridgway PF. Prognosis and management of adult Wild Type GastroIntestinal Stromal Tumours (GISTs): A pooled analysis and review of literature. Surg Oncol [Internet]. 2016 May [cited 2016 May 16];
11. Joensuu H, Rutkowski P, Nishida T, et al. KIT and PDGFRA mutations and the risk of GI stromal tumor recurrence. J Clin Oncol [Internet]. 2015 Feb 20 [cited 2016 May 18];33(6):634–42.
12. Chojecki A, Moss RA, Zhong H, et al. Abstract 08: Role of upfront genomic analysis of gastrointestinal stromal tumors to identify imatinib-insensitive or resistant cases. Clin Cancer Res [Internet]. 2016;22(1_Supplement):08
13. Cauchi C, Trent JC, Edwards K, et al. An unusual site of metastasis from gastrointestinal stromal tumor. Rare Tumors [Internet]. 2010 Jan;2(4):e58.
14. Hilal L, Barada K, Mukherji D, Temraz S, Shamseddine A. Gastrointestinal (GI) leiomyosarcoma (LMS) case series and review on diagnosis, management, and prognosis. Med Oncol [Internet]. 2016;33(2):20.
15. De Petris G, Leung ST. Pseudoneoplasms of the gastrointestinal tract. Arch Pathol Lab Med [Internet]. 2010;134(3):378–92.
16. Yacoub A, Bank L, Sidhu JS. First Case of Small Bowel Cancer in a Post Roux-en-Y Gastric Bypass Weight-Loss Surgery: A Case Report [Internet]. Journal of Medical Cases. 2015 [cited 2016 May 16]. p. 137–9.
17. Magge D, Holtzman MP. Gastric Adenocarcinoma in patients with Roux-en-Y Gastric bypass: A case series. Surg Obes Relat Dis; 2015;11(5):e35–8.
Published
2016-11-05
Section
Case Report
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