Primary Jejunal Gastrointestinal Stromal Tumor: Diagnosis Delay of 3 Years but Successful Management in Early Stage (II) by Surgery and Adjuvant Therapy

Abstract

In the digestive system, mesenchymal origin of tumors is quite rare; in general, they are recognized as gastrointestinal stromal tumors (GISTs). The incidence of GISTs is very low (2 in 100,000), while jejunal GISTs are extremely rare, accounting for 0.1–3% of all gastrointestinal (GI) tumors. Small intestinal GISTs are the second most common (25%) site in the GI tract, usually occurring in the duodenum. We present the case of a 62-year-old Bangladeshi female with a history of GI bleeding 3 years earlier; the cause of the bleeding had not been found despite extensive investigations. In the meantime, the patient had developed occasional abdominal pain and lumpy feelings in the right side of the abdomen without any GI bleeding. Exploratory laparotomy was carried out in view of a small intestinal mesenteric mass in a computed tomography scan. On midline incision there was a 6 × 6 cm mass in the antimesenteric border of the jejunum approximately 30 cm from the duodenojejunal flexure, which was resected followed by anastomosis. The presentation of GISTs ranges from asymptomatic to mild abdominal pain and mass (5–50%) and mechanical obstruction (5%) as well as hemorrhage – perforation having rarely been reported (0.8%) – making the diagnosis difficult. Exophytic growth of these tumors has been noted in 18–30% of cases. In view of intermediate risk of malignancy, the patient was started with adjuvant imatinib 400 mg once daily due to probability of disease recurrence (24%).

An Extragastrointestinal Stromal Tumor Arising From the Omentum in a Young Hispanic Male

“…Initial workup for GISTs includes abdominal and pelvic imaging specifically using CT with intravenous and oral contrast to help define the bowel margins [ 16 ]. Magnetic resonance imaging and positron emission tomography may help define the mass but are less useful in this scenario.…”

“…After excision and surgical recovery, maintenance therapy of the neoplasm may be pursued. For tumors larger than 2 cm, chest imaging with X-ray or CT is recommended [ 16 ]. Given the association of GISTs with genetic syndromes, it is important to have younger patients evaluated for mutations as they may be at increased risk for further disease from these syndromes.…”

Solutions to the Drawbacks of Photothermal and Photodynamic Cancer Therapy

“…[ 1 ] The treatment of tumors has always been an urgent need to be addressed in various countries. In addition to the continuous improvement and innovation of traditional treatments such as surgical resection, radiotherapy, and chemotherapy, [ 2–4 ] many new treatments have gradually entered the stage. For example, tumor immunotherapy has gained a great progress, especially in the treatment of hematological tumors.…”