Coexistence of gastrointestinal stromal tumor of the stomach and small bowel adenocarcinoma: A case report

Year 2021, Volume: 38 Issue: 3, 393 - 395, 01.05.2021

Talat Ayyıldız , İbrahim Gören , Beytullah Yıldırım , Kağan Karabulut , Filiz  Karagöz , Murat Danacı Ahmet Bektaş , Kenan Erzurumlu

Abstract

The coexistence of gastrointestinal tumors (GIST’s) with other several primary malignant neoplasms has been demonstrated. However, there is no study that reported simultaneous occurrence of primary small bowel adenocarcinoma (SBA) and a GIST located in the stomach. Here, we report the first case of SBA and a synchronous gastric GIST. Surgical resection and clinicopathological characterization were performed for the masses identified through endoscopic and radiologic studies. Computed tomography scan showed a 13 mm mass located at the gastric antrum and another mass lesion partially occluding the jejunum. A biopsy specimen was obtained from the mass at the proximal jejunum by enteroscopy. The tumor was reported as adenocarcinoma. The patient was operated by the general surgery team. The features of the submucosal lesion resected from the antrum were consistent with a diagnosis of a GIST which contained spindle cells and showed positive staining with CD-117 and CD-34. Mitosis was not observed and Ki67 index was below 10%. This is the first case of coexistence of GIST of the stomach and a SBA to be reported in English-language literature. The prominent characteristics of our case include its antral localisation, male sex, absence of mitosis and incidental diagnosis.

Keywords

GIST, Small bowel adenocarcinoma, Gastric tumor, Submucosal lesion

References

• Reference 1 Agaimy, A., Wünsch, P. H., Sobin, L. H., Lasota, J., Miettinen, M., 2006. Occurrence of other malignancies in patients with gastrointestinal stromal tumors. Semin. Diagn. Pathol. 23, 120–129.
• Reference2 Bilimoria, K. Y., Bentrem, D. J., Wayne, J. D., Ko, C. Y., Bennett, C. L., Talamonti, M. S., 2009. Small bowel cancer in the United States: changes in epidemiology, treatment, and survival over the last 20 years. Ann. Surg. 249, 63–71.
• Reference3 Bümming, P., Ahlman, H., Andersson, J., Meis-Kindblom, J. M., Kindblom, L. G., Nilsson, B., 2006. Population-based study of the diagnosis and treatment of gastrointestinal stromal tumours. Br. J. Sur. 93, 836–843.
• Reference4 Caterino, S., Lorenzon, L., Petrucciani, N., Iannicelli, E., Pilozzi, E., Romiti, A., Cavallini, M., & Ziparo, V., 2011. Gastrointestinal stromal tumors: correlation between symptoms at presentation, tumor location and prognostic factors in 47 consecutive patients. World. J. Surg. Oncol. 9, 13
• Reference5 Corless, C. L., Barnett, C. M., Heinrich, M. C., 2011. Gastrointestinal stromal tumours: origin and molecular oncology. Nat. Rev. Cancer. 11, 865–878.
• Reference6 Dasanu, C. A., Mesologites, T., Trikudanathan, G., 2011. Synchronous tumors: adenosquamous carcinoma of pancreas and GIST of stomach. J. Gastrointest. Cancer. 42, 186–189.
• Reference7 Fletcher, C. D., Berman, J. J., Corless, C., Gorstein, F., Lasota, J., Longley, B. J., Miettinen, M., O'Leary, T. J., Remotti, H., Rubin, B. P., Shmookler, B., Sobin, L. H., Weiss, S. W., 2002. Diagnosis of gastrointestinal stromal tumors: A consensus approach. Hum. Pathol. 33, 459–465
• Reference8 Gill, S. S., Heuman, D. M., Mihas, A. A., 2001. Small intestinal neoplasms. J. Clin. Gastroenterol. 33, 267–282.
• Reference9 Gonçalves, R., Linhares, E., Albagli, R., Valadão, M., Vilhena, B., Romano, S., Ferreira, C. G., 2010. Occurrence of other tumors in patients with GIST. Surg. Oncol. 19, e140–e143.
• Reference10 Hohenberger, P., Ronellenfitsch, U., Oladeji, O., Pink, D., Ströbel, P., Wardelmann, E., Reichardt, P., 2010. Pattern of recurrence in patients with ruptured primary gastrointestinal stromal tumour. Br. J.Surg. 97, 1854–1859
• Reference11 Joensuu, H., Vehtari, A., Riihimäki, J., Nishida, T., Steigen, S. E., Brabec, P., Plank, L., Nilsson, B., Cirilli, C., Braconi, C., Bordoni, A., Magnusson, M. K., Linke, Z., Sufliarsky, J., Federico, M., Jonasson, J. G., Dei Tos, A. P., Rutkowski, P., 2012. Risk of recurrence of gastrointestinal stromal tumour after surgery: an analysis of pooled population-based cohorts. Lancet Oncol. 13, 265–274.
• Reference12 Karahan, N., Başpinar, Ş., Bozkurt, K. K., Devrım, T., Kapucuoğlu, F. N., 2013. Nörofibromatozis Tip-1'li Hastada Multipl Gastrointestinal Stromal Tümör ve Midede Taşlı Yüzük Hücreli Karsinom Birlikteliği: Olgu Sunumu [Coexistence of multiple gastrointestinal stromal tumors and signet ring cell carcinoma of stomach in a patient with neurofibromatosis type-1: case report]. Turk. Patoloji. Derg. 29, 64–68.
• Reference13 Kindblom, L. G., Remotti, H. E., Aldenborg, F., Meis-Kindblom, J. M., 1998. Gastrointestinal pacemaker cell tumor (GIPACT): gastrointestinal stromal tumors show phenotypic characteristics of the interstitial cells of Cajal. Am. J. Pathol.152, 1259–1269.
• Reference14 Maiorana, A., Fante, R., Maria Cesinaro, A., Adriana Fano, R., 2000. Synchronous occurrence of epithelial and stromal tumors in the stomach: a report of 6 cases. Pathol. Lab. Med. 124, 682–686.
• Reference15 Medeiros, F., Corless, C. L., Duensing, A., Hornick, J. L., Oliveira, A. M., Heinrich, M. C., Fletcher, J. A., Fletcher, C. D., 2004. KIT-negative gastrointestinal stromal tumors: proof of concept and therapeutic implications. Am. J. Surg. Pathol. 28, 889–894.
• Reference16 Mucciarini, C., Rossi, G., Bertolini, F., Valli, R., Cirilli, C., Rashid, I., Marcheselli, L., Luppi, G., Federico, M., 2007. Incidence and clinicopathologic features of gastrointestinal stromal tumors. A population-based study. BMC. Cancer. 7, 230.
• Reference17 Sarlomo-Rikala, M., Kovatich, A. J., Barusevicius, A., Miettinen, M., 1998. CD117: a sensitive marker for gastrointestinal stromal tumors that is more specific than CD34. Mod. Pathol. 11, 728–734.
• Reference18Talamonti, M. S., Goetz, L. H., Rao, S., Joehl, R. J., 2002. Primary cancers of the small bowel: analysis of prognostic factors and results of surgical management. Arch. Surg. 137, 564–571.
• Reference19 West, R. B., Corless, C. L., Chen, X., Rubin, B. P., Subramanian, S., Montgomery, K., Zhu, S., Ball, C. A., Nielsen, T. O., Patel, R., Goldblum, J. R., Brown, P. O., Heinrich, M. C., van de Rijn, M., 2004. The novel marker, DOG1, is expressed ubiquitously in gastrointestinal stromal tumors irrespective of KIT or PDGFRA mutation status. Am. J. Pathol. 165, 107–113.