tailieunhanh - Báo cáo khoa học: "GIST suture-line recurrence at a gastrojejunal anastomosis 8 years after gastrectomy: can GIST ever be described as truly benign? A case report"

Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành y học dành cho các bạn tham khảo đề tài: GIST suture-line recurrence at a gastrojejunal anastomosis 8 years after gastrectomy: can GIST ever be described as truly benign? A case report | Papalambros et al. World Journal of Surgical Oncology 2010 8 90 http content 8 1 90 WORLD JOURNAL OF SURGICAL ONCOLOGY CASE REPORT Open Access GIST suture-line recurrence at a gastrojejunal anastomosis 8 years after gastrectomy can GIST ever be described as truly benign A case report 12 2 3 3 Alexandros Papalambros Athanasios Petrou Nicholas Brennan Kostantinos Bramis Evangelos Felekouras Efstathios Papalambros4 Abstract We present the case of a 71 year old man with recurrence of a Gastro Intestinal Stromal Tumour GIST at the gastrojejunal anastomosis eight years following partial gastrectomy for a very small primary gastric GIST. He presented acutely on both occasions with haemodynamic shock secondary to massive haematemesis. During his initial presentation in 2001 an emergency laparotomy was performed demonstrating a pre-pyloric ulcerative lesion. The histopathology was in keeping with a diagnosis of a gastric GIST with a 2 cm tumour with 5 mitosis per 50 HPF no signs of necrosis and invasion limited to the mucosa. Eight years later the same patient presented with a similar clinical picture of haemodynamic instability secondary to haematemesis. Emergency endoscopy showed an irregularly shaped elevated lesion on the gastrojejunostomy line suggestive of recurrence. He subsequently underwent completion gastrectomy and the histology revealed a cm GIST tumour composed of spindle cells with 5 mitosis per 50 HPF tumor invasion into the submucosa and positive expression ofc-kit and SMA. The patient remains recurrence free 18 months post surgery. The literature suggests that tumour size mitotic rate and tumour site are the most important predictive factors of recurrence. Additional features such as the presence of necrosis local tumour invasion and positive resection margins can also influence recurrence rates. In this case the lesion was a gastric GIST very small 2 cm had low proliferation rate 5 mitosis HPF lacked necrosis and was limited to the mucosa.