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Image of the Month—Diagnosis
Arch Surg. 2006;141:710.
Answer: Jejunal Stromal Tumor
Gastrointestinal stromal tumors are the most common nonepithelial tumors that may arise anywhere in the gastrointestinal tract. They occur more frequently in elderly and middle-aged persons. Men and women are equally affected. The most common location is the stomach, and the second most frequent location is the small intestine. It has a good prognosis in the stomach, but it has a worse prognosis in small-intestinal localization.1-3 The biological behavior of primitive gastrointestinal stromal tumor has yet to be completely clarified in terms of growth rate and metastatic potential. Small lesions with infrequent mitotic activity are considered benign, but growth over time will increase the malignant potential and lead to local symptoms such as bleeding, obstruction, and pain.4-5 Although most patients with stromal tumors are asymptomatic, some tumors can grow. The clinical importance of gastrointestinal stromal tumor is owing to its malignant potential, including extragastric location, size greater than 5 cm, central necrosis, a rapid growth rate, and metastatic potential. The pathological assessment of malignancy is routinely performed using the high mitotic index.6 In our case, resection was found to be efficient because there was 1 mitotic figure in 50 high-power fields.
In gastrointestinal stromal tumor cases, surgical resection is widely accepted as the definitive treatment. Laparoscopy is an important, preferable method to diagnose and treat the masses that have positional mobility and unclear localization, as in our case. Laparoscopic resection of gastric stromal tumor was first described in 1992.1 It was easy to resect the mass and reconstruct the lumen of the intestine with an endoscopic gastrointestinal anastomosis stapler because the mass was pedunculated and mobile.1-2,6-7
Although tumors of the gastrointestinal tract may be seen very rarely in the small intestine, stromal tumors should be kept in mind in differential diagnoses.
AUTHOR INFORMATION
Correspondence: Dursun Ali Sahin, MD, Karaman Mah. Leylak Cd. Manolya Apt No. 13/12, 03100 Afyon, Turkey (dursunalisahin{at}yahoo.com).
Accepted for Publication: May 19, 2005.
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1. Carlomagno G, Beneduce P. A gastrointestinal stromal tumor (GIST) masquerading as an ovarian mass. World J Surg Oncol. 2004;2:15.
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2. Nguyen NT, Jim J, Nguyen A, Lee J, Chang K. Laparoscopic resection of gastric stromal tumor: a tailored approach. Am Surg. 2003;69:946-950.
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3. Reinstein LJ, Ahmed A, Gilbert-Barness E, Pomerance HH. Clinico-pathologic conference: 12-year-old girl with fatigue, anemia, weight loss, abdominal distention, and occasional nausea and vomiting. Pediatr Pathol Mol Med. 2003;22:471-480.
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4. Dougherty MJ, Compton C, Talbert M, Wood WC. Sarcomas of the gastrointestinal tract: separation into favorable and unfavorable prognostic groups by mitotic count. Ann Surg. 1991;214:569-574.
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5. Koga H, Ochiai A, Nakanishi Y, et al. Reevaluation of prognostic factors in gastric leiomyosarcoma. Am J Gastroenterol. 1995;90:1307-1312.
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6. Ehrmantraut W, Sardi A. Laparoscopy-assisted small bowel resection. Am Surg. 1997;63:996-1001.
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7. Kimata M, Kubota T, Otani Y, et al. Gastrointestinal stromal tumors treated by laparoscopic surgery: report of three cases. Surg Today. 2000;30:177-180.
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SECTION EDITOR: GRACE S. ROZYCKI, MD
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