Small bowel gastrointestinal stromal tumor (GIST) is an uncommon tumor, with an estimated frequency of 10–20/L million population, occurring usually in the 6 decade of life. GISTs, mainly ones larger than 4 cm have a wide range of presentations from abdominal discomfort and bloating to abdominal emergencies due to massive gastrointestinal (GI) hemorrhage, with pressure necrosis and ulceration of the overlying mucosa is the main mechanism leading to GI hemorrhage. Life-threatening hemorrhage is a rare initial presentation. Among the wide differential diagnosis for GI bleeding, jejunal GIST is one of the rarest etiologies. Due to its location and hence the inability to identify by endoscopy it is difficult to diagnose. From here, computed tomography (CT) angiography is considered essential for identification of the site of GI bleed, which aids in diagnosis of GIST. The mainstay treatment for this emergent presentation is resection, which if done in a timely manner results in a good clinical outcome. Herein, we report a case of a 46-yearold male patient presenting with massive GI bleed from jejunal GIST, leading to hemodynamic instability, requiring massive transfusion protocol managed by small bowel resection, after failure of radiologic embolization. In rare instances GISTs present as massive GI bleeding necessitating admission to the hospital and urgent interference. In our case the early multidisciplinary approach manifested by involvement of interventional radiology with the surgical team was the cornerstone in the successful management of our patient and should be considered in all cases of massive upper GI bleeding.
{"title":"Jejunal gastrointestinal stromal tumor (GIST): a case report presenting as life threatening emergency","authors":"M. Saad, I. Hajj, E. Saikaly","doi":"10.21037/gist-20-3","DOIUrl":"https://doi.org/10.21037/gist-20-3","url":null,"abstract":"Small bowel gastrointestinal stromal tumor (GIST) is an uncommon tumor, with an estimated frequency of 10–20/L million population, occurring usually in the 6 decade of life. GISTs, mainly ones larger than 4 cm have a wide range of presentations from abdominal discomfort and bloating to abdominal emergencies due to massive gastrointestinal (GI) hemorrhage, with pressure necrosis and ulceration of the overlying mucosa is the main mechanism leading to GI hemorrhage. Life-threatening hemorrhage is a rare initial presentation. Among the wide differential diagnosis for GI bleeding, jejunal GIST is one of the rarest etiologies. Due to its location and hence the inability to identify by endoscopy it is difficult to diagnose. From here, computed tomography (CT) angiography is considered essential for identification of the site of GI bleed, which aids in diagnosis of GIST. The mainstay treatment for this emergent presentation is resection, which if done in a timely manner results in a good clinical outcome. Herein, we report a case of a 46-yearold male patient presenting with massive GI bleed from jejunal GIST, leading to hemodynamic instability, requiring massive transfusion protocol managed by small bowel resection, after failure of radiologic embolization. In rare instances GISTs present as massive GI bleeding necessitating admission to the hospital and urgent interference. In our case the early multidisciplinary approach manifested by involvement of interventional radiology with the surgical team was the cornerstone in the successful management of our patient and should be considered in all cases of massive upper GI bleeding.","PeriodicalId":93755,"journal":{"name":"Gastrointestinal stromal tumor","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43400259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-01DOI: 10.21037/gist.2019.10.02
{"title":"Application of the CARE guideline as reporting standard in the Gastrointestinal Stromal Tumor","authors":"","doi":"10.21037/gist.2019.10.02","DOIUrl":"https://doi.org/10.21037/gist.2019.10.02","url":null,"abstract":"","PeriodicalId":93755,"journal":{"name":"Gastrointestinal stromal tumor","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47422586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-02-14DOI: 10.21037/GIST.2019.01.03
M. Urbini
Gastrointestinal stromal tumors (GISTs) represent the most common mesenchymal tumor of the gastrointestinal tract (80%), with an annual incidence of 10–15 cases per million people (1). GISTs have become a paradigm for the use of molecular diagnostics and targeted therapy, since its molecular classification is able to predict treatment response. Most GISTs are driven by activating mutations in KIT (70–80% of cases) or PDGFRA (10%) receptor tyrosine kinases. This discovery represents the rationale of the efficacy of target therapies efficacy using small molecule tyrosine kinase inhibitors (TKIs) for this malignancy (1,2).
{"title":"Avapritinib: preclinical studies of a promising novel therapeutic option for gastrointestinal stromal tumors","authors":"M. Urbini","doi":"10.21037/GIST.2019.01.03","DOIUrl":"https://doi.org/10.21037/GIST.2019.01.03","url":null,"abstract":"Gastrointestinal stromal tumors (GISTs) represent the most common mesenchymal tumor of the gastrointestinal tract (80%), with an annual incidence of 10–15 cases per million people (1). GISTs have become a paradigm for the use of molecular diagnostics and targeted therapy, since its molecular classification is able to predict treatment response. Most GISTs are driven by activating mutations in KIT (70–80% of cases) or PDGFRA (10%) receptor tyrosine kinases. This discovery represents the rationale of the efficacy of target therapies efficacy using small molecule tyrosine kinase inhibitors (TKIs) for this malignancy (1,2).","PeriodicalId":93755,"journal":{"name":"Gastrointestinal stromal tumor","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/GIST.2019.01.03","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44573759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-01DOI: 10.21037/gist.2019.01.02
L. Chen, Tao Chen
Currently, coexistence of gastrointestinal adenocarcinoma and gastrointestinal stromal tumors (GISTs) is still infrequent. What’s more, there are few guidelines for the drug therapy of both types of synchronous tumors. Here, we report such a dangerous case and review the related literature for a better treatment. A 79-year-old male patient was admitted to our hospital for abdominal pain and diarrhea more than a month and stopped relieve nature nine days. He was preliminarily diagnosed as sigmoid colon adenocarcinoma and GISTs after having a Computed Tomography scan at another hospital. After gastroscopy, colonoscopy and pathological examination, we further diagnosed synchronous advanced colorectal cancer (CRC) and high-risk GISTs. Through literature review and medical records, we carefully developed the treatment protocol for this case, which is the chemotherapy plan for gastrointestinal adenocarcinoma plus imatinib. There is still insufficient evidence on the safety and efficacy of the regimen and more research and trials are needed to evaluate it.
{"title":"Treatment of advanced gastrointestinal adenocarcinoma complicated with high-risk gastrointestinal stromal tumors (GISTs) in an elderly male patient: a case report and literature review","authors":"L. Chen, Tao Chen","doi":"10.21037/gist.2019.01.02","DOIUrl":"https://doi.org/10.21037/gist.2019.01.02","url":null,"abstract":"Currently, coexistence of gastrointestinal adenocarcinoma and gastrointestinal stromal tumors (GISTs) is still infrequent. What’s more, there are few guidelines for the drug therapy of both types of synchronous tumors. Here, we report such a dangerous case and review the related literature for a better treatment. A 79-year-old male patient was admitted to our hospital for abdominal pain and diarrhea more than a month and stopped relieve nature nine days. He was preliminarily diagnosed as sigmoid colon adenocarcinoma and GISTs after having a Computed Tomography scan at another hospital. After gastroscopy, colonoscopy and pathological examination, we further diagnosed synchronous advanced colorectal cancer (CRC) and high-risk GISTs. Through literature review and medical records, we carefully developed the treatment protocol for this case, which is the chemotherapy plan for gastrointestinal adenocarcinoma plus imatinib. There is still insufficient evidence on the safety and efficacy of the regimen and more research and trials are needed to evaluate it.","PeriodicalId":93755,"journal":{"name":"Gastrointestinal stromal tumor","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/gist.2019.01.02","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49369926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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