Journal of Regional Section of Serbian Medical Association in Zajecar

Year 2012     Vol 37     No 3
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      UDK 616.33-006.6

ISSN 035-2899, 37(2012) br.3 p.177-182

Case report

Gastrointestinal stromal tumour of gaster – (non) specific symptoms and diagnosis
Gastrointestinalni tumor želuca – (ne)specifičnost simptoma i dijagnostika

Marko Cvetković
Zdravstveni centar Zaječar


Introduction: Gastrointestinal stromal tumour (GIST) is defined as mesenchymal tumour of gastrointestinal (GI) tract, generated by mutation of KIT or PDGFRA genes that express tyrosine kinase protein Kit CD 117. GIST may occur at any site of GI tract and this is what clinical presentation depends on. Asymptomatic forms, nonspecific symptoms, like flatulence, abdominal discomfort, acute (melena or hematemesis) or chronic(associated with anaemia) bleeding from GI tract and imunohistochemycal features are the main characteristics of this tumour. Annual incidence is approximately 10 cases per million. The aim of this case report is to contribute to an easy recognition of symptoms, diagnosis and therapy of this rare form of tumour. Case report: In January 2009, a 73-year-old female patient came to see her doctor and had been suffering from flatulence and abdominal discomfort mostly postprandial at least for a few weeks. The first physical examination did not indicate any changes. Blood test and biochemical analyses were within normal parameters. A two-week therapy with H2 blocators and proton pump inhibitors was not effective. In February 2009, CT imaging was done at the patient’s demand. CT scan showed a 110mm large expansive formation in left hypohondrium between the pancreas, left kidney and spleen. The patient was referred to a higher health facility. Repeated physical examination showed deeper paraumbilical resistention. Abdominal ultrasound showed inhomogen formation 168x114x148mm large in the region of pancreas cauda and the left kidney. MRI scan showed left subphrenical big solid central necrotic mass which has shifted local organs and structures. In late February 2009, the patient underwent surgery. The tumour was a part of the back wall of the gaster, which was determined during the surgery. That was the reason for the total gastrectomia. Pathohystological and immune histochemical report found that the tumour was a kind of mesenchymal tumour, with spindle cells, and with diffuse immune reactivity against c-kit/CD117(+++), CD34(+++), PDGFRA(+/-) and vimentina (+++). Mitotic rate was 7/50HPFs. In May 2011, 26 months after the total resection of primary GIST, a control CT has found changes likely metastatic deposit in liver; following this, the patient was sent to the ontological consilium wherein a decision was made on further treatment. Conclusion: Surgery remains the mainstay of therapy for patients with primary GIST with no evidence of metastasis, and should be initial therapy if the tumour is techni-cally resectable. Because it is an uncommon disease, GIST may not be considered in the differential diagnosis of a patient with a localized abdominal mass. The size of a tumour sometimes makes it difficult to diagnose tumour on CT or MRI images. Thus, a pathologic diagnosis of GIST may not be known before or even during surgery. Preoperative biopsy of a resectable mass is commonly performed, but is associated with slight risks. GISTs may be soft and fragile, and biopsy may cause haemorrhage and increase the risk for tumour dissemination. For this reason, postoperative pathology assessment is essential to confirm the diagnosis after the removal of any suspected GIST.
Key words: GIST, c-kit, Imatinib mesylat

Napomena: kompletan tekst rada na srpskom jeziku
Note: full text in Serbian
      Corresponding Address:
Marko Cvetković
Đorđa Simeonovića 28, 19000 Zaječar
Paper received: 10.4.2012
Paper accepted: 19.5.2012
Paper Internet issues: 27.12.2012

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Timočki medicinski glasnik, Zdravstveni centar Zaječar
Journal of Regional section of Serbian medical association in Zajecar
Rasadnička bb, 19000 Zaječar, Srbija

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