title: Giant gastrointestinal stromal tumor (GIST) of the stomach cause of high bowel obstruction: surgical management.
abstract: BACKGROUND
  Gastrointestinal stromal tumors (GISTs) represent 85% of all mesenchymal neoplasms that affect the gastrointestinal (GI) tract. These GISTs range in size from small lesions to large masses. Often they are clinically silent until they reach a significant size, so their discovery is usually incidental.
  
  
  METHODS
  A 67-year-old man was admitted at our general surgery department with a persistent abdominal pain in the left hypochondrium, associated with nausea and vomiting. Clinical examination revealed a palpable mass in the epigastrium and in the left hypochondrium, which was approximately 40 cm long. Ultrasonography and computed tomography of the abdomen showed a large mass of 40 × 25 cm, which extended from the posterior wall of the stomach to the spleen, involving the body and the tail of the pancreas. The patient underwent en-block resection of the mass, sleeve resection of the stomach, and distal pancreatectomy-splenectomy. The histopathology of the resected specimen was consistent with a gastrointestinal stromal tumor of the stomach (positive for CD 117) with a high risk of malignancy (mitotic count >5/50 high-power fieldand Ki67/Mib1 >10%). The postoperative course was uneventful and treatment with imatinib mesylate began immediately. The patient appears to be disease free after four years.
  
  
  CONCLUSIONS
  Giant GISTs of the stomach are rare. Surgical resection with curative intent is feasible. The combination of surgical resection and imatinib can provide long-termdisease-free survival. An R0 resection is the best achievable treatment, therefore the patient should be evaluated over time for potential resectability.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cappellani
authors.forename: Gaetano
authors.initials: G
authors.lastname: Piccolo
authors.forename: Francesco
authors.initials: F
authors.lastname: Cardì
authors.forename: Andrea
authors.initials: A
authors.lastname: Cavallaro
authors.forename: Emanuele
authors.initials: E
authors.lastname: Lo Menzo
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Cavallaro
authors.forename: Antonio
authors.initials: A
authors.lastname: Zanghì
authors.forename: Maria
authors.initials: M
authors.lastname: Di Vita
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Berretta
mesh_terms: D000368:Aged; D005743:Gastrectomy; D046152:Gastrointestinal Stromal Tumors / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007415:Intestinal Obstruction / Q000150:complications*; D008297:Male; D010180:Pancreatectomy; D011379:Prognosis; D013156:Splenectomy; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D014057:Tomography, X-Ray Computed
references.citation: J Gastrointest Surg. 2010 Mar;14(3):557-61
references.pmid: 20033343
references.citation: Surg Today. 2001;31(4):350-4
references.pmid: 11321348
references.citation: World J Surg Oncol. 2008 Apr 04;6:37
references.pmid: 18394167
references.citation: Science. 2003 Jan 31;299(5607):708-10
references.pmid: 12522257
references.citation: World J Surg Oncol. 2010 Jun 02;8:47
references.pmid: 20515511
references.citation: Lancet Oncol. 2009 Nov;10(11):1045-52
references.pmid: 19793678
references.citation: Am J Pathol. 1998 May;152(5):1259-69
references.pmid: 9588894
references.citation: Ann Surg Oncol. 2013 Feb;20(2):586-92
references.pmid: 22965573
references.citation: Cancer Res. 2001 Nov 15;61(22):8118-21
references.pmid: 11719439
references.citation: Lancet. 2006 Oct 14;368(9544):1329-38
references.pmid: 17046465
references.citation: Semin Diagn Pathol. 2006 May;23(2):70-83
references.pmid: 17193820
references.citation: Br J Surg. 1999 Apr;86(4):545-9
references.pmid: 10215834
references.citation: Ann Surg. 2000 Jan;231(1):51-8
references.pmid: 10636102
references.citation: World J Surg Oncol. 2005 Feb 15;3(1):11
references.pmid: 15713236
references.citation: World J Surg Oncol. 2012 Apr 27;10:66
references.pmid: 22540369
references.citation: Am J Surg Pathol. 2004 Jul;28(7):889-94
references.pmid: 15223958
references.citation: Adv Surg. 2011;45:197-209
references.pmid: 21954688
references.citation: J Natl Compr Canc Netw. 2010 Apr;8 Suppl 2:S1-41; quiz S42-4
references.pmid: 20457867