title: Giant extra gastrointestinal stromal tumor of lesser omentum obscuring the diagnosis of a choloperitoneum.
abstract: BACKGROUND
  Herein we present an extremely rare case of a giant extra gastrointestinal stromal tumor (EGIST) of the lesser omentum obscuring the diagnosis of a choloperitoneum.
  
  
  METHODS
  A 79 years old female was admitted to our hospital with symptoms of vomiting and epigastric pain. Abdominal computer tomography revealed a sizable formation that was diagnosed as a tumor of the pancreas. In laparotomy, a choloperitoneum was diagnosed as the cause of patient's symptoms. A tumor adherent firmly to the lesser curvature of stomach was also discovered. Cholecystectomy and subtotal gastrectomy were performed. Histologically, the tumor was diagnosed as a EGIST of the lesser omentum. The patient did not receive any adjuvant therapy and after two years of follow up she is without any recurrence.
  
  
  CONCLUSIONS
  Omental EGISTs may remain clinically silent despite the large tumor's size. It is difficult to differentiate a EGIST in the lesser omentum from a GIST of the lesser curvature of the stomach, despite the use of advanced radiological imaging techniques. Our case of a giant EGIST of lesser omentum obscuring the diagnosis of acute choloperitoneum is the only one reported in literature.
  
  
  CONCLUSIONS
  EGISTs that arise from the omentum are very rare and complete surgical resection is the only effective treatment approach. Adjuvant therapy following resection of localized disease has become standard of care in high risk cases.
authors: Surgical Department, General Hospital Agios Pavlos, Thessaloniki, Greece. Electronic address: ioannisskandalos@yahoo.gr.
authors: Ioannis K
authors: IK
authors: Skandalos
authors: Nikolaos F
authors: NF
authors: Hotzoglou
authors: Kyriaki Ch
authors: KCh
authors: Matsi
authors: Xanthi A
authors: XA
authors: Pitta
authors: Athanasios I
authors: AI
authors: Kamas
keywords: Choloperitoneum; EGIST; Gastrectomy; Lesser omentum
references: Eur J Surg Oncol. 2011 Oct;37(10):890-6
references: 21737227
references: Am J Surg Pathol. 2004 Apr;28(4):479-88
references: 15087667
references: J Pathol. 2001 Apr;193(4):505-10
references: 11276010
references: Cancer. 2005 Feb 15;103(4):821-9
references: 15648083
references: Am J Surg Pathol. 1999 Sep;23(9):1109-18
references: 10478672
references: World J Gastroenterol. 2007 Apr 14;13(14):2077-82
references: 17465451
references: Radiologe. 2009 Dec;49(12):1109-16
references: 19787329
references: Int J Surg Case Rep. 2011;2(8):253-5
references: 22096744
references: Nat Rev Gastroenterol Hepatol. 2009 Jun;6(6):363-71
references: 19365407
references: Arch Pathol Lab Med. 2006 Oct;130(10):1466-78
references: 17090188
references: Case Rep Gastroenterol. 2012 May;6(2):375-80
references: 22855655
references: Surg Today. 2001;31(8):715-8
references: 11510610
references: Clin Cancer Res. 2009 Sep 15;15(18):5902-9
references: 19737946
references: Science. 1998 Jan 23;279(5350):577-80
references: 9438854
references: Virchows Arch. 2010 Feb;456(2):111-27
references: 20165865
references: Pathol Int. 2001 Jul;51(7):524-31
references: 11472565
references: Am J Surg Pathol. 2004 Jul;28(7):889-94
references: 15223958