Abstract
Gastrointestinal stromal tumors arise from mesenchymal cells of gastrointestinal tract and are seen rarely. In fewer than 5% of cases they arise from outside of gastrointestinal tract, they originate primarily from mesentery, omentum and peritoneum. These are called extragastrointestinal tumors and they share the histological features with their gastrointestinal counterparts. A 57-year-old male patient was admitted to our hospital with complaint of abdominal pain. In his physical examination, an abdominal mass was detected in his left lower quadrant. Radiological examinations revealed an abdominal mass measuring 13x9 cm in diameter, adjacent to the bladder. Laparotomy demonstrated a lobulating mass of about 13x10 cm in diameter, originating from mesenterium of the sigmoid colon. En-bloc resection of the tumor with sigmoidectomy and end-to-end anastomosis was performed. Histopathology of the specimen showed that the tumor demonstrating high cellularity composed of spindle-shaped tumor cells. There was no continuity of tumor within the sigmoid colon and the margins of specimen were tumor-negative. Immunohistochemically, the tumor was positive for c-kit (CD 117). The tumor was diagnosed as a gastrointestinal stromal tumor originating from mesenterium of the sigmoid colon. A gastrointestinal stromal tumor of the sigmoid mesenterium is a rare entity. Surgical resection is the treatment of choice for these tumors, which usually have a poor prognosis.
Keywords:
Extra-gastrointestinal stromal tumor, surgical therapy, sigmoid mesocolon
References
1Kindblom LG, Remotti HE, Aldenborg F, Meis-Kindblom JM. Gastrointestinal pacemaker cell tumour (GIPACT): gastrointestinal stromal tumours show phenotypic characteristics of the interstitial cells of Cajal. Am J Pathol 1998;152:1259- 1269.
2Mazur MT, Clark HB. Gastric stromal tumors: Reappraisal of histogenesis. Am J Surg Pathol 1983; 7: 507-519.
3Franzini C, Alessandri L, Piscioli I, Donato S, Faraci R, Morelli L, Del Nonno F, Licci S. Extra-gastrointestinal stromal tumor of the greater omentum: report of a case and review of the literature. World J Surg Oncol 2008; 6: 25.
4Brady MS, Perino G, Tallini G, Russo P, Woodruff JM. Malignant mesenchymoma. Cancer 1996;77:467-473.
5Nilsson B, Bumming P, Meis-Kindblom JM, Oden A, Dortok A, Gustavsson B, Sablinska K, Kinblom LG. Gastrointestinal stromal tumors: The incidence, prevalence, clinical course, and prognostication in the preimatinib mesylate era. Cancer 2005; 103: 821–829.
6Miettinen M, Lasota J. Gastrointestinal stromal tumors: review on morphology, molecular pathology, prognosis, and differential diagnosis. Arch Pathol Lab Med 2006; 130: 1466-1478.
7Miettinen M, Monihan JM, Sarlomo- Rikala M, Kovatich AJ, Carr NJ, Emory TS, Sobin LH. Gastrointestinal stromal tumors/smooth muscle tumors/GISTs in the omentum and mesentery: clinicopathologic and immunohistochemical study of 26 cases. Am J Surg Pathol 1999;23:1109–1118.
8Yamamoto H, Oda Y, Kawaguchi K, Nakamura N, Takahira T, Tamiya S, Saito T, Oshiro Y, Ohta M, Yao T, Tsuneyoshi M. c-kit and PDGFRA mutations in extragastrointestinal stromal tumor (gastrointestinal stromal tumor of the soft tissue). Am J Surg Pathol 2004;28:479–488.
9Reith JD, Goldblum JR, Lyles RH, Weiss SW. Extragastrointestinal (soft tissue) stromal tumors: an analysis of 48 cases with emphasis on histological predictors of outcome. Mod Pathol 2000;13:577– 585.
10Miettinen M, Sobin LH, Lasota J. Gastrointestinal stromal tumors of the stomach: a clinicopathologic, immunohistochemical, and molecular genetic study of 1765 cases with long-term follow-up. Am J Surg Pathol 2005; 29: 52–68.
11Miettinen M, Lasota J. Gastrointestinal stromal tumors—definition, clinical, histological, immunohistochemical, and molecular genetic features and differential diagnosis. Virchows Archiv 2001; 438: 1–12.
12Darnell A, Dalmau E, Pericay C, Musulen E, Martin J, Puig J, Malet A, Saigi E, Rey M. Gastrointestinal stromal tumors. Abdom Imaging 2006; 31: 387-399.
13Ishida H, Ishida J: Primary tumours of the greater omentum. Eur Radiol 1998; 8: 1598-601.
14Fletcher CD, Berman JJ, Corless C Gorstein F, Lasota J, Longley BJ, Miettinen M, O'Leary TJ, Remotti H, Rubin BP, Shmookler B, Sobin LH, Weiss SW. Diagnosis of gastrointestinal stromal tumors: A consensus approach. Hum Pathol 2002; 33: 459–465.
15Joensuu H. Gastrointestinal stromal tumor (GIST). Ann Oncol 2006; 17(supp 10): 280-286.
16Chaudhry UI, DeMatteo RP. Management of resectable gastrointestinal stromal tumor. Hematol Oncol Clin North Am 2009; 23: 79-96.
17Adachi T, Oda Y, Sakamoto A, Terashi T, Tamiya S, Hachitanda Y, Tsuneyoshi M. Prognostic factors in the so-called malignant mesenchymoma: a clinicopathological and immunohistochemical analysis. Oncol Rep 2003;10: 803-811.
18D'Amato G, Steinert DM, McAuliffe JC, Trent JC. Update on the biology and therapy of gastrointestinal stromal tumors. Cancer Control 2005; 12: 44-56.