Jejunal Gastrointestinal Stromal Tumor: Case Report and Literature Review
Main Article Content
Abstract
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract and originate from the interstitial cells of Cajal. Although most of these tumors are located in the stomach, a smaller proportion develop in the small intestine, with the jejunum being a relatively uncommon site. The clinical presentation of GISTs is variable and often nonspecific, which may hinder early diagnosis. The most frequent symptoms include abdominal pain, anemia, gastrointestinal bleeding, or the presence of an abdominal mass; however, in some cases, the tumor may be detected incidentally during imaging studies performed for other reasons. We present the case of an adult patient with a gastrointestinal stromal tumor located in the jejunum who presented with progressive abdominal pain and weight loss. Imaging studies revealed a tumor lesion arising from the small intestine, and segmental surgical resection with adequate margins was performed. Histopathological and immunohistochemical analysis confirmed the diagnosis of gastrointestinal stromal tumor, with positivity for CD117 and DOG1. The postoperative course was favorable, and the patient remained under clinical follow-up without evidence of tumor recurrence. This case highlights the importance of considering GISTs in the differential diagnosis of small bowel tumors, as well as the fundamental role of histopathological and immunohistochemical studies in confirming the diagnosis. Surgical treatment remains the main therapeutic option for localized tumors, while targeted therapies have significantly improved the prognosis of patients with advanced disease.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
I. Blay, J. Y., Kang, Y. K., Nishida, T., & von Mehren, M. (2021). Gastrointestinal stromal tumours. Nature Reviews Disease Primers, 7(1), 22.
https://doi.org/10.1038/s41572-021-00254-5
II. Casali, P. G., Abecassis, N., Bauer, S., Biagini, R., Bielack, S., Bonvalot, S., ... & Blay, J. Y. (2018). Gastrointestinal stromal tumours: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Annals of Oncology, 29(Suppl. 4), iv68–iv78. https://doi.org/10.1093/annonc/mdy095
III. Corless, C. L., Barnett, C. M., & Heinrich, M. C. (2011). Gastrointestinal stromal tumours: Origin and molecular oncology. Nature Reviews Cancer, 11(12), 865–878. https://doi.org/10.1038/nrc3143
IV. DeMatteo, R. P., Lewis, J. J., Leung, D., Mudan, S. S., Woodruff, J. M., & Brennan, M. F. (2000). Two hundred gastrointestinal stromal tumors: Recurrence patterns and prognostic factors for survival. Annals of Surgery, 231(1), 51–58.
V. Fletcher, C. D., Berman, J. J., Corless, C., Gorstein, F., Lasota, J., Longley, B. J., ... & Rubin, B. P. (2002). Diagnosis of gastrointestinal stromal tumors: A consensus approach. Human Pathology, 33(5), 459–465.
https://doi.org/10.1053/hupa.2002.123545
VI. Joensuu, H. (2008). Risk stratification of patients diagnosed with gastrointestinal stromal tumor. Human Pathology, 39(10), 1411–1419.
https://doi.org/10.1016/j.humpath.2008.06.025
VII. Joensuu, H., Hohenberger, P., & Corless, C. L. (2013). Gastrointestinal stromal tumour. The Lancet, 382(9896), 973–983.
https://doi.org/10.1016/S0140-6736(13)60106-3
VIII. Miettinen, M., & Lasota, J. (2006). Gastrointestinal stromal tumors: Pathology and prognosis at different sites. Seminars in Diagnostic Pathology, 23(2), 70–83. https://doi.org/10.1053/j.semdp.2006.09.001
IX. Miettinen, M., & Lasota, J. (2006). Gastrointestinal stromal tumors: Review on morphology, molecular pathology, prognosis, and differential diagnosis. Archives of Pathology & Laboratory Medicine, 130(10), 1466–1478.
X. Nishida, T., Blay, J. Y., Hirota, S., Kitagawa, Y., & Kang, Y. K. (2016). The standard diagnosis, treatment, and follow-up of gastrointestinal stromal tumors based on guidelines. Gastric Cancer, 19(1), 3–14. https://doi.org/10.1007/s10120-015-0526-8
XI. Rubin, B. P., & Heinrich, M. C. (2007). Gastrointestinal stromal tumour. The Lancet, 369(9574), 1731–1741. https://doi.org/10.1016/S0140-6736(07)60780-6
XII. Søreide, K., Sandvik, O. M., Søreide, J. A., Giljaca, V., Jureckova, A., & Bulusu, V. R. (2016). Global epidemiology of gastrointestinal stromal tumours (GIST): A systematic review of population-based cohort studies. Cancer Epidemiology, 40, 39–46. https://doi.org/10.1016/j.canep.2015.10.031
XIII. Von Mehren, M., Kane, J. M., Bui, M. M., Choy, E., Connelly, M., Dry, S., ... & NCCN Guidelines Panel. (2020). NCCN guidelines insights: Soft tissue sarcoma, version 1.2021. Journal of the National Comprehensive Cancer Network, 18(12), 1604–1612.
XIV. Hirota, S., Isozaki, K., Moriyama, Y., Hashimoto, K., Nishida, T., Ishiguro, S., ... & Kitamura, Y. (1998). Gain-of-function mutations of c-kit in human gastrointestinal stromal tumors. Science, 279(5350), 577–580.
https://doi.org/10.1126/science.279.5350.577
XV. DeMatteo, R. P., Ballman, K. V., Antonescu, C. R., Maki, R. G., Pisters, P. W., Demetri, G. D., ... & Brennan, M. F. (2009). Adjuvant imatinib mesylate after resection of localized gastrointestinal stromal tumour. The Lancet, 373(9669), 1097–1104. https://doi.org/10.1016/S0140-6736(09)60500-6