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2.
Medicine (Baltimore) ; 99(4): e18863, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31977886

RESUMO

RATIONALE: Hemolymphangioma is a benign tumor comprised of the newly-formed lymph spaces and blood vessels, which can usually be found in the head and neck of the affected children. There are few reports regarding cases with hemolymphangioma in small intestine, spleen, esophagus, and other organs. PATIENT CONCERNS: Herein, a 55-year-old woman was presented in this study, she had complained of discomfort in the right upper abdomen for 2 months, and was discovered with a space-occupying lesion in proximal jejunum on computed tomography (CT). Eventually, the lesions were confirmed through double-balloon enteroscopy (DBE) to be located in the jejunum 60 cm away from the Treitz ligament. DIAGNOSE: Subsequently, the small intestine was partially resected, and postoperative pathology had confirmed the diagnosis of small intestinal hemolymphangioma. INTERVENTIONS: Excisional surgery of the lesion was planned. On surgery, the lesions were discovered to be about 33 cm to 22 cm when engorged the superficial vessels. No enlarged lymph nodes were seen at the root of the mesentery, and no obvious lesion was observed in the remaining small intestine. OUTCOMES: Follow-up for 6 months showed no recurrence. LESSONS: Hemolymphangioma lacks typical clinical symptoms, and the correct preoperative diagnosis of hemolymphangioma remains challenging. Due to the increasing use of endoscopic diagnostic techniques, it is expected that hemolymphangioma in gastrointestinal tract may be detected and endoluminal located before surgery more feasibly. This case report aimed to highlight the contributions of CT and DBE to an accurate preoperative diagnosis and surgical strategy planning.


Assuntos
Neoplasias do Jejuno/diagnóstico por imagem , Neoplasias do Jejuno/cirurgia , Linfangioma/diagnóstico por imagem , Linfangioma/cirurgia , Enteroscopia de Duplo Balão , Feminino , Humanos , Neoplasias do Jejuno/patologia , Linfangioma/patologia , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
3.
Medicine (Baltimore) ; 98(51): e14222, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31860943

RESUMO

RATIONALE: Patients with gastrointestinal stromal tumors (GISTs) are often found to have liver metastases at their 1st presentation. Most patients need preoperative treatment to reduce the size of the liver metastases to increase the possibility of surgical resection. Currently, imatinib mesylate is the drug of 1st choice for preoperative treatment and sunitinib malate (SM) is seldom used. Here we report a case of GIST with liver metastases where SM was used as a preoperative treatment. PATIENT CONCERNS: A 56-year-old worker presented with intermittent abdominal pain and eating difficulties. DIAGNOSES: An enhanced computed tomography scan showed a 15 × 15 × 10 cm malignant mass in the upper abdomen, and 2 metastases (15.1 × 13.1 cm and 14.8 × 8.8 cm) in the liver. The postcaval and middle hepatic veins were compressed by the liver metastases, making radical resection very difficult. INTERVENTIONS: First the primary tumor in the jejunum was resected, and then SM was used as a preoperative treatment to reduce the size of the liver metastases to improve the possibility of surgical resection. OUTCOMES: Both liver metastases regressed considerably in size and it was then possible to perform a radical resection. LESSONS: The SM has the potential to be used as preoperative therapy for GIST with large liver metastases. This method provides a new option for the preoperative treatment of GIST with liver metastases.


Assuntos
Tumores do Estroma Gastrointestinal/tratamento farmacológico , Tumores do Estroma Gastrointestinal/patologia , Neoplasias do Jejuno/tratamento farmacológico , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/secundário , Sunitinibe/uso terapêutico , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Seguimentos , Tumores do Estroma Gastrointestinal/cirurgia , Hepatectomia/métodos , Humanos , Neoplasias do Jejuno/patologia , Neoplasias do Jejuno/cirurgia , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/métodos , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Cuidados Pré-Operatórios/métodos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
4.
BMC Surg ; 19(1): 194, 2019 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-31842856

RESUMO

BACKGROUND: Desmoid tumors, also known as aggressive fibromatosis, are extremely rare, accounting for less than 3% of soft-tissue sarcomas and less than 0,03% of all neoplasms. The diagnosis is usually delayed because of the lack of specific symptoms, and can sometimes lead to serious and, even fatal complications. CASE PRESENTATION: We report the case of a 27-year-old male patient presenting with the clinical picture of acute appendicitis. During the operation, we found a tumor in the jejunum with a necrotic zone and perforation on its surface, causing hemorrhagic effusion into the abdominal cavity and subsequent peritonitis. The tumor was removed with negative margins via resection of the small bowel. The final histological result showed aggressive fibromatosis. CONCLUSIONS: Aggressive fibromatosis remains a serious problem with the possibility of locally aggressive behavior with high rates of recurrence. Sometimes, its clinical and macroscopic recognition can be immensely tricky. As shown by our patient, on rare occasions, desmoid tumors can lead to acute surgical abdomen requiring an emergency operation.


Assuntos
Apendicite/diagnóstico , Fibromatose Agressiva/diagnóstico , Neoplasias do Jejuno/diagnóstico , Abdome Agudo/etiologia , Doença Aguda , Adulto , Diagnóstico Diferencial , Fibromatose Agressiva/complicações , Fibromatose Agressiva/cirurgia , Humanos , Neoplasias do Jejuno/complicações , Neoplasias do Jejuno/cirurgia , Masculino , Peritonite/etiologia
5.
J. coloproctol. (Rio J., Impr.) ; 39(4): 385-388, Oct.-Dec. 2019. ilus
Artigo em Inglês | LILACS | ID: biblio-1056637

RESUMO

Abstract Gastrointestinal stromal tumors, although rare, are the most common primary mesenchymal neoplasms of the gastrointestinal tract and originate from the interstitial cells of Cajal. They present slow growth and symptoms such as bleeding, abdominal pain or discomfort, and the presence of an abdominal mass. The most affected organs are the stomach and small intestine. Differential diagnoses for gastrointestinal stromal tumor include adenocarcinoma and small intestine lymphoma, metastasis, and carcinoid tumor. Gastrointestinal stromal tumors have been associated with familial syndromes such as type 1 neurofibromatosis, considered a predisposing factor for tumors in the small intestine. This study aimed to report a case of gastrointestinal stromal tumor in the jejunal region in a patient with type 1 neurofibromatosis, followed-up for two years, who underwent laparoscopic segmental enterectomy and diagnosis determined by histopathology and immunohistochemistry. The diagnosis of small intestine gastrointestinal stromal tumor is challenging because of its low incidence, nonspecific symptoms, relative inaccessibility of the small intestine to conventional endoscopic examination, broad spectrum of radiological appearances, and the fact that the nature of the mass is difficult to determine with imaging examinations of the abdomen alone. Thus, the small intestine gastrointestinal stromal tumor may be erroneously diagnosed as pancreatic, gynecological, or mesenteric tumors. The literature does not present many reports on the association of jejunal gastrointestinal stromal tumor with neurofibromatosis. Understanding the tumoral behavior of small intestine gastrointestinal stromal tumor in this subgroup of patients would allow better follow-up.


Resumo Os tumores estromais gastrointestinais, embora raros, são as neoplasias mesenquimais primárias mais comuns do trato gastrointestinal e originam-se das células intersticiais de Cajal. Apresentam crescimento lento e manifestam sintomas como sangramento, dor ou desconforto abdominal e presença de massa abdominal. Os órgãos mais acometidos são estômago e intestino delgado. Os diagnósticos diferenciais para tumores estromais gastrointestinais incluem adenocarcinoma e linfoma de intestino delgado, metástases e tumor carcinoide. Os tumores estromais gastrointestinais têm sido associados a síndromes familiares como a neurofibromatose tipo 1, considerada um fator predisponente para tumores no intestino delgado. O objetivo desse trabalho é relatar um caso de tumor estromal gastrointestinal em região jejunal em paciente portadora de neurofibromatose tipo 1, com 2 anos de seguimento, submetida a enterectomia segmentar laparoscópica e diagnóstico determinados pela histopatologia e imuno-histoquímica. O diagnóstico de tumor estromal gastrointestinal do intestino delgado é desafiador, devido a sua baixa incidência, sintomas inespecíficos, relativa inacessibilidade do intestino delgado ao exame endoscópico convencional, amplo espectro de aparências radiológicas e difícil determinação da natureza da massa apenas com exames de imagens do abdome. Assim, tumor estromal gastrointestinal no intestino delgado podem ser erroneamente diagnosticados como tumores pancreáticos, tumores ginecológicos, ou tumores do mesentério. A descrição científica da associação de tumor estromal gastrointestinal de jejuno com neurofibromatose é incomum. Tais descrições permitem melhor seguimento dos pacientes a partir do momento que se entende o comportamento tumoral do tumor estromal gastrointestinal de intestino delgado nesse subgrupo de pacientes.


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Neurofibromatose 1/complicações , Tumores do Estroma Gastrointestinal/complicações , Neoplasias do Jejuno/complicações , Laparoscopia , Tumores do Estroma Gastrointestinal/cirurgia , Tumores do Estroma Gastrointestinal/diagnóstico por imagem , Neoplasias do Jejuno/cirurgia , Neoplasias do Jejuno/diagnóstico por imagem
6.
World J Surg Oncol ; 17(1): 170, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31651341

RESUMO

BACKGROUND: Lymphangiomas are uncommon congenital malformations that present mainly in the head, neck, and axillar regions in pediatric patients. Mesenteric cystic lymphangiomas (MCLs), which occasionally present with substantial growth and the invasion of adjacent vital structures, are rarely reported in adults. We report a case of MCL in an adult who was treated with laparoscopic-assisted excision. CASE PRESENTATION: A 40-year-old Japanese man visited his family physician for prolonged periumbilical pain. Plain computed tomography (CT) showed a low-density mass in his left abdomen, and he was referred to our hospital 2 weeks later. His abdomen was flat and soft, and no mass was felt upon palpation. Routine laboratory data showed no abnormalities in the blood cell counts. The levels of tumor markers, such as carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), and cancer antigen 125 (CA125), were within normal ranges. Contrast-enhanced CT was performed, and a low-density mass was observed with an irregular outline and poor contrast, as well as involvement of the peripheral mesenteric artery and partial compression of the adjacent jejunum without dilatation of the oral side of the bowel. The patient was diagnosed with lymphatic cysts and observed for 1 month without symptom exacerbation. Follow-up CT showed no increase in the size of the mass but showed apparent invasion of the jejunal wall without bowel obstruction. Magnetic resonance imaging (MRI) showed intermediate intensity on T1-weighted imaging (T1WI) and high intensity on T2-weighted imaging (T2WI). The coronal view on T2WI clearly showed an accumulation of cystic lesions. We performed tumor excision with partial resection of the jejunum in a laparoscopic-assisted manner. Pathological examination showed multicystic lesions with an attenuated endothelial lining, surrounding rich adipose tissue and scattered smooth muscle fibers; the patient was diagnosed with MCL. Immunohistochemical assays supported this diagnosis. CONCLUSIONS: This is rare case of MCL presenting in an adult who underwent successful laparoscopic-assisted resection. Mesenteric lymphangioma (ML) should be considered in the differential diagnosis of patients with intraabdominal cysts. Radical excision is optimal, even when the patient is asymptomatic. Laparoscopic-assisted tumor resection is a suitable surgical method for treating MLs located in the peripheral mesentery.


Assuntos
Neoplasias do Jejuno/cirurgia , Laparoscopia/métodos , Linfangioma Cístico/cirurgia , Neoplasias Peritoneais/cirurgia , Adulto , Humanos , Neoplasias do Jejuno/diagnóstico por imagem , Neoplasias do Jejuno/patologia , Linfangioma Cístico/diagnóstico por imagem , Linfangioma Cístico/patologia , Masculino , Mesentério , Neoplasias Peritoneais/diagnóstico por imagem , Neoplasias Peritoneais/patologia , Tomografia Computadorizada por Raios X
7.
Dtsch Med Wochenschr ; 144(21): 1505-1508, 2019 10.
Artigo em Alemão | MEDLINE | ID: mdl-31634928

RESUMO

HISTOLOGY AND CLINICAL FINDINGS: We report on a 66-year-old-patient with plasmocytoma, who presented with melena since 3 days, dyspnea and dizzyness. INVESTIGATION AND DIAGNOSIS: Because of the laboratory and clinical examination the suspected diagnosis was an active gastrointestinal bleeding. The performed gastroduodenoscopy and sigmoidoscopy could not verify an active bleeding. Thus a contrast-enhanced computed tomography was performed additionally and showed abnormal enhancement as well as a ballooning of the proximal jejunum. Subsequently a jejunoscopy was performed where an actively bleeding mass was found. TREATMENT AND COURSE: Due to the known medical history of a plasmocytoma and in conjunction with the performed examinations the suspected diagnosis of an extramedullary metastasis of a plasmocytoma in the jejunum was made. Since only temporary control of the bleeding could be achieved, a segmental resection of the small bowel was performed. The following histological examination confirmed the diagnosis. CONCLUSION: The differential diagnosis for gastrointestinal bleeding includes also rarely neoplastic manifestations in the small bowel. Contrast-enhanced computed tomography can aide in the localization of the bleeding side and determination of the cause of hemorrhage.


Assuntos
Neoplasias do Jejuno , Melena/etiologia , Plasmocitoma , Idoso , Endoscopia Gastrointestinal , Feminino , Humanos , Neoplasias do Jejuno/complicações , Neoplasias do Jejuno/diagnóstico por imagem , Neoplasias do Jejuno/cirurgia , Jejuno/diagnóstico por imagem , Jejuno/cirurgia , Plasmocitoma/complicações , Plasmocitoma/patologia
8.
G Chir ; 40(3): 225-229, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31484013

RESUMO

INTRODUCTION: Jejunal adenocarcinoma is a very rare disease but the frequency of this rare carcinoma is higher in celiac patients. We report the first case report of a second jejunal loop adenocarcinoma associated with celiac disease. PRESENTATION OF CASE: A 47-year-old woman, with a history of celiac disease. Computerized tomographic scans of the abdomen and pelvis demonstrated a severe retroperitoneal lymphoadenopathy, para-aortic, inter-aorto-caval, porto-caval, posterior pancreaticoduodenal space, celiac trunk, lesser gastric curvature, lymph node grouping. The patient underwent digiunal resection and regional lymphadenectomy. Diagnosis was poorly differentiated jejunal adenocarcinoma, infiltrating subserosal adipose tissue, metastasing in five out of eight regional lymph nodes. U.I.C.C. 2017 grading = pT3 pN2 G3 R0; Stage IIIB. DISCUSSION: The jejunum accounts for 11-25% of small bowel adenocarcinoma, that accounts for less than 5% of gastrointestinal cancer, notwithstanding that 90% of the mucosa surface area of the digestive tract is made by small intestine. To the best of our knowledge, this is the first report on a second loop jejunal adenocarcinoma complicating celiac disease. In our study, the diagnosis of cancer was made by computed tomography (CT) of abdomen and the patient was operated. For the diagnosis of small bowel tumour, CT enteroclysis has a sensitivity of 85-95% and a specificity of 90-96%. Complete resection (RO) of the jejunal adenocarcinoma, with regional lymph nodes resection and jejuno-jejunal anastomosis should be performed. CONCLUSION: After curative surgical resections of small bowel adenocarcinoma, adjuvant chemo-therapy has not shown a clear benefit in retrospective studies. Preoperative Chemo-Radio-therapy and careful Imaging Staging are the first steps to planning surgery.


Assuntos
Adenocarcinoma/complicações , Doença Celíaca/complicações , Neoplasias do Jejuno/complicações , Doenças Raras/complicações , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/cirurgia , Feminino , Humanos , Neoplasias do Jejuno/diagnóstico por imagem , Neoplasias do Jejuno/cirurgia , Jejuno/diagnóstico por imagem , Jejuno/cirurgia , Excisão de Linfonodo , Pessoa de Meia-Idade , Doenças Raras/diagnóstico por imagem , Doenças Raras/cirurgia , Tomografia Computadorizada por Raios X
9.
Ann Ital Chir ; 82019 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-31310242

RESUMO

BACKGROUND: Perivascular epithelioid cell tumors are rare mesenchymal tumors composed of histologically and immunohistochemically distinctive perivascular epithelioid cells. They are considered ubiquitous tumors and have been described in different organs, but gastro-intestinal PEComas are diseases of extreme rarity. METHODS: We report a case of a 51-year-old woman, without a medical history of tuberous sclerosis complex, affected by abdominal PEComa, adhering tightly to the jejunal loop and to the spleen. RESULTS: During the surgical operation, a large abdominal mass was found, and surgical resection was carried out. Definitive histologic and ultrastructural findings were consistent with PEComa. CONCLUSION: Given the rarity of GI-PEComas and the lack of cases reported in the literature, we want to emphasize the importance of conducting further studies in this regard, to better describe their biological behaviour. KEY WORDS: Gastro-intestinal tumor, PEComa, Perivascular epithelioid cell tumors.


Assuntos
Neoplasias do Jejuno/diagnóstico , Segunda Neoplasia Primária/diagnóstico , Neoplasias de Células Epitelioides Perivasculares/diagnóstico , Dor Abdominal/etiologia , Neoplasias da Mama/terapia , Células Epitelioides/patologia , Feminino , Humanos , Neoplasias do Jejuno/diagnóstico por imagem , Neoplasias do Jejuno/patologia , Neoplasias do Jejuno/cirurgia , Pessoa de Meia-Idade , Segunda Neoplasia Primária/diagnóstico por imagem , Segunda Neoplasia Primária/patologia , Segunda Neoplasia Primária/cirurgia , Neoplasias de Células Epitelioides Perivasculares/patologia , Neoplasias de Células Epitelioides Perivasculares/cirurgia , Tomografia Computadorizada por Raios X
10.
Perm J ; 232019.
Artigo em Inglês | MEDLINE | ID: mdl-31314729

RESUMO

INTRODUCTION: Ewing sarcoma most commonly arises in bones but rarely presents in extraskeletal locations. We report one such case arising from the jejunum. CASE PRESENTATION: A 67-year-old woman presented with acute-onset, right lower quadrant pain. Computed tomography results showed a large mass within the midjejunum with pneumoperitoneum. Surgical excision was performed, and an extraskeletal Ewing sarcoma of the jejunum was suspected histologically. The diagnosis was confirmed with fluorescence in situ hybridization studies. CONCLUSION: This case emphasizes the importance of recognizing this rare presentation in the small intestine to broaden the differential diagnosis of adult intraabdominal tumors.


Assuntos
Neoplasias do Jejuno/diagnóstico por imagem , Neoplasias do Jejuno/cirurgia , Sarcoma de Ewing/diagnóstico por imagem , Sarcoma de Ewing/cirurgia , Tomografia Computadorizada por Raios X , Idoso , Diagnóstico Diferencial , Feminino , Humanos
11.
BMJ Case Rep ; 12(6)2019 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-31164378

RESUMO

Type 1 neurofibromatosis (NF1) is a hereditary disorder with an incidence of approximately 1:3000 at birth. Gastrointestinal (GI) lesions occur in approximately one-third of the patients, with most being asymptomatic and diagnosed incidentally. Symptomatic lesions leading to GI bleeding are uncommon. We share our experience of an elderly man with NF1, who presented with massive recurrent GI bleeding secondary to jejunal neurofibromas. The lesions were identified on CT scan of abdomen, and the patient was managed with resection of the involved bowel segment.


Assuntos
Hemorragia Gastrointestinal/diagnóstico , Neoplasias do Jejuno/diagnóstico , Neurofibromatose 1/diagnóstico , Idoso , Colonoscopia , Diagnóstico Diferencial , Hemorragia Gastrointestinal/complicações , Hemorragia Gastrointestinal/cirurgia , Humanos , Neoplasias do Jejuno/complicações , Neoplasias do Jejuno/diagnóstico por imagem , Neoplasias do Jejuno/cirurgia , Masculino , Neurofibromatose 1/complicações , Neurofibromatose 1/diagnóstico por imagem , Neurofibromatose 1/cirurgia , Recidiva , Tomografia Computadorizada por Raios X
13.
Artigo em Alemão | MEDLINE | ID: mdl-30808031

RESUMO

A 2-year-old Arabian horse was presented with severe colic symptoms. During explorative laparotomy, a jejuno-jejunal invagination secondary to a submucosal intestinal mass was detected. The involved jejunal segment was surgically removed and an end-to-end anastomosis was created. Opening the specimen demonstrated the presence of a nodular mass on the head of the intussusceptum, measuring 10 cm in diameter, and almost completely obliterating the intestinal lumen. Additionally, a severe hyperemia of the jejunal mucosa was visible. Histological examination, which revealed a well-demarcated mass in the submucosa of the jejunum consisting of well-differentiated adipocytes, led to the diagnosis of an intramural lipoma. The small intestinal mucosa displayed mild to moderate signs of congestion. Pedunculated lipomas in the mesentery of horses causing intestinal volvulus and obstruction are a frequent cause of small-intestine strangulation in aged horses. To the authors' knowledge, intramural intestinal lipomas to date have not been described in the horse. The mare recovered without complications and was free of colic symptoms after 6 months.


Assuntos
Doenças dos Cavalos/cirurgia , Neoplasias do Jejuno/veterinária , Jejuno/cirurgia , Animais , Cólica/etiologia , Doenças dos Cavalos/etiologia , Cavalos , Intussuscepção/etiologia , Intussuscepção/cirurgia , Intussuscepção/veterinária , Neoplasias do Jejuno/complicações , Neoplasias do Jejuno/cirurgia , Lipoma/complicações , Lipoma/cirurgia , Lipoma/veterinária
14.
BMJ Case Rep ; 12(1)2019 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-30696643

RESUMO

We describe a case of intestinal obstruction caused by a small bowel adenocarcinoma misdiagnosed as psychogenic disorder. A woman in her 40s was admitted to Nagoya City University Hospital with fatigue, anorexia, nausea and vomiting. CT, oesophagogastroduodenoscopy and colonoscopy revealed no signs of organic abnormality in her gastrointestinal tract. As the patient had previously been diagnosed with and treated for depression, her symptoms were suspected to be due to psychogenic disorder. Therefore, she was diagnosed with severe depression and was administered antidepressant agents. Despite intense psychiatric treatment, her symptoms worsened and she was later diagnosed with ileus due to adenocarcinoma in the jejunum. After drainage by insertion of a transnasal decompression tube, a partial jejunum resection was performed. After the resection, the patient's symptoms including fatigue and depression resolved without the use of antidepressant agents.


Assuntos
Adenocarcinoma/complicações , Adenocarcinoma/diagnóstico por imagem , Transtorno Depressivo Maior , Obstrução Intestinal/etiologia , Neoplasias do Jejuno/complicações , Neoplasias do Jejuno/diagnóstico por imagem , Adenocarcinoma/cirurgia , Diagnóstico Diferencial , Erros de Diagnóstico , Feminino , Humanos , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/cirurgia , Intestino Delgado/diagnóstico por imagem , Intestino Delgado/cirurgia , Neoplasias do Jejuno/cirurgia , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X/métodos
16.
Curr Probl Diagn Radiol ; 48(3): 298-301, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29169676

RESUMO

Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of the gastrointestinal tract and may occasionally present with acute gastrointestinal bleed (GIB). Multidetector computed tomography (MDCT) angiography is extremely useful in demonstrating the tumor as well as the presence of active hemorrhage, thereby guiding subsequent interventional or surgical management. We report a case of a 38-year-old man who presented with acute-onset melena and compensated shock, whose source of bleed remained elusive on endoscopy. MDCT angiography performed on a dual-energy scanner showed a jejunal tumor with active intraluminal contrast extravasation. The tumor was subsequently resected and the patient did well on follow-up. This was one of the few instances when MDCT angiography demonstrated active bleeding in a GIST and the first such case demonstrated on a dual-energy scanner.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Hemorragia Gastrointestinal/diagnóstico por imagem , Tumores do Estroma Gastrointestinal/diagnóstico por imagem , Neoplasias do Jejuno/diagnóstico por imagem , Tomografia Computadorizada Multidetectores/métodos , Adulto , Diagnóstico Diferencial , Hemorragia Gastrointestinal/cirurgia , Tumores do Estroma Gastrointestinal/cirurgia , Humanos , Neoplasias do Jejuno/cirurgia , Masculino
17.
Ann Ital Chir ; 82019 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-32390651

RESUMO

Gastrointestinal stromal tumors(GISTs) are rare neoplasms of the gastrointestinal(GI) system originating from the mesenchyme. GISTs mostly develop in the stomach and small intestine. We present here a case of jejunal GIST which is the rarest subtype. A 54-year-old man presented with lower right side abdominal pain. On workup, images showed a 7cm solid-cycstic lesion adjacent to ascending colon. On surgical exploration, a large jejunal tumor en bloc resected and jejuno-jejunal primary anastomosis was performed. Pathologic results showed a 9cm jejunal GIST with 5% proliferation index. Immunohistochemistry results demonstrated high expressions of CD117, whereas CD34 negative. The patient was discharged uneventfully. GISTs should be considered in patients with abdominal pain. The mainstay treatment of the jejunal GIST is complete surgical resection. The definitive diagnosis of GISTs is by immunohistochemical stains. KEY WORDS: GIST, Stromal tumor, Jejunum.


Assuntos
Tumores do Estroma Gastrointestinal , Neoplasias do Jejuno , Tumores do Estroma Gastrointestinal/diagnóstico , Tumores do Estroma Gastrointestinal/cirurgia , Humanos , Neoplasias do Jejuno/diagnóstico , Neoplasias do Jejuno/cirurgia , Masculino , Pessoa de Meia-Idade
18.
Pan Afr Med J ; 34: 197, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-32180871

RESUMO

Gastrointestinal stromal tumors are the most common mesenchymal tumors of the gastrointestinal tract. They are generally considered as solitary tumors. Here we report the case of a 66-year-old man with familial history of digestive cancers, admitted after a 2-months history of gastrointestinal bleeding. Colonoscopy showed a circumferential ulcerated tumor of the sigmoid which was a well differentiated adenocarcinoma on biopsy. Computerized tomography showed only the lesion of the sigmoid. The patient underwent a left colectomy followed by immediate end-to-end anastomosis. Per-operatively, jejunal mass was discovered and a jejunal segmentectomy was performed. Pathologic examination revealed a colic adenocarcinoma pT2N0M0 associated with a low risk stromal tumor of the jejunum CD117+ and DOG-1+. No adjuvant therapy was given. After 64 months of follow-up, the patient showed no evidence of recurrence. Clinicians should be aware of the coexistence of malignancies and carry careful investigations for accurate diagnosis and better patients' prognosis.


Assuntos
Adenocarcinoma/diagnóstico , Neoplasias do Colo/diagnóstico , Tumores do Estroma Gastrointestinal/diagnóstico , Neoplasias do Jejuno/diagnóstico , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Idoso , Colectomia , Neoplasias do Colo/patologia , Neoplasias do Colo/cirurgia , Colonoscopia , Hemorragia Gastrointestinal/etiologia , Tumores do Estroma Gastrointestinal/patologia , Tumores do Estroma Gastrointestinal/cirurgia , Humanos , Neoplasias do Jejuno/patologia , Neoplasias do Jejuno/cirurgia , Masculino , Neoplasias Primárias Múltiplas
19.
BMJ Case Rep ; 11(1)2018 Dec 13.
Artigo em Inglês | MEDLINE | ID: mdl-30567229

RESUMO

Peutz-Jeghers syndrome (PJS) is an autosomal dominant cancer-predisposing condition characterised by intestinal hamartomatous polyps and distinct melanin depositions in skin and mucosa. Small intestinal cancer in patients with PJS usually presents by the third decade. A 7-year-old-PJS boy presented with recurrent episodes of colicky abdominal pain and melena requiring repeated blood transfusions. Abdominal CT scan revealed multiple jejunal polyps with jejunoileal intussusception. On exploration, the intussuscepted bowel was resected along with its mesentery and anastomosed. Simultaneously, multiple enterotomies with resection of palpable polyps were performed. The resected bowel showed well-differentiated stage 2A adenocarcinoma with clear resected margins. Postoperatively, the complaints were relieved. On follow-up, he was asymptomatic and is now on yearly cancer surveillance. This is probably the youngest reported case of small bowel cancer in PJS.


Assuntos
Adenocarcinoma/congênito , Pólipos Intestinais/congênito , Intussuscepção/congênito , Neoplasias do Jejuno/congênito , Síndrome de Peutz-Jeghers/complicações , Adenocarcinoma/cirurgia , Criança , Humanos , Pólipos Intestinais/cirurgia , Intestino Delgado/patologia , Intestino Delgado/cirurgia , Intussuscepção/cirurgia , Neoplasias do Jejuno/cirurgia , Masculino , Melena/congênito , Linhagem
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