Key Clinical Message
Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of the gastrointestinal tract. Lack of clinical symptoms and findings on preoperative upper endoscopy makes its diagnosis difficult in bariatric patients. A laparoscopic resection of the gastric GIST during bariatric surgery is associated with good long‐term prognosis.
Keywords: Bariatric surgery, gastrointestinal stromal tumor, laparoscopic sleeve gastrectomy, morbid obesity
Question: Fifty‐one‐year‐old female with obesity (body mass index 38.2 kg/m2), hypertension, and sleep apnea underwent an elective laparoscopic sleeve gastrectomy. She had no symptoms suggesting the presence of a gastric tumor and preoperative upper endoscopy was normal. During surgery, a 1 cm nodule was found on the proximal anterior surface of the stomach (Fig. 1). It was resected along with the gastric specimen, and histopathology showed spindle‐shaped cells (Fig. 2). What is the diagnosis?
Figure 1.
Intraoperative picture during laparoscopic sleeve gastrectomy demonstrates gastrointestinal stromal tumor (white arrow) on the anterior surface of the stomach.
Figure 2.
Microscopic image demonstrating spindle‐shaped cells on histopathology.
Answer: Gastrointestinal stromal tumor (GIST) of stomach.
The incidence of GIST is higher in obese patients 1. Symptoms are nonspecific, which makes the diagnosis difficult. Most GIST in bariatric surgery patients are incidental intraoperative findings and usually have low‐grade malignancy 2. Surgery is the mainstay of therapy, and the goal was to achieve negative microscopic margins 1. Lymph node metastasis is rare. It can be managed by laparoscopic approach.
Conflict of Interest
None declared.
Authorship
SS: designed, acquired, analyzed, interpreted the data. Drafted and approved the work to be published.
Clinical Case Reports 2017; 5(11): 1905–1906
References
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