P-0162 - Benign mesenchymal non-GIST tumors of the subdiaphragmal digestive tract
|Date||28 June 2014|
|Event||World GI 2014|
|Topics|| Gastrointestinal Cancers
|Citation||Annals of Oncology (2014) 25 (suppl_2): ii14-ii104. 10.1093/annonc/mdu165|
M. Diaconescu, S. Diaconescu
Morphological, immunochemical and ultrastructural but also clinical and prognostic differences between numerous types of mesenchymal (stromal, nonepithelial) tumors of the gastrointestinal tract prompted us to remembrance of an anecdotic personal series of sixteen observations of benign mesenchymal “non-stromal” subdiaphragmal gastrointestinal tumors encountered in more than four decades of surgical practice.
The diagnosis was mainly established on clinical grounds, some lesions being incidentally discovered, and confirmed by radiology, endoscopy, intraoperative exploration and microscopic pathology examination, both provide specimens for immunohistochemical and ultrastructural examinations with KIT and PDGFRA being achieved only in few cases in last period. The medical files, imaging documents, pathology and operative protocols were reviewed. All these tumors were operated on undergoing case adapted surgery with medium and long term periods of follow-up.
Since 1970 in more than four decades of surgical activity, we recorded sixteen observations of mesenchymal non GIST digestive tumors, 9 males and 7 females with an average age of 53 (range 30-72) years. Definitive pathologic diagnosis was schwannomas in 9 cases, 8 gastric and one colic, leiomyomas in 3 cases, gastric, ileal and colic, one case each, two lipomas, gastric and colic and finally one fibroma and one “mixoma” both belonging stomach. All of these tumors were operated on undergoing case adapted conservative or standard extended operations. There were no postoperative morbidity and mortality in our series. Average follow-up for our patients was performed at periods of 24 (range 6-60) months and there were not registered recurrences or metastasis.
Clinical rarity, nonspecific symptomatology slow course, late or fortuit diagnosis the non GIST digestive lesions must be recognised as well differentiating them from well contoured GISTs neoplasms. A surgeon faced with clinical or paraclinical data which suggest the possibility of a non GIST tumor, must exhaust the exploring options in order to offer the optimal case adapted conservative (mucous or parietal ruff excision), atypical or better standard (segmentar or sectorial) visceral resection. Long-term postoperative follow-up of these rare cases is mandatory.