Clnical presentation and surgical treatment of small bowel gastrointestinal stromal tumors: retrospective analisys of 13 cases

State University of Medicine and Pharmacy “Nicolae Testemitanu”, Chişinău, Republic of MoldovaIntroduction: Small bowel tumors are rare malignancies that account for 1-5% of all gastrointestinal tumors. Despite the progress in recent years in the treatment of small bowel tumors, their diagnosis is difficult to date because of nonspecific symptoms. To analyze the clinicopathologic characteristics, diagnostic options and complex treatment of 13 cases of small bowel gastrointestinal stromal tumors (GIST). Materials and Methods: 13 consecutive patients with small bowel G ISTs, 5 males (38.5%) and 8 females (61.5% ), male: female ratio 1:1.6, median age of 55.1 ± 3.3 (95% CE47.90-62.25) years (28-71 years), who underwent surgery from 2008 to 2014, were included in this study. The clinical records of the patients were analyzed retrospectively. Results: Abdominal pain (11 cases, 84.6%) was the most common complaint. Abdominal CT was routinely performed on 9 (69.2%) patients. The preoperative diagnosis was established in 7 (53.8%) cases by abdominal CT. In 5 cases the tumors manifested clinically with complications: hemorrhage - 2 (15.4% ) patients, obstruction - 2 (15.4%) patients and perforation - 1 (7.7%) patient. In 3 (23.1% ) patients the tumor was localized in the duodenum, in 8 (61.5%) - in the jejunum and in 2 (15.4%) - in the ileum. All patients received surgery: 2 - cephalic pancreatoduodenectomy, 9 - small bowel resection, 1 - duodenal resection and 1 - wedge resection. The distribution of stages of the disease was as follows: IA=23.1% (n=3), 11=7.7% (n=l), IIIA=30.7% (n=4), IIIB=23.1% (n=3) and I V= 15.4% (n=2). The mean number of tumors was 2.5 ± 0.7 (from 1 to 9). The mean maximum diameter of the tumors was 9.5 ± 1.3 (from 3.7 to 20) cm. All 13 patients (100% ) showed positivity for c-KIT(CD l l 7). The overall median number of mitoses/50HPF was 8.8 ± 1.2 (95% 0 :6 .1 5 -1 1 .5 4 ). The median number of mitoses/50HPF in patients with high risk of recurrence was 11.1 ± 1.1 (95% 0:8.60-13.62) (from 7 to 18) (n=9) and 3.7 ± 0.5 (95% 0 :2 .2 2 7 - 5.273) (from 3 to 5) (n=4) in patients with low risk of recurrence. A total of 9 (69.2%) patients received adjuvant treatment with imatinib mesylate 400mg/day. Conclusion: Clinical manifestations of small bowel GISTs are non-specific and preoperative diagnosis is difficult. Surgery is the only curative option in the complex treatment of this disease

Tumorile gastrointestinale stromale ale duodenului. Revista literaturii

Tumorile gastrointestinale stromale (GIST) sunt cele mai frecvente tumori mezenchimale ale tractului gastrointestinal, derivate din celulele Cajal sau precursorii acestora. Conform incidenței, duodenul este una dintre cele mai puțin frecvente localizări primare. Diagnosticul se bazează pe caracteristicile morfologice și imunohistochimice ale tumorii care de cele mai multe ori exprimă pozitivitate pentru markerul c-KIT(CD117). Prezentarea clinică este variabilă, dar cel mai frecvent simptom în GIST duodenal este hemoragia gastrointestinală, urmat de durerea abdominală și, mai puțin frecvent, descoperirea incidentală în cadrul altor investigații de diagnostic. Pilonul de bază în tratament îl reprezintă rezecția chirurgicală radicală a bolii locale, dar ratele de recurență sunt mari. Managementul modern al bolii GIST combină utilizarea intervenției chirurgicale în asociere cu noile direcții de terapie țintită

Tumorile gastrointestinale stromale gastrice (Revista literaturii)

Tumorile gastrointestinale stromale (GIST) sunt cele mai frecvente tumori mezenchimale ale tractului gastrointestinal, derivate din celulele Cajal sau precursorii acestora. Conform incidenței stomacul este cea mai frecventă localizare primară. Procesele cheie responsabile de patogenia maladiei rezidă în expresia mutațiilor, mai ales, ale genei c-KIT și rareori ale genei PDGFRA. Diagnosticul se bazează pe caracteristicile morfologice și imunohistochimice ale tumorii care de cele mai multe ori exprimă pozitivitate pentru markerul c-KIT (CD117). Prezentarea clinică a GIST este variabilă, dar simptomele cele mai uzuale includ prezența unei mase abdominale palpabile sau hemoragie gastrointestinală. Pilonul de bază în tratament îl reprezintă rezecția chirurgicală radicală a bolii locale, dar ratele de recurență sunt mari. Managementul modern al bolii GIST combină utilizarea manipulațiilor chirurgicale împreună cu noile direcții ale terapiei țintite

Tumorile gastrointestinale stromale gastrice gigante

Background. Gastrointestinal stromal tumors (GIST) represent 0.1-3% of all mesenchymal neoplasms of the gastrointestinal tract and giant gastric (GG) GIST are rare. Objective of the study. Study of clinical, histopathological and immunohistochemical features and treatment results of GG GIST. Material and Methods. 92 patients with GG GIST(c-kit(CD117)(+) treated between 2007-2019. Study group–14 patients with GG GIST, M:F=1.8:1, mean age-59.78±2.35(95%CI:54.69-64.87) years. Results. Surgical options: excision of gastric tumor-2(14,3%), gastric wedge resection-7(50%), partial gastrectomy-5(35,7%). The mean maximum size of tumors 23,69±0,81(95%CI:21,93-25,44)cm. Immunohistochemical phenotype: CD117(+)–14(100%), CD34(+)–12(85.7%), desmin(+)–3(21.4%), vimentin(+)–10(71.4%), S-100(+)–3(21.4%), SMA(+)–8(57.1%), NSE–2(14.3%). Mean number of mitoses–24.36±6.3(95%CI:10.65-38.06). Tumors with high mitotic count were registered more frequent than with low mitotic count–11(78.6%) vs. 3(21.4%)(p<0.05). Metastases at first presentation– 28.6%(n=4) cases. Complex treatment – surgical and target therapy with imatinib mesylate–14(100%) patients. Conclusion. GG GIST are rare, but possess a higher risk of progression. Complex treatment is the best curative option. Introducere. Tumorile gastrointestinale stromale (TGIS) reprezintă 0,1-3% din neoplaziile mezenchimale ale tractului digestiv. TGIS gastrice gigante (GG) se întâlnesc rar. Scopul lucrării. Analiza particularităților clinice, a aspectelor histopatologice, imunohistochimice și a rezultatelor tratamentului TGIS GG. Material și Metode. 92 de pacienți cu TGIS GG (c-kit(CD117)(+) operați între 2007-2019. Lotul de cercetare–14 pacienți cu TGIS GG, raportul femei:bărbați– 1:1,8, vârsta medie 59,78±2,35 ani. Rezultate. Volumul operațiilor: excizia tumorii peretelui gastric– 2(14,3%), rezecție gastrică limitată–7(50%), gastrectomie subtotală–5(35,7%). Dimensiunea maximă în medie a tumorilor 23,69±0,81 cm. Profilul imunohistochimic al tumorilor: CD117(+)–14(100%), CD34(+)–12(85,7%), desmină(+)–3(21,4%), vimentină(+)–10(71,4%), S-100(+)–3(21,4%), SMA– 8(57,1%), NSE–2(14,3%). Numărul mediu al mitozelor– 24,36±6,3(95%CI:10,65-38,06). Tumorile cu indice mitotic înalt au predominat asupra tumorilor cu indice mitotic redus– 11(78,6%) vs. 3(21,4%)(p<0,05). Metastaze la adresarea primară– 28,6%(n=4) cazuri. Tratament combinat – chirurgical și target terapie cu imatinib mesilat– 14(100%) pacienți. Concluzii. TGIS gastrice gigante sunt rare, dar frecvent cu risc înalt de progresare. Tratamentul combinat este opțiunea curativă optimă

Gastrointestinal autonomic nerve tumor: report of a case

Introduction: Gastrointestinal autonomic nerve tumors (GANT) are a rare subgroup of gastrointestinal stromal tumors (GIST). Their histological appearance is similar to that of other GISTs. Up to date only about 200 cases were published in English literature. Aim: We report an additionally case of gastric GANT. Methods: A 72 years old female patient was admitted with abdominal tumor mass which occurred in the stomach according CT scan. She underwent a surgery and subtotal gastrectomy was performed. Results: Postoperative recovery was uneventful. Histological examination and immunohistochemical analysis revealed the diagnosis of a gastrointestinal autonomic nerve tumor. The immunohistochemical profile of the tumor revealed positive staining to c-kit (CD117), CD34, vimentin and S-100, positive staining to neuron-specific enolase (NSE) and negative staining to desmin. Three months after initial diagnosis and surgery the patient is asymptomatic and was scheduled for very close follow up. Conclusion: Radical surgical resection of gastrointestinal autonomic nerve tumors seems to be the only available curative approach to date in patients with no metastasis

Гигантские гастроинтестинальные стромальные опухоли желудка.

&bdquo;Giant gastric GISTs&rdquo;Tumorile gastrointestinale stromale (TGIS) sunt cele mai frecvente tumori mezenchimale ale tractului gastrointestinal. Conform incidenței, stomacul este cea mai frecventă localizarea primară. TGIS gigante (&gt;15 cm) ale stomacului se &icirc;nt&acirc;lnesc destul de rar. Diagnosticul se bazează pe caracteristicile morfologice și imunohistochimice ale tumorii c-KIT(CD117)(+). TGIS ale stomacului răm&acirc;n asimptomatice p&acirc;nă la atingerea dimensiunilor mari. Tratamentul principal &icirc;l reprezintă rezecția chirurgicală radicală a bolii locale. Tratamentul modern al bolii combină intervențiile chirurgicale cu noile direcții ale terapiei țintite.Гигантские гастроинтестинальные стромальные опухоли желудка

Detection of late complications of the permanent vascular access in hemodialysed patients using ultrasound and imaging methods. Pilot study

Introduction: The strategic direction to increase the lifetime of the PVA is to ensure'proper function for the existing PVA maximally possible by early diagnosis of potential complications assessing the vascular diameter, hemodynamic characteristics of PVA and vascular status of existing reserves using DU and CT angiography with 3D reconstruction. Aim: Detection of late complications of the permanent (P) vascular access (VA) in hemodialysed patients using Dupplex ultrasound (DU) and CT angiography with 3D reconstruction. Material and methods: between 2006 and 2012 - 82 patients were enrolled in the study with endstage chronic renal failure who underwent iterative hemodialysis (HD) in various Hemodialysis departments: IMPSP CNŞPMU, IMSP SCR, IMSP SCM №3 „Sfântă Treime”, IMSP SR Comrat, IMSP SR Cahul, IMSP SM Bălţi, ICŞDOSMC. The mean age was 49.62ll.48 (27-72) years; the male/female ratio was 42/40. The mean duration of treatment with iterative HD was 5.6110.52 (0.2-16) years. DU was performed with the device „Vivid S6”, General Eectrics, Medical Systems. Qualitative and quantitative parameters of blood flow in arterio-venous fistula (AVF), vascular resistance index and pulsatility index were evaluated. In 7 (8.5%) patients, because of considerable difficulties in interpretation of results by DU, CT angiography with 3D reconstruction was performed using Siemens Emotion 16 (Germany) with Ultravist solution - 150 ml i/v. Results: in case of AVF stenosis the blood flow determined by DU was turbulent and collateral, decreased to 500-600 ml/min; in cases of aneurysms - it was 2500-5000 ml/min. 3D-CT angiography allowed visualization of the full trajectory of AVF, including arterio-venous anastomosis, permeability/obstruction of central vein, the degree and extension of the stenosis. In 3 cases the diagnosis of central vein stenosis was confirmed. In one case of multiple aneurysms of AVF the full path of the VA was viewed, including the arterio-venous anastomosis with multiple aneurysmal dilatation (n=3). In 3 patients the depletion of upper limbs vascular reserves was found. Late complications of VA were diagnosed in 44 patients (53.6%). In 24 (29.2%) patients the depletion of vascular reserves were established. The complications pattern: AVF thrombosis - 29.5% (n=13), AVF stenosis - 36.4% (n=16), aneurysm - 29.5% (n=13), blood steal syndrome - 2.3% (n=l), carpal tunnel syndrome - 2.3% (n=l). Conclusions: DU of upper limb vessels is the method of choice in studying hemodynamic parameters of AVF. CT angiography provides significant advantages compared to DU in determining the degree and extent of stenosis, in assessing the state of the vascular system of the upper limbs and of central veins, and also in determining the vascular reserves of the patient in order to choose the optimal method of correction of complications

Aneurysmal dilatations of the vascular access for hemodyalisis: surgical treatment

The aim of the research is to choose the optimal methods of diagnosis and rational surgical treatment in patients with aneurysmal type dilatations (ATD) who are on dialysis. Dilatation type aneurysms (DTA) are part of the late complications of arterio-venous fistula (AVF) and can be seen in all types of fistulas, as a result of both repeated puncture and decreased vein elasticity. Surgical management is controversial for DTA. In the study were included 15 patients with CRF, stage V (KDOQI) who are on dialysis in the department of Hemodialysis (HD) in the CNŞPMU with AVF dysfunction caused by DTA between 2006-2009. The mean age was 51,07±3,05 years (34 - 75 years). The male/female ratio was 6/8. The mean treatment period of iterative HD was 6,54±0,76 years (2-12 years). The mean period of time of aneurysm occurrence from the formation of AVF was 45,38±9,47 months (6-84 months). Using Dupplex ultrasound preoperative is compulsory both for the assessment of peripheral vascular system condition, and for setting the diagnosis. In 9 patients indications for surgical treatment were: a) decrease of blood flow in AVF (n=2); b) spontaneous rupture of the aneurysm of the AVF with external bleeding (n=2); c) pseudoaneurysm with PTFE graft infection (n=l); d) presence of calcinates in the aneurysm wall and of pain syndrome (n=l); e) aneurysm of the AVF in association with stenosis and partial thrombosis (n=3). According to location, the DTA are situated: on anastomosis line (n=2), at the puncture site (n=4), partial venous aneurysm (n=2), pseudoaneurysm of the polytetrafluoroethylene (PTFE) graft (n=l). Surgical treatment was performed in 9 (60%) from 15 patients. Following types of surgical correction were used: aneurysmectomy + AVF formation using PTFE graft (n=2), resection of the aneurysm with the reestablishment of native AVF with a segment of PTFE (n=l), resection of the aneurysm + reconstruction of the native AVF (n=4), aneurysmectomy + central venous catheter (n=l), reconstruction of synthetic AVF (PTFE) (n=l). The surgical option is made according to the size of the aneurysm, blood flow in the AVF and the patient’s vascular supply. The goal of the surgical treatment is to preserve the native AVF, but in case of absence of necessary peripheral vascular reserves - synthetic PTFE graft is recommended to form a new vascular access

Invaginaţia intestinală la adult

Invaginaţiile la adulţi sunt rare. Cel mai des triggerii invaginaţiilor reprezintă tumori benigne sau maligne, situate în mucoasă. Cel mai frecvent simptom la prezentare este durerea. CT abdominală a fost raportată a fi cea mai âsensibilă metodă de diagnostic de vizualizare a invaginaţiei în perioada preoperatorie. Intervenţia chirurgicală este metoda de tratament de elecţie, dar volumul ei este determinat intraoperator

Surgical management of mesenteric ischemia

The aim of the research was to assess the initial results of the application of “Damage Control Surgery” (DCS) principle in the treatment of acute mesenteric ischemia (AMI). Despite the successes achieved in the surgical treatment of the AMI the lethality rate in this group of patients is still 70-90%. Several surgical options have been reflected until now in literature, but there are few articles on the application of DCS principle in the surgical management of AMI. We present the results of the surgical management of 13 consecutive cases of AMI treated according to the DCS management option (immediate resection of nonviable bowel without the reconstruction of the digestive tract, laparostoma, including VAC-system, stabilizing the patient in the Intensive Care department and eventual elective reconstructive surgery later) between January 2009 and march 2010. Mean age was 67.92±2.48 (48-79) years, with the mean period of time before check-in of 45.62±14.47 hours. Diagnosis was set using the results of D-dimers test, 3D-CT with angiography and laparoscopy. 11 cases of arterial AMI and 2 cases of venous AMI were identified. The primary surgery included resection of the nonviable portion of the intestine: ileum (n=2), jejunum+ileum (n=3), jejunum+ileum+right hemicolonectomy (n=8). The final reconstructive surgery was performed after 50.82± 5.31 hours. The postoperative mortality was 61.53% (died 8 patients). The initial experience demonstrates that the Damage Control Surgery principle can be considered the only surgical option for the treatment of patients with AMI. The final conclusions will be defined after the analysis of a bigger group of patients