Large abdominal cyst #rupture of tumor #GIST# bestsurgeon

An elderly male presented with an asymptomatic large abdominal cyst for almost 5 years.

The cyst got ruptured and he had severe abdominal pain.

He underwent surgery and cust excision , the cyst was arising from the Duodeno Jejunal flexure, a very critical area. The cyst was removed completely along with a sleeve of bowel wall near the DJ flexure.

The post operative recovery was uneventful.

The histopathology was quite surprising and came out to be spindle cell neoplasm and IHC was confirmative of a GIST, Gastro intestinal stromal tumor.

GIST's are tumors rising from highly specialised cells called ICC cels ( Interstitial cells of canal), they have clinical behaviour like any other GI cancer and can be aggressive malignancies.

Most common site is the stomach followed by small intestine. can affect the rectum and the colon and the esophagus also. Retroperitoneal ( non GI ) Gist is also well known but rare.

These tumors are small to large, exophytic and spread by local invasion and by blood stream. Lymphatic spread is very rare.

Diagnosis:
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CECT abdomen is often diagnostic. There are no tumor markers. A biopsy is often diagnostic and confirmative.

These tumors are PET avid and a PET scan is very useful for staging and response assesment to neo adjuvant treatment with Imatinib and follow up for recurrence.

Treatment:
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1) Surgical excision is the treatment of choice and curative. These tumors do not need wide margins and lymph node dissection. Hence, upfront surgery is the treatment of choice.

2) Neoadjuvant therapy: Tumor with strategic location like the Duodenum, GE junction and rectum etc where organ preservation is of utmost important and essential, in these specific scenarios, neo adjuvant therapy with imatinib for 6 months till the rumor regresses in size and an organ preserving surgery is feasible.

3) Adjuvant. therapy: Tumors with high risk features and ruptured tumors need adjuvant therapy for 3 years following surgical resection, The most commonly used targeted therapy Imatinib.

Dr Datta Ram U is a senior Surgical Gastroenterologist and advanced Laparoscopic & Robotic surgeon in Hyderabad. He has over 2 decades of experience in Surgical Gastroenterology and Laparoscopic surgery.

His expertise includes advanced Laparoscopic surgery for GI and Liver and Pancreatic cancers, bile duct injuries, Liver resections for cholangiocarcinoma and Liver transplantation.

He is very well known for other basic GI surgeries like gall bladder removal, appendix removal and Proctology.

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