engleski

Synchronous gastric cancer and multiple gastrointestinal stromal tumor in the stomach of a patient with non Hodkgin s lymphoma – a case report

A gastrointestinal stromal tumor (GIST) is one of the most common mesenchymal tumors of the gastrointestinal tract (1-3% of all gastrointestinal malignancies). They are typically defined as tumors whose behavior is driven by mutations in the Kit gene or PDGFRA gene. During the last two decades understanding of gastrointestinal stromal tumors have a major progress specially in area of diagnostic modality and treatment. A 72 years old male patient with earlier diagnosis of non Hodgkin s lymphoma, now in reemission, was admitted on haemathology department due to anemia. Esophagogastroscopy revealed a tumor in antrum (3x3cm). Biopsy was taken and pathology analysis finds out adenocarcinoma (intestinal type according to Lauren). Abdominal MSCT was normal, exept antral tumor detected earlier on esophagogastroscopy. Due to age, comorbidity, location and size of tumor Bilroth II gastric rescection was planed, but during stomach mobilization and exploration we found a subserosal tumor (1x1cm) in gastric fundus. Despite a initially negative findig on frozen section, D2 gastrectomy was performed. In pathologic specimen of stomach two different neoplasm were reveald: an adenocarcinoma and GIST. The adenocarcinoma was T1N1M0, intestinal type according to Lauren classification. The pathological findings disclosed also a multifocal GIST on 5 different location on stomach specimen including initially negative frozen section on gastric fundus. All GISTs were less than 1 cm in diameter and all were composed of spindle and epitheloid cells without atypia. CD117(KIT) positivity, CD34 positivity, low mitotic activity, smooth muscle actin and scatter desmin negativity was observed. Ki67, proliferation marker was less than 2%. The synchronous occurrence of gastric adenocarcinoma and multiple gastric GISTs in patient with metachronous non Hodgkin lymphoma is not reported in literature, according to our knowledge. Until now the literature has only a few reports of synchronus GIST and stomach cancer without clarifcation is this sinchronicity incidental or there is a causativ factor inducing the develepment of tumors of different histiotypes in the same organ. Further confirmation is required, util than surgeon and other physicians involved in treatment of simmilar patients should be acquaint with this intersting condition.

gastrointestinal stromal tumor; non-Hodgkin lymphom

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