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Wandering small intestinal stromal tumor: A case report
Jin-Zhan Su, Shu-Feng Fan, Xia Song, Lu-Jun Cao, Dong-Ying Su
Jin-Zhan Su, Shu-Feng Fan, Xia Song, Dong-Ying Su, Department of Radiology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310005, Zhejiang Province, China
Lu-Jun Cao, Department of Radiology, The Hospital of the Zhejiang University, Hangzhou 310058, Zhejiang Province, China
Author contributions: Su JZ and Fan SF were involved in data collection and interpretation; Song X and Fan SF drafted the manuscript; Cao LJ and Su DY contributed in the revision.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xia Song, MS, Department of Radiology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310005, Zhejiang Province, China. firstname.lastname@example.org
Received: May 11, 2022 Peer-review started: May 11, 2022 First decision: July 29, 2022 Revised: August 16, 2022 Accepted: September 7, 2022 Article in press: September 7, 2022 Published online: October 16, 2022
The occurrence of gastrointestinal stromal tumors (GISTs) in the small intestine is rare, and a case of wandering small intestinal stromal tumor has been rarely reported to date. Dissemination of this case can help inform future diagnosis and effective treatment.
A 68-year-old patient presented to us with tarry stools. Computed tomography showed a mobile tumor moving widely within the abdominal cavity. As the laboratory data showed a low range of red blood cells and an immediate surgery was not indicated, we performed digital subtraction angiography and embolization to achieve hemostasis. Surgical resection was performed after the patient’s condition improved. The tumor was successfully removed laparoscopically. Histological examination revealed submucosal GIST with infarction, which was of intermediate-risk, with mitotic count < 1 per 10 high-power field. Immunohistochemical studies revealed the following: CD117+, Dog1+, CD34+, SMA+, S100-, CK-, Des-, SOX-11-, STAT6-, Ki67 Hotspots 10%+. The patient was ultimately diagnosed with wandering small intestinal stromal tumor.
When a highly vascularized tumor is clinically encountered in the small intestine, the possibility of stromal tumors should be considered. However, when the tumor cannot be visualized at its original location, the possibility of tumor migration is considered.
Core Tip: Stromal tumors of the small intestine are rare. Symptoms range from none to mass effect and hemorrhage. With nonspecific symptoms, computed tomography is helpful in visualizing contrast-enhancing lesions in the small intestine. In even rarer cases, these tumors may mobilize and produce symptoms that mimic conditions, such as intestinal torsion. Recognition of wandering stromal tumors of the small intestine facilitates the timely diagnosis and treatment. Evaluation includes imaging, digital subtraction angiography, and histopathology. Surgery remains the gold standard of treatment.