Wagner T, Mustafov O, Hummels M, Grabenkamp A, Thomas MN, Schiffmann LM, Bruns CJ, Stippel DL, Wahba R. Imaged guided surgery during arteriovenous malformation of gastrointestinal stromal tumor using hyperspectral and indocyanine green visualization techniques: A case report. World J Clin Cases 2023; 11(23): 5530-5537 [PMID: 37637700 DOI: 10.12998/wjcc.v11.i23.5530]
Corresponding Author of This Article
Tristan Wagner, MD, Doctor, Clinic and Polyclinic for General, Visceral, Tumor and Transplant Surgery, University of Cologne, Kerpener Str. 62, Cologne 50923, North Rhine Westphalia, Germany. tcwcloud@icloud.com
Research Domain of This Article
Surgery
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Aug 16, 2023; 11(23): 5530-5537 Published online Aug 16, 2023. doi: 10.12998/wjcc.v11.i23.5530
Imaged guided surgery during arteriovenous malformation of gastrointestinal stromal tumor using hyperspectral and indocyanine green visualization techniques: A case report
Tristan Wagner, Onur Mustafov, Marielle Hummels, Anders Grabenkamp, Michael N Thomas, Lars Mortimer Schiffmann, Christiane J Bruns, Dirk L Stippel, Roger Wahba
Tristan Wagner, Onur Mustafov, Marielle Hummels, Anders Grabenkamp, Michael N Thomas, Lars Mortimer Schiffmann, Christiane J Bruns, Dirk L Stippel, Roger Wahba, Clinic and Polyclinic for General, Visceral, Tumor and Transplant Surgery, University of Cologne, Cologne 50923, North Rhine Westphalia, Germany
Author contributions: All authors have read and approve the final manuscript. Wagner T wrote the paper, analyzed data, contributed new reagents/analytic tools, designed research; Mustafov O, Hummels M, Grabenkamp A, wrote the paper; Thomas MO; Schiffmann LM, Bruns JC, Stippel DL and Wahba R analyzed data.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of interest to report.
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: Tristan Wagner, MD, Doctor, Clinic and Polyclinic for General, Visceral, Tumor and Transplant Surgery, University of Cologne, Kerpener Str. 62, Cologne 50923, North Rhine Westphalia, Germany. tcwcloud@icloud.com
Received: March 31, 2023 Peer-review started: March 31, 2023 First decision: May 8, 2023 Revised: May 28, 2023 Accepted: July 18, 2023 Article in press: July 18, 2023 Published online: August 16, 2023
Abstract
BACKGROUND
This case report demonstrates the simultaneous development of a gastrointestinal stromal tumour (GIST) with arteriovenous malformations (AVMs) within the jejunal mesentery. A 74-year-old male presented to the department of surgery at our institution with a one-month history of abdominal pain. Contrast-enhanced computed tomography revealed an AVM. During exploratory laparotomy, hyperspectral imaging (HSI) and indocyanine green (ICG) fluorescence were used to evaluate the extent of the tumour and determine the resection margins. Intraoperative imaging confirmed AVM, while histopathological evaluation showed an epithelioid, partially spindle cell GIST.
CASE SUMMARY
This is the first case reporting the use of HSI and ICG to image GIST intermingled with an AVM. The resection margins were planned using intraoperative analysis of additional optical data. Image-guided surgery enhances the clinician’s knowledge of tissue composition and facilitates tissue differentiation.
CONCLUSION
Since image-guided surgery is safe, this procedure should increase in popularity among the next generation of surgeons as it is associated with better postoperative outcomes.
Core Tip: Three imaging techniques and histopathology were used to determine the nature of the formation. Computed tomography diagnosed the arteriovenous malformation, but could not rule out any malignancies. Indocyanine green confirmed the initial diagnosis of the vascular malformation and helped with the resection margins. Hyperspecteral imaging on the other hand, suggested the presence of a tumour, which was confirmed later by histological examination. The combination of both intraoperative techniques allowed students and surgical novices to understand the underlying anatomy and the vascular supply of the tumour.
