Incidental Finding of a Low-risk Gastrointestinal Stromal Tumor during Bariatric Surgery: A Case Report
Gallegos De Luna CF
Departamento de Cirugía General, Unidad Médica de Alta Especialidad, Hospital de Especialidades, Centro Médico Nacional de Occidente, IMSS, Guadalajara, Jalisco, México.
Peña Montañez GA *
Departamento de Cirugía General, Unidad Médica de Alta Especialidad, Hospital de Especialidades, Centro Médico Nacional de Occidente, IMSS, Guadalajara, Jalisco, México.
Sanchez Gonzalez M
Departamento de Cirugía General, Unidad Médica de Alta Especialidad, Hospital de Especialidades, Centro Médico Nacional de Occidente, IMSS, Guadalajara, Jalisco, México.
Siordia Cruz NS
Departamento de Cirugía General, Unidad Médica de Alta Especialidad, Hospital de Especialidades, Centro Médico Nacional de Occidente, IMSS, Guadalajara, Jalisco, México.
Suarez Carreon LO
Departamento de Cirugía General, Unidad Médica de Alta Especialidad, Hospital de Especialidades, Centro Médico Nacional de Occidente, IMSS, Guadalajara, Jalisco, México.
*Author to whom correspondence should be addressed.
Abstract
Aims: Management of low-grade fusocellular gastrointestinal stromal tumors (GIST) in the context of a clinical case where it is found incidentally during bariatric surgery.
Presentation of Case: Involves the incidental finding of a gastrointestinal stromal tumor (GIST) during bariatric surgery in a 49-year-old female patient. The tumor was located in the jejunum, 120 cm from the ligament of Treitz, with the following histological characteristics: Spindle cell type, low-risk, 1.5 cm in size, with no mitosis, pleomorphism, or necrosis. Positive immunohistochemistry for CD117 (c-KIT), smooth muscle actin, and DOG1. A surgical resection was performed during the gastric bypass procedure. This low- risk GIST was adequately treated with surgical resection. Oncological follow-up is crucial, as the prognosis is favorable for small, low-grade tumors.
Discussion: In this case of an incidental, very low-risk jejunal GIST (<2 cm, <5 mitoses) found during bariatric surgery, there is no established consensus on the optimal surveillance modality and frequency for resected GISTs. However, long-term follow-up is important, as 12.2% of GIST recurrences may occur after five years.
Conclusion: Routine follow-up may not be essential for very low-risk and low-risk GISTs after resection.
Keywords: GIST, gastrointestinal stromal tumor, bariatric surgery, incidental tumor, gastric bypass