ABCD: Arquivos Brasileiros de Cirurgia Digestiva (Jun 2007)
GIST e adenocarcinoma gástrico sincrônicos: relato de caso e revisão da literatura Synchronous gastric GIST and adenocarcinoma: case report and literature review
Abstract
INTRODUÇÃO: Tumores estromais gastrointestinais (GISTs) são neoplasias mesenquimais incomuns que afetam o trato gastrointestinal. Existem poucos relatos na literatura da ocorrência sincrônica de tumores mesenquimais e outros tumores primários gastrointestinais. RELATO DO CASO: Paciente de 61 anos do sexo feminino que procurou o serviço com queixa de dor abdominal iniciada há 2 anos. No exame físico palpava-se uma massa de 10 cm no abdome superior. A tomografia evidenciou massa em contato com a grande curvatura gástrica sem linfonodomegalias. Na endoscopia foi identificada apenas na pequena curvatura lesão na mucosa com 2 cm cuja biópsia demonstrou tratar-se de adenocarcinoma. Foi realizado ultra-som endoscópico que demonstrou que a lesão na pequena curvatura estava restrita à camada muscular e também visualizou-se lesão na grande curvatura originária da 4º camada ultra-sonográfica gástrica (muscular). Com esse diagnóstico e estadiamento a paciente foi submetida à gastrectomia total com linfadenectomia D2 e anastomose esôfago-jejunal em Y-de-Roux. O exame anatomopatológico demonstrou que a lesão na pequena curvatura correspondia a um adenocarcinoma microtubular restrito a camada muscular e a lesão na grande curvatura um GIST de alto grau. O estadiamento TNM final foi T2N1M0. A paciente evoluiu sem intercorrências recebendo alta no 11º pós-operatório CONCLUSÃO: A ocorrência sincrônica de GISTs e outros tumores gastrointestinais têm ocorrido com mais freqüência do que antes se considerava. Embora este fato pareça ser apenas uma coincidência sua ocorrência pode envolver agentes carcinogênicos comuns.BACKGROUND: Gastrointestinal stromal tumors (GISTs) are an uncommon mesenchymal neoplasm affecting the GI tract. The synchronous occurrence of mesenchymal tumors and other primary gastrointestinal malignancies have been rarely reported in the literature. CASE REPORT: A 61 year-old female patient came to our department complaining of diffuse abdominal pain, which had begun 2 years ago. At physical examination a mass with approximately 10 cm, located in the upper abdomen, was palpable. A CT scan demonstrated a mass in contact with the greater gastric curvature without lymphnodal enlargement. At endoscopy, no lesions were seen in the greater curvature, but a 2,0 cm mucosal lesion was visualized in the upper portion of the lesser curvature. The biopsy of the lesion in the lesser curvature was positive for adenocarcinoma. An endoscopic ultrasound was performed and demonstrated that the lesion in the lesser curvature was restricted to the gastric muscular layer and the mass in the greater curvature was originated from the gastric fourth ultrasonographic layer (muscular). The patient was submitted to a total gastrectomy with D2 lymphadenectomy and a Y of Roux esophago-jejunal anastomosis. The pathological exam demonstrated that the lesion in the lesser curvature was a microtubular adenocarcinoma restricted to the muscular layer. The lesion in the greater curvature was a high grade GIST. The final TNM stage was T2N1M0. The patient recovery was uneventful being discharged from the hospital after 11 days. CONCLUSION: The synchronous occurrence of GISTs and other gastrointestinal malignanies is more common than has been considered. Although the synchronous occurrence of GIST and other abdominal malignancies seems to be just a coincidence, the development of these tumors may involve common carcinogenic agents.
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