A 14-year-old patient was admitted in our hospital on
25th May 2012 after an abdominal U/S revealed the presence of a
solid, hypoechogenic mass, which was at the beginning interpreted as a
paraortic lymphnode (diameter of 5.6 cm). No other signs of malignancy were
found in the abdominal cavity.
We have confirmed our U/S diagnosis with a abdominal CT
scan, and also the radiologist found the intra-abdominal mass, for which he had
put a differential diagnosis with a mesenteric lymphnode. We have decided on
open laparatomy, finding the FNA-biopsy suggested by the radiologist too risky.
Actually at laparatomy we realized that it was neither
a paraortic nor a mesenteric lymphnode but a solid mass at the anti-mesenteric
aspect of an ileal loop.
We were able to excise the lesion without opening the
bowel.
The post operation recovery was uneventful and the
patient healed completely.
The biopsy report has demonstrated a GIST
(gastrointestinal stromal tumour) measuring 6.5 x 5.5 x 4 cm in diameters. The
weight was 66 g.. The GIST subtype was spindle cell. The mitotic rate was
1/50HPF. The histological grade was G1 (low grade). Margins were positive for
GIST.
Due to the possibility of relapses, the possibility of
previous seeding of microscopic mts in the intestinal loops, and the need of
complete staging, we have referred the patient the University Hospital in Nairobi
for further management (Surgical 2nd look with ileal resection?
Chemotherapy? Follow up only?).
Br Dr Giuseppe Gaido
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