Skandalos Ioannis K, Hotzoglou Nikolaos F, Matsi Kyriaki Ch, Pitta Xanthi A, Kamas Athanasios I
Surgical Department, General Hospital Agios Pavlos, Thessaloniki, Greece.
Int J Surg Case Rep. 2013;4(10):818-21. doi: 10.1016/j.ijscr.2013.07.006. Epub 2013 Jul 24.
Herein we present an extremely rare case of a giant extra gastrointestinal stromal tumor (EGIST) of the lesser omentum obscuring the diagnosis of a choloperitoneum.
A 79 years old female was admitted to our hospital with symptoms of vomiting and epigastric pain. Abdominal computer tomography revealed a sizable formation that was diagnosed as a tumor of the pancreas. In laparotomy, a choloperitoneum was diagnosed as the cause of patient's symptoms. A tumor adherent firmly to the lesser curvature of stomach was also discovered. Cholecystectomy and subtotal gastrectomy were performed. Histologically, the tumor was diagnosed as a EGIST of the lesser omentum. The patient did not receive any adjuvant therapy and after two years of follow up she is without any recurrence.
Omental EGISTs may remain clinically silent despite the large tumor's size. It is difficult to differentiate a EGIST in the lesser omentum from a GIST of the lesser curvature of the stomach, despite the use of advanced radiological imaging techniques. Our case of a giant EGIST of lesser omentum obscuring the diagnosis of acute choloperitoneum is the only one reported in literature.
EGISTs that arise from the omentum are very rare and complete surgical resection is the only effective treatment approach. Adjuvant therapy following resection of localized disease has become standard of care in high risk cases.
在此，我们报告一例极为罕见的小网膜巨大胃肠道外间质瘤（EGIST），该肿瘤掩盖了胆汁性腹膜炎的诊断。
一名79岁女性因呕吐和上腹部疼痛入院。腹部计算机断层扫描显示一个较大的肿物，诊断为胰腺肿瘤。在剖腹手术中，诊断胆汁性腹膜炎为患者症状的病因。还发现一个与胃小弯紧密粘连的肿瘤。进行了胆囊切除术和胃次全切除术。组织学检查显示，该肿瘤被诊断为小网膜EGIST。患者未接受任何辅助治疗，经过两年的随访，未出现任何复发。
尽管网膜EGIST肿瘤体积较大，但在临床上可能并无症状。尽管使用了先进的放射成像技术，仍难以将小网膜EGIST与胃小弯的胃肠道间质瘤（GIST）区分开来。我们报道的这例小网膜巨大EGIST掩盖急性胆汁性腹膜炎诊断的病例是文献中唯一报道的。
起源于网膜的EGIST非常罕见，完整的手术切除是唯一有效的治疗方法。对于局限性疾病切除后的辅助治疗已成为高危病例的标准治疗方案。
