Le Brian H, Nguyen Jasmine, Bossert Anna, Crandall Tonie, Robinson-Bennett Bernice
Pathology, Reading Hospital-Tower Health, West Reading, USA.
Medicine, Philadelphia College of Osteopathic Medicine, Philadelphia, USA.
Cureus. 2019 Jun 27;11(6):e5019. doi: 10.7759/cureus.5019.
The rectovaginal septum is a rare location for gastrointestinal stromal tumors (GIST) to occur. When such is the case, the question arises as to whether the lesion, which is morphologically and immunophenotypically identical to its gastrointestinal counterpart, should be referred to as an extragastrointestinal stromal tumor (EGIST). A 77-year-old, gravida 4, para 4004 post-menopausal female with an unremarkable gynecologic history presented with brown vaginal discharge. On examination, a 4 to 5-cm nodule was palpated along the rectovaginal septum. Ultrasound revealed a 4.8-cm circumscribed, solid mass with internal blood flow located posterior and inferior to the cervix. At laparoscopy, the uterus and adnexae were deemed to be normal for age, without gross pathologic abnormalities. The nodule was resected in an enucleation procedure; subsequent histopathologic examination revealed a low-grade, spindled cell neoplasm with diffuse immunoreactivity for CD117 (cKit) and DOG1, diagnostic of GIST. Further molecular testing elucidated a mutation in exon 9 of the Kit gene. A decision was made by the patient for close observation; there is no clinical or radiographic evidence of recurrence one year after initial diagnosis.
直肠阴道隔是胃肠道间质瘤（GIST）发生的罕见部位。当出现这种情况时，就会产生一个问题，即这个在形态学和免疫表型上与其胃肠道对应物相同的病变，是否应被称为胃肠道外间质瘤（EGIST）。一名77岁、孕4产4004的绝经后女性，妇科病史无异常，出现褐色阴道分泌物。检查时，在直肠阴道隔处可触及一个4至5厘米的结节。超声显示宫颈后方和下方有一个4.8厘米的边界清晰的实性肿块，内部有血流。腹腔镜检查时，子宫和附件在年龄上被认为正常，无明显病理异常。通过摘除术切除了结节；随后的组织病理学检查显示为低级别梭形细胞瘤，对CD117（cKit）和DOG1呈弥漫性免疫反应，诊断为GIST。进一步的分子检测发现Kit基因第9外显子存在突变。患者决定密切观察；初次诊断一年后，没有临床或影像学复发证据。
