Zhao Congcan, Jin Liquan, Tan Yunbo, Chen Yiming, Su Ziting, Li Wenwu, Yang Qing
1st Department of General Surgery, The First Affiliated Hospital of Dali University, Dali, Yunnan, China.
Front Oncol. 2023 Oct 16;13:1206991. doi: 10.3389/fonc.2023.1206991. eCollection 2023.
Multiple gastrointestinal stromal tumors (GISTs) combined with cutaneous multiple neurofibromas are clinically rare. This paper presents a case of multiple gastrointestinal stromal tumors in the jejunum of a 68-year-old mother, along with her daughter who also had coexisting cutaneous multiple neurofibromas. The mother had been experiencing repeated melena for over 2 years and had previously been diagnosed with multiple small intestinal masses at other hospitals. Additionally, her 42-year-old daughter was admitted to our department due to recurrent abdominal pain caused by cholecystolithiasis. The mother and daughter both exhibited multiple nodular masses of varying sizes on their skin, including the truncus, limbs, and face, which were diagnosed as neurofibromas. The mother underwent a partial excision of the jejunum and a lateral jejunojejunal anastomosis side-to-side, as well as excision of skin lesions in our department. The final diagnosis of wild-type GISTs associated with neurofibromatosis type 1 (NF1) was confirmed through postoperative pathology, immunohistochemistry, and genetic testing results. During preoperative gastrointestinal endoscopy and intraoperative laparoscopic exploration of the gastrointestinal tract, no obvious tumors were found in her daughter. A combination of patient observations and a review of relevant literature in the field suggests that when patients present with gastrointestinal symptoms and multiple irregular painless swellings in the skin, it is important to consider the possibility of an association with NF1 and GIST. Additionally, obtaining a detailed family history can save time and improve the diagnosis of patients with both NF1 and GIST. We recommend that even if there are no gastrointestinal manifestations of GISTs in the offspring of newly mutated NF1 patients, regular review of gastroenteroscopy, imaging examination, and long-term follow-up after middle age are still crucial for the early diagnosis and treatment of NF1-related GISTs.
多发性胃肠道间质瘤(GIST)合并皮肤多发性神经纤维瘤在临床上较为罕见。本文报告一例68岁母亲空肠多发性胃肠道间质瘤病例,其女儿同时患有皮肤多发性神经纤维瘤。母亲反复黑便2年多,曾在其他医院被诊断为多发小肠肿物。此外,她42岁的女儿因胆囊结石反复腹痛入住我科。母女二人皮肤均有大小不一的多个结节状肿物,分布于躯干、四肢和面部,诊断为神经纤维瘤。母亲在我科接受了空肠部分切除及空肠侧侧吻合术,同时切除了皮肤病变。术后病理、免疫组化及基因检测结果确诊为与1型神经纤维瘤病(NF1)相关的野生型GIST。术前胃肠内镜检查及术中腹腔镜探查胃肠道时,其女儿未发现明显肿瘤。结合患者观察及该领域相关文献回顾表明,当患者出现胃肠道症状及皮肤多发不规则无痛性肿物时,应考虑与NF1和GIST相关的可能性。此外,详细询问家族史可节省时间并提高NF1和GIST患者的诊断率。我们建议,即使新突变NF1患者的后代无GIST的胃肠道表现,中年后定期复查胃镜、影像学检查及长期随访对于NF1相关GIST的早期诊断和治疗仍至关重要。