Giant gastrointestinal stromal tumor of the mediastinum associated with an esophageal hiatal hernia and chest discomfort: a case report

Abstract Background Gastrointestinal stromal tumors (GISTs) grow relatively slowly and without specific symptoms; therefore, they are typically incidental findings. We report a rare gastric GIST in the mediastinum associated with chest discomfort and an esophageal hiatal hernia. Case presentation An...

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Main Authors: Ryosuke Fujisawa, Yuji Akiyama, Takeshi Iwaya, Fumitaka Endo, Haruka Nikai, Shigeaki Baba, Takehiro Chiba, Toshimoto Kimura, Takeshi Takahara, Koki Otsuka, Hiroyuki Nitta, Masaru Mizuno, Keisuke Koeda, Akira Sasaki
Format: Article
Language:English
Published: Japan Surgical Society 2018-12-01
Series:Surgical Case Reports
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Online Access:http://link.springer.com/article/10.1186/s40792-018-0553-x
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author Ryosuke Fujisawa
Yuji Akiyama
Takeshi Iwaya
Fumitaka Endo
Haruka Nikai
Shigeaki Baba
Takehiro Chiba
Toshimoto Kimura
Takeshi Takahara
Koki Otsuka
Hiroyuki Nitta
Masaru Mizuno
Keisuke Koeda
Akira Sasaki
author_facet Ryosuke Fujisawa
Yuji Akiyama
Takeshi Iwaya
Fumitaka Endo
Haruka Nikai
Shigeaki Baba
Takehiro Chiba
Toshimoto Kimura
Takeshi Takahara
Koki Otsuka
Hiroyuki Nitta
Masaru Mizuno
Keisuke Koeda
Akira Sasaki
author_sort Ryosuke Fujisawa
collection DOAJ
description Abstract Background Gastrointestinal stromal tumors (GISTs) grow relatively slowly and without specific symptoms; therefore, they are typically incidental findings. We report a rare gastric GIST in the mediastinum associated with chest discomfort and an esophageal hiatal hernia. Case presentation An 81-year-old woman with chest discomfort was admitted to the hospital, where barium esophagography showed a sliding esophageal hiatal hernia and a tumor of the lower esophagus and gastric wall. Esophagogastroscopy confirmed the presence of a huge submucosal tumor that extended from the lower esophagus to the gastric fundus. According to computed tomography, the mediastinal mass measured 12.7 cm and had heterogeneous low-density areas. A submucosal gastric tumor, which we suspected to be a GIST, was diagnosed in association with an esophageal hiatal hernia. Using thoracolaparotomy, we performed a total gastrectomy, a lower esophagectomy, and a Roux-en-Y reconstruction with the jejunum. The presumptive diagnosis was confirmed through immunohistochemical examination; immunostaining yielded results positive for CD34 and c-kit. The patient was discharged from the hospital 13 days after surgery with no complications and remained disease-free at follow-up 24 months after surgery. Conclusions GIST should be considered in the differential diagnosis of tumors growing in the mediastinum.
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spelling doaj-art-e855ea8a24264aacb08c7fc9017377312025-08-20T03:19:10ZengJapan Surgical SocietySurgical Case Reports2198-77932018-12-01411710.1186/s40792-018-0553-xGiant gastrointestinal stromal tumor of the mediastinum associated with an esophageal hiatal hernia and chest discomfort: a case reportRyosuke Fujisawa0Yuji Akiyama1Takeshi Iwaya2Fumitaka Endo3Haruka Nikai4Shigeaki Baba5Takehiro Chiba6Toshimoto Kimura7Takeshi Takahara8Koki Otsuka9Hiroyuki Nitta10Masaru Mizuno11Keisuke Koeda12Akira Sasaki13Department of Surgery, Iwate Medical University School of MedicineDepartment of Surgery, Iwate Medical University School of MedicineDepartment of Surgery, Iwate Medical University School of MedicineDepartment of Surgery, Iwate Medical University School of MedicineDepartment of Surgery, Iwate Medical University School of MedicineDepartment of Surgery, Iwate Medical University School of MedicineDepartment of Surgery, Iwate Medical University School of MedicineDepartment of Surgery, Iwate Medical University School of MedicineDepartment of Surgery, Iwate Medical University School of MedicineDepartment of Surgery, Iwate Medical University School of MedicineDepartment of Surgery, Iwate Medical University School of MedicineDepartment of Surgery, Iwate Medical University School of MedicineDepartment of Medical Safety Science, Iwate Medical University School of MedicineDepartment of Surgery, Iwate Medical University School of MedicineAbstract Background Gastrointestinal stromal tumors (GISTs) grow relatively slowly and without specific symptoms; therefore, they are typically incidental findings. We report a rare gastric GIST in the mediastinum associated with chest discomfort and an esophageal hiatal hernia. Case presentation An 81-year-old woman with chest discomfort was admitted to the hospital, where barium esophagography showed a sliding esophageal hiatal hernia and a tumor of the lower esophagus and gastric wall. Esophagogastroscopy confirmed the presence of a huge submucosal tumor that extended from the lower esophagus to the gastric fundus. According to computed tomography, the mediastinal mass measured 12.7 cm and had heterogeneous low-density areas. A submucosal gastric tumor, which we suspected to be a GIST, was diagnosed in association with an esophageal hiatal hernia. Using thoracolaparotomy, we performed a total gastrectomy, a lower esophagectomy, and a Roux-en-Y reconstruction with the jejunum. The presumptive diagnosis was confirmed through immunohistochemical examination; immunostaining yielded results positive for CD34 and c-kit. The patient was discharged from the hospital 13 days after surgery with no complications and remained disease-free at follow-up 24 months after surgery. Conclusions GIST should be considered in the differential diagnosis of tumors growing in the mediastinum.http://link.springer.com/article/10.1186/s40792-018-0553-xGastric gastrointestinal stromal tumorGiant gastrointestinal stromal tumorMediastinal tumorHiatal hernia
spellingShingle Ryosuke Fujisawa
Yuji Akiyama
Takeshi Iwaya
Fumitaka Endo
Haruka Nikai
Shigeaki Baba
Takehiro Chiba
Toshimoto Kimura
Takeshi Takahara
Koki Otsuka
Hiroyuki Nitta
Masaru Mizuno
Keisuke Koeda
Akira Sasaki
Giant gastrointestinal stromal tumor of the mediastinum associated with an esophageal hiatal hernia and chest discomfort: a case report
Surgical Case Reports
Gastric gastrointestinal stromal tumor
Giant gastrointestinal stromal tumor
Mediastinal tumor
Hiatal hernia
title Giant gastrointestinal stromal tumor of the mediastinum associated with an esophageal hiatal hernia and chest discomfort: a case report
title_full Giant gastrointestinal stromal tumor of the mediastinum associated with an esophageal hiatal hernia and chest discomfort: a case report
title_fullStr Giant gastrointestinal stromal tumor of the mediastinum associated with an esophageal hiatal hernia and chest discomfort: a case report
title_full_unstemmed Giant gastrointestinal stromal tumor of the mediastinum associated with an esophageal hiatal hernia and chest discomfort: a case report
title_short Giant gastrointestinal stromal tumor of the mediastinum associated with an esophageal hiatal hernia and chest discomfort: a case report
title_sort giant gastrointestinal stromal tumor of the mediastinum associated with an esophageal hiatal hernia and chest discomfort a case report
topic Gastric gastrointestinal stromal tumor
Giant gastrointestinal stromal tumor
Mediastinal tumor
Hiatal hernia
url http://link.springer.com/article/10.1186/s40792-018-0553-x
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