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Special Feature
July 1, 2006

Image of the Month—Diagnosis

Arch Surg. 2006;141(7):709-710. doi:10.1001/archsurg.141.7.710
Answer: Jejunal Stromal Tumor

Gastrointestinal stromal tumors are the most common nonepithelial tumors that may arise anywhere in the gastrointestinal tract. They occur more frequently in elderly and middle-aged persons. Men and women are equally affected. The most common location is the stomach, and the second most frequent location is the small intestine. It has a good prognosis in the stomach, but it has a worse prognosis in small-intestinal localization.13The biological behavior of primitive gastrointestinal stromal tumor has yet to be completely clarified in terms of growth rate and metastatic potential. Small lesions with infrequent mitotic activity are considered benign, but growth over time will increase the malignant potential and lead to local symptoms such as bleeding, obstruction, and pain.4,5Although most patients with stromal tumors are asymptomatic, some tumors can grow. The clinical importance of gastrointestinal stromal tumor is owing to its malignant potential, including extragastric location, size greater than 5 cm, central necrosis, a rapid growth rate, and metastatic potential. The pathological assessment of malignancy is routinely performed using the high mitotic index.6In our case, resection was found to be efficient because there was 1 mitotic figure in 50 high-power fields.

In gastrointestinal stromal tumor cases, surgical resection is widely accepted as the definitive treatment. Laparoscopy is an important, preferable method to diagnose and treat the masses that have positional mobility and unclear localization, as in our case. Laparoscopic resection of gastric stromal tumor was first described in 1992.1It was easy to resect the mass and reconstruct the lumen of the intestine with an endoscopic gastrointestinal anastomosis stapler because the mass was pedunculated and mobile.1,2,6,7

Although tumors of the gastrointestinal tract may be seen very rarely in the small intestine, stromal tumors should be kept in mind in differential diagnoses.

Correspondence:Dursun Ali Sahin, MD, Karaman Mah. Leylak Cd. Manolya Apt No. 13/12, 03100 Afyon, Turkey (dursunalisahin@yahoo.com).

Accepted for Publication:May 19, 2005.

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