remove the mass. The intraoperative bleeding was approxi-

the time of discharge. Mild periorbital edema occurred dur­ing the administration of dasatinib, which was tolerated by the patient. To January 2022, the patient had been followed up for 42months, and there were no signs of tumor recur­rence or metastasis (Fig.15.5).

The patient’s vital signs were stable, and the abdomen was full, soft, without rebound tenderness. There was no pal­pable mass in the abdomen, and no edema in the lower limbs.

After completing preoperative preparation, the patient under­went open radical gastrectomy under general anesthesia. Intraoperative ndings were the following: no ascites in the abdominal cavity, smooth pelvic peritoneum, cysts in the liver, no solid nodules, no abnormalities in the pancreas or spleen, and no abnormalities in the small intestine or mesan­gium. Two large masses, from the gastric cardia near great curvature and anterior wall of body, were observed, with diameters of 5cm×4cm×4cm and 3cm×3cm×3cm. The masses originated from the submucosa of the gastric wall and grew into and out of the gastric cavity in the shape of dumbbell. There were normal gastric wall tissue intervals between the two tumors (Fig. 16.2). The tumor was com-

The patient received adjuvant treatment with imatinib after surgery, and no signs of recurrence or metastasis were found up to the last follow-up (10months after surgery).

family history. These are mostly caused by embryonal muta­tions, and are characterized by young onset, mostly small intestinal GIST, and are accompanied by intestinal Cajal cell proliferation [2]. (2) NF1 and Carney triad related GIST. These GISTs usually have no mutation in KIT or PDGFRA, and the expression of CD34, CD117 and DOG-1 was negative by immunohistochemistry [3]. (3) Primary multiple sporadic GIST, generally caused by somatic muta­tions. The clinical manifestations are generally the same as solitary GIST, and these are mostly found in elderly patients. Based on the medical history, physical examination, and pathological results, the patient was given a preliminary diagnosis of multiple sporadic GIST, which is common in the stomach and small intestine, or both locations. The pathology of this patient was particularly special. The cell morphology of tumor 1 was different from that of tumor 2 and 3. The former was spindle cell type, while the latter two were epithelial cell type. Different cell morphology suggests different cytological origins of tumor. Unfortunately, we have not yet obtained the results of multiple tumor gene tests of this patient. Currently, there is no unied pathological risk classication for primary multiple GIST in clinic. The modi­ed NIH and AFIP classication do not specify a pathologi­cal risk classication standard for multiple GIST, and nal risk is generally taken as that of the tumor with highest risk classication in clinical practice [4, 5].

Previously healthy, the patient reported no history of sur­gery, trauma, or food and drug allergies. The patient’s father died due to cerebral infarction, and the patient’s mother was alive.

Heart Color Doppler Ultrasound No obvious abnormali­ties were observed in the shape, structure, or function of the heart.

The patient was a middle-aged man who was admitted to the hospital with a “stomach mass found in physical examination for 14 days.” On admission, it was diagnosed as gastric fun­dus mass, approximately 15.6 mm × 9.9 mm in size. Considering the possibility of small gastric GIST, and the presence of uneven mass echoes on ultrasound gastroscopy, and adverse factors, surgical resection should be considered. The patient was generally in good health and no obvious abnormalities were found in cardiopulmonary function assessments. The ECOG score was 1 point. Laparoscopic resection of gastric fundus mass was considered feasible. Considering the small size of the tumor, intraoperative gas­troscopy was prepared, so that this technique could be used to locate the tumor under intraoperative endoscopy if necessary. Further therapeutic schedule would be determined by patho­logical diagnosis.

posterior wall of the fundus of the stomach, this was approxi­mately 0.5cm in size (Fig.16.6). The remaining gastric wall was fully explored laparoscopically, and no other masses were found. The two masses were completely removed with a straight intraluminal cutting and closing device (Fig. 16.7). The gastric cavity was carefully examined under gastroscopy during the operation, and no other masses were seen.