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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_706_Библиотеки_им_академика_М_И_Перельмана.pdf
xii
TianlongLing Department of Gastrointestinal Surgery, Renji Hospital, Shanghai Jiaotong
University School of Medicine, Shanghai, China
TaoChen Department of General Surgery, Nanfang Hospital, Southern Medical University,
Guangzhou, China
Chun Zhuang Department of Gastrointestinal Surgery, Renji Hospital, Shanghai Jiaotong
University School of Medicine, Shanghai, China
LinTu Department of Gastrointestinal Surgery, Renji Hospital, Shanghai Jiaotong University
School of Medicine, Shanghai, China
Xin Wu Department of General Surgery, The First Medical Center, Chinese PLA General
Hospital, Beijing, China
Translators
TaoWang Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College,
Huazhong University of Science and Technology, Wuhan, China
GanMao Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College,
Huazhong University of Science and Technology, Wuhan, China
XinyuZeng Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College,
Huazhong University of Science and Technology, Wuhan, China
Editors and Contributors
QianShen Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College,
Huazhong University of Science and Technology, Wuhan, China
QiJiang Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College,
Huazhong University of Science and Technology, Wuhan, China
JiaxianYu Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College,
Huazhong University of Science and Technology, Wuhan, China
Yao Lin Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College,
Huazhong University of Science and Technology, Wuhan, China
Chengguo Li Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical
College, Huazhong University of Science and Technology, Wuhan, China
LeiYang Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College,
Huazhong University of Science and Technology, Wuhan, China
YongzhouHuang Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical
College, Huazhong University of Science and Technology, Wuhan, China
BoNi Department of Gastrointestinal Surgery, Renji Hospital, Shanghai Jiaotong University
School of Medicine, Shanghai, China
WenchangYang Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical
College, Huazhong University of Science and Technology, Wuhan, China
JianboLyu Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College,
Huazhong University of Science and Technology, Wuhan, China
PeiZhou Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College,
Huazhong University of Science and Technology, Wuhan, China
Peng Zhang Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical
College, Huazhong University of Science and Technology, Wuhan, China
Editors and Contributors
xiii
Yuqiang Du Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical
College, Huazhong University of Science and Technology, Wuhan, China
LiwuZeng Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College,
Huazhong University of Science and Technology, Wuhan, China
Xiaoqi Li Department of Gastrointestinal Surgery, Renji Hospital, Shanghai Jiaotong
University School of Medicine, Shanghai, China
TianlongLing Department of Gastrointestinal Surgery, Renji Hospital, Shanghai Jiaotong
University School of Medicine, Shanghai, China
Chen Huang Department of Gastrointestinal Surgery, Renji Hospital, Shanghai Jiaotong
University School of Medicine, Shanghai, China
Chun Zhuang Department of Gastrointestinal Surgery, Renji Hospital, Shanghai Jiaotong
University School of Medicine, Shanghai, China
Xinli Ma Department of Gastrointestinal Surgery, Renji Hospital, Shanghai Jiaotong
University School of Medicine, Shanghai, China
LinTu Department of Gastrointestinal Surgery, Renji Hospital, Shanghai Jiaotong University
School of Medicine, Shanghai, China
Linxi Yang Department of Gastrointestinal Surgery, Renji Hospital, Shanghai Jiaotong
University School of Medicine, Shanghai, China
Part I
Surgical Management of Gastrointestinal
Stromal Tumors
Laparoscopic Management
ofGastrointestinal Stromal Tumors
TaoWang, MingWang, GanMao, JieJia, andHuiCao
1
Keywords
Gastrointestinal stromal tumor · Surgery · Laparoscopy
Jejunum
1.1 Case 1 A64-Year-Old Man withGIST
Who Underwent Laparoscopic
Surgery
TaoWang and MingWang
1.1.1 Introduction
Surgical resection is the preferred treatment for locally
resectable gastrointestinal stromal tumor (GIST). Surgery
should follow the principles of complete tumor resection,
avoiding tumor rupture, and ensuring negative histological
margins. Open surgery was previously the dominant treatment for gastric GIST.In recent years, with the advancement
of surgical technology and equipment and the promotion of
minimally invasive procedures, laparoscopic surgery has
become more widely used in the treatment of GIST, especially gastric GIST [1].
1.1.2 Case Background
A 64-year-old man presented to the local hospital with
repeated dull pain and discomfort in the right upper
abdominal quadrant. A CT scan of the chest showed: a
small streak shadow in both pulmonary lobes, a little
bilateral pleural effusion, enlarged lymph nodes in the
mediastinum and right hilar calcication foci, multiple
cysts in the liver, gallbladder stones, and a space-occupying lesion in the left upper abdominal quadrant. In light of
these ndings, further examination was recommended.
Subsequently, gastroscopy and abdominal enhanced CT
were performed. Gastroscopy revealed a submucosal
bulge with a diameter of 4.5cm in the fundus of the stomach, which was suspected to be a GIST. Enhanced CT
revealed a space-occupying lesion at the bottom of the
stomach, approximately 5.5cm×5.0cm in size (possible
GIST); multiple cysts in the liver; multiple stones in the
gallbladder; and multiple cysts on both kidneys. During
the course of the disease, the patient had no discomfort
such as nausea, vomiting, constipation, diarrhea,
hematemesis, or melena. The patient was admitted to the
hospital for further treatment.
1.1.2.1 Past History andFamily History
The patient was previously healthy and reported no drug
allergies. The patient’s parents were alive, and there was no
similar medical history within the family.
1.1.2.2 Physical Examination
The abdomen was at, without gastric or intestinal pattern
T. Wang · G. Mao · J. Jia (*)
Department of Gastrointestinal Surgery, Union Hospital, Tongji
Medical College, Huazhong University of Science and Technology,
Wuhan, China
e-mail: wangtaojx@hust.edu.cn; maogan@hust.edu.cn
M.Wang (*) · H. Cao
Department of Gastrointestinal Surgery, Renji Hospital, Shanghai
Jiaotong University School of Medicine, Shanghai, China
© People’s Medical Publishing House, PR of China 2024
K. Tao, H. Cao (eds.), Clinical Management of Gastrointestinal Stromal Tumor, https://doi.org/10.1007/978-981-99-9392-5_1
and peristaltic waves. The abdomen was soft, without tenderness, rebound tenderness, or palpable mass, and bowel
sounds were normal.
1.1.2.3 Auxiliary Examination
Gastroscopy A submucosal bulge, suspected to be GIST,
4.5cm in diameter, was seen in the fundus of the stomach.
3
4
T. Wang et al.
Supercial atrophic gastritis with erosion and duodenal
papilla erosion was observed. The pathology showed moderate chronic active inammation of the mucosa with the formation of lymphoid follicles.
Abdominal CT A space-occupying lesion was found at the
fundus of the stomach, considered to be a possible
GIST. Furthermore, multiple cysts in the liver, multiple
stones in the gallbladder, and multiple cysts in both kidneys
were observed (Fig.1.1).
Initial Diagnosis
1. Fundus GIST
2. Gallbladder stones with cholecystitis
3. Multiple cysts in the liver
1.1.3 Therapy
1.1.3.1 Case Analysis
The patient was an elderly man, who visited the hospital following the accidental nding of a gastric fundus mass in the
course of diagnosing and treating gallbladder stones. Imaging
and gastroscopy suggested the possibility of GIST in the fundus of the stomach. The patient was generally in good condition, and the tumor was deemed to be resectable. No
metastasis was found, and surgery could be performed. Since
the gastric tumor was located in the fundus of the stomach, it
was suitable for laparoscopic surgery, and laparoscopic cho-
lecystectomy could also be performed at the same time.
Postoperative treatment was to be based on the results of
pathology and genetic testing.
1.1.3.2 Treatment
The patient underwent laparoscopic gastric tumor resection
with cholecystectomy on October 17, 2018. The gallbladder
was approximately 7.0cm× 5.0 cm ×3.0cm in size. The
gallbladder wall was rough, and the gallbladder contained
three mixed stones, all of which were approximately 1cm in
diameter. The common bile duct was not dilated. A tumor
with a diameter of 5cm was found on the upper portion of
the greater curvature of the stomach, protruding into and out
of the gastric cavity. The mass originated from the submucosa, and there was no swelling of the peri-gastric lymph
nodes. After the fundus and upper part of the stomach were
fully freed during the operation, the tumor was removed
using a linear cutting and closing device (Fig. 1.2). The
excised tumor was placed in an extraction bag and the umbilical incision was extended to allow for the removal of the
specimen.
1.1.3.3 Postoperative Pathology andGenetic
Testing
Pathological Diagnosis Gastric GIST, 5.5cm × 5.0cm ×
5.0cm in size, mitotic count 4/50 HPF (Fig.1.3).
Immunohistochemistry CD117 (+), DOG-1 (+), CD34
(+), SMA (−), S-100 (−), Ki-67 (Li: 3%), SDHB (+).
Fig. 1.1 A space-occupying lesion of the gastric fundus
1 Laparoscopic Management ofGastrointestinal Stromal Tumors
5
patient received 400mg/d imatinib as adjuvant therapy, the
general condition of the patient was good and there were no
obvious side effects. After taking imatinib for 1 year, the
drug was discontinued. During the regular follow-up for
39months after the operation, no recurrence or metastasis of
GIST occurred in the patient.
1.2 Case 2 ACase ofLaparoscopic
Surgery forJejunal GIST
GanMao and JieJia
1.2.1 Introduction
Fig. 1.2 Complete tumor resection with a laparoscopic linear cutting
stapler
Fig. 1.3 Gross specimen
Genetic Testing A heterozygous mutation was found on
exon 11 of KIT, 559GTT>GAT. This mutation caused the
encoded amino acid to be converted from valine to aspartic
acid. The 9, 13, and 17 exons of KIT and the 12 and 18 exons
of PDGFRA were all wild type.
1.1.4 Prognosis
The patient followed a liquid diet for 3days after surgery and
was discharged 5days after surgery. The pathological examination results conrmed the diagnosis of GIST with a moderate risk of recurrence. During outpatient follow-up, the
The growth of jejunoileal GIST is relatively insidious, and
small asymptomatic GIST is rarely found based on clinical
manifestations. Jejunoileal GIST has a high malignant
potential [2]. Therefore, surgical resection should be actively
performed. Laparoscopic surgery is safe and feasible for
small GIST (those with a diameter of ≤5 cm), when the
tumor is relatively free [3]. In addition, laparoscopic techniques are of great value for judging the position of GIST in
the small bowel during operation.
1.2.2 Case Background
The patient, a 52-year-old man, had tarry stool, twice a day,
with no obvious cause, which started 1week ago. This was
accompanied by nausea and vomiting. He was admitted to
the hospital for treatment.
1.2.2.1 Past History andFamily History
The patient reported that he was usually in good health and
had no history of allergies. The patient’s parents were in
good health and there was no similar medical history in the
family.
1.2.2.2 Physical Examination
The abdomen was at and soft, without palpable masses.
The liver and spleen are not palpable below the costal margin, and there was no tenderness or rebound tenderness.
There was also no percussion pain in the kidney area, or
shifting dullness, and bowel sounds were normal.
1.2.2.3 Auxiliary Examination
Blood Routine WBC 4.70×109 /L, RBC 5.37×1012/L, Hb
142g/L, PLT 216×109/L, NEUT% 59.1%, LY% 32.2%.
6
T. Wang et al.
Blood Biochemistry TBil 9.2μmol/L, DBil 4.5μmol/L, TP
78.0g/L, ALB 50.9g/L, Cre 88.1μmol/L, BUN 3.12mmol/L,
Na+ 141.2mmol/L, K+ 4.53mmol/L, Cl− 96.7mmol/L.
Abdominal CT A whole abdomen scan with enhanced CT
on December 14, 2018, showed that the segmental wall of
the jejunum in the left lower abdomen was thickened, with a
range of approximately 3.4 cm × 3.0 cm. Enhanced CT
showed obvious enhancement of the lesion. The adjacent
serosal surface was smooth, and there were no obviously
enlarged lymph nodes around the lesion. The results were
suggestive of GIST. No other abnormalities were detected
(Fig.1.4).
Initial Diagnosis Jejunal GIST.
1.2.3 Therapy
1.2.3.1 Case Analysis
The patient was a middle-aged man who presented to the
doctor with tarry stools for a week. After completing the relevant examinations, the preliminary diagnosis was considered to be a GIST in the jejunum which was approximately
3.4cm×3.0cm in size. Because the tumor did not appear to
invade the surrounding organs or tissues and had a small
diameter, it was suitable for laparoscopic resection.
Postoperative treatment was to be guided based on the results
of pathology and genetic testing.
tumor resection on December 20, 2018. Intraoperative
exploration revealed that the tumor was located at the jejunum, 100 cm away from Treitz ligament, with a size of
approximately 4.0cm×3.0cm. A laparoscopic linear cutting stapler was used to resect the jejunum with a margin of
1cm from the tumor. The tumor was placed in an extraction
bag, and extracted through the umbilical incision.
Subsequently a side-to-side jejunal anastomosis was performed to close the intestinal cavity. Absorbable thread was
intermittently sutured to reinforce the anastomosis. The
laparoscopic access points were sutured and the operation
was deemed successful. The operation time was 60min, and
the intraoperative blood loss was approximately 20 mL
(Figs.1.5 and 1.6).
1.2.3.3 Postoperative Pathology andGenetic
Testing
Pathological Diagnosis Jejunal GIST.The size of the mass
was 3.5cm×2.0cm, mitotic count 5/50 HPF.According to
the modied National Institutes of Health (NIH) risk classication the tumor was low risk.
1.2.3.2 Treatment
The patient underwent preoperative preparation following
the concept of enhanced recovery after surgery (ERAS) as
well as underwent laparoscopic exploration and jejunal
Fig. 1.4 The jejunal tumor
Fig. 1.5 Dissection of the proximal jejunum
Fig. 1.6 Side-to-side anastomosis of jejunum
1 Laparoscopic Management ofGastrointestinal Stromal Tumors
7
Immunohistochemistry CD117 (+), DOG-1 (+), CD34 (+),
SMA (−), S-100 (−), Ki-67 (Li: <5%).
Genetic Testing Heterozygous mutation in exon 11 of KIT,
the mutation type was p.Y570_P573dup; exon 12 and 18 of
PDGFRA were wild type.
1.2.4 Prognosis
The patient recovered well after the operation and was discharged on the fth postoperative day. No targeted drug therapy was administered after the operation as the tumor was
classied as low-risk. As of January 2022, the patient had
been followed up for 37months without recurrence.
1.2.5 Experience ofDiagnosis andTherapy
1.2.5.1 The Feasibility andControversy
ofLaparoscopic Surgery forGIST
In the past, laparotomy was the primary surgical procedure
performed for the treatment of gastric GIST. Since GIST
rarely metastasizes through a lymphatic route, it is generally
sufcient to ensure a negative margin by wedge resection
[4]. Therefore, in recent years, the updated guidelines have
supported the application of laparoscopic surgery for gastric
GIST and gradually relaxed the indications [1, 5]. However,
tumor rupture is still an independent, poor prognostic factor
for GIST [6]. Once a tumor ruptures into the abdominal cavity, the risk of recurrence is extremely high. Therefore, the
possibility of GIST tumor being fragile and easy to rupture
limits the application of laparoscopic surgery. Chinese consensus guidelines for GIST highlights that that these indications should be strictly controlled when choosing
laparoscopic surgery to treat GIST, and the operation should
be carefully regulated [5]. Laparoscopy is not recommended
for patients with large tumors, difcult operations, or those
who require combined organ resection.
1.2.5.2 Basic Principles ofLaparoscopic Surgery
forGIST
Laparoscopic surgery for GIST also follows the basic principles of open surgery. The principle of “less contact, less
squeezing” should be followed during the operation, and
care should be taken to avoid tumor rupture and spreading,
leading to abdominal implantation or blood metastasis.
Therefore, it is necessary to use an extraction bag after resection. Removing the tumor in small portions to allow for minimally invasive surgery with small incisions should be
avoided as this can affect the pathological evaluation after
surgery.
1.2.5.3 Laparoscopic Surgery Treatment
Strategies forGIST inDierent Locations
The current guideline consensus is that laparoscopic techniques are recommended for GIST with small tumor diameters and when the tumor is located in a favorable anatomical
location (such as the anterior wall of the stomach, the
greater curvature of the stomach, jejunum, or ileum).
However, no prospective clinical research has been conducted to determine whether relatively small GIST, located
in difcult anatomical sites (such as posterior gastric wall,
lesser curvature of the stomach, near the cardia, near the
pylorus), are also suitable for laparoscopic surgery. From
the limited retrospective research data and clinical practice
in our hospital, it is safe and feasible to perform laparoscopic surgery for some gastric GIST in difcult anatomical locations [7], but there are certain differences for
surgical treatment strategies based on different anatomical
regions and size restrictions. It is more suitable to close the
gastric cavity using manual rather than instrumental suturing after resection, and the dual- mirror technique is
recommended.
1.3 Expert Comments
HuiCao
Laparoscopic treatment strategies vary depending on the
size, anatomical location, and different gross growth patterns of GIST. For example, a GIST on the greater curvature and fundus of the stomach can often be resected with
an intracavitary cutting closure device. While for a GIST
on the minor curvature, adjacent to the cardia or pylorus, it
is more difcult to use an intracavitary cutting closure
device for resection, and closure often requires involvement of a portion of local gastric wall. Manual suturing
after resection requires greater surgical skills for the surgeon and identifying the location of small GIST that completely protrude into the cavity may need to rely on
intraoperative gastroscopy.
Compared to open surgery, laparoscopic surgery has the
advantages of small incisions, better vision, less bleeding,
and less pain [8]. However, GIST are brittle and prone to
rupture, and the postoperative recurrence rate will be greatly
increased. Therefore, whether laparoscopic surgery can be
used for GIST with large diameters or complex anatomical
locations is still controversial. Surgeons who have received
rigorous training in laparoscopic techniques need to fully
evaluate the difculty of tumor resection and the risk of
tumor rupture during the perioperative period while focusing
on minimally invasive surgery and choose the best surgical
method to maximize patient benets.
8
T. Wang et al.
References
1. von Mehren M, Randall RL, Benjamin RS, Boles S, Bui MM,
Ganjoo KN, George S, Gonzalez RJ, Heslin MJ, Kane JM, Keedy
V, Kim E, Koon H, Mayerson J, McCarter M, McGarry SV,
Meyer C, Morris ZS, O’Donnell RJ, Pappo AS, Paz IB, Petersen
IA, Pfeifer JD, Riedel RF, Ruo B, Schuetze S, Tap WD, Wayne
JD, Bergman MA, Scavone JL. Soft tissue sarcoma, version
2.2018, NCCN clinical practice guidelines in oncology. J Natl
Compr Cancer Netw. 2018;16(5):536–63. https://doi.org/10.6004/
jnccn.2018.0025.
2. Dematteo RP, Gold JS, Saran L, Gönen M, Liau KH, Maki RG,
Singer S, Besmer P, Brennan MF, Antonescu CR. Tumor mitotic
rate, size, and location independently predict recurrence after resection of primary gastrointestinal stromal tumor (GIST). Cancer.
2008;112(3):608–15. https://doi.org/10.1002/cncr.23199.
3. Liao CH, Yeh CN, Wang SY, Fu CY, Tsai CY, Liu YY, Cheng CT, Yeh
TS. Surgical option for intestinal gastrointestinal stromal tumors-
-perioperative and oncological outcomes of laparoscopic surgery.
Anticancer Res. 2015;35(2):1033–40. https://ar.iiarjournals.org/
content/35/2/1033.long
4. Güller U, Tarantino I, Cerny T, Schmied BM, Warschkow
R. Population-based SEER trend analysis of overall and cancer-
specic survival in 5138 patients with gastrointestinal stromal
tumor. BMC Cancer. 2015;15:557–68. https://doi.org/10.1186/
s12885- 015- 1554- 9.
5. Li J, Ye Y, Wang J, Zhang B, Qin S, Shi Y, He Y, Liang X, Liu X,
Zhou Y, Wu X, Zhang X, Wang M, Gao Z, Lin T, Cao H, Shen L,
Chinese Society of Clinical Oncology Csco Expert Committee On
Gastrointestinal Stromal Tumor. Chinese consensus guidelines
for diagnosis and management of gastrointestinal stromal tumor.
Chin J Cancer Res. 2017;29(4):281–93. https://doi.org/10.21147/j.
issn.1000- 9604.2017.04.01.
6. Blay JY, Kang YK, Nishida T, von Mehren M. Gastrointestinal
stromal tumours. Nat Rev Dis Primers. 2021;7(1):22. https://doi.
org/10.1038/s41572- 021- 00254- 5.
7. Xiong Z, Wan W, Zeng X, Liu W, Wang T, Zhang R, Li C, Yang W,
Zhang P, Tao K.Laparoscopic versus open surgery for gastric gastrointestinal stromal tumors: a propensity score matching analysis.
J Gastrointest Surg. 2020;24(8):1785–94. https://doi.org/10.1007/
s11605- 019- 04318- 6.
8. Hu J, Or BH, Hu K, Wang ML.Comparison of the post-operative
outcomes and survival of laparoscopic versus open resections for
gastric gastrointestinal stromal tumors: a multi-center prospective cohort study. Int J Surg. 2016;33(Pt A):65–71. https://doi.
org/10.1016/j.ijsu.2016.07.064.
Laparoscopic Combined
withEndoscopic Management
ofGastrointestinal Stromal Tumors
XinyuZeng, MingWang, QianShen, HuikuanChu,
andGangZhao
2
Keywords
Gastrointestinal stromal tumors · Laparoscopy surgery
Endoscopic surgery · Laparoscopy · Endoscopy
Cooperation
2.1 Case 3 A41-Year-Old Woman
withGIST Who Underwent
Laparoscopic andEndoscopic
Cooperative Surgery
XinyuZeng and MingWang
2.1.1 Introduction
Laparoscopic and endoscopic cooperative surgery has
emerged as a minimally invasive surgical technique for GIST
in recent years. In the past, when laparoscopy was performed
alone, it was not easy to detect small lesions (tumor diameter
<2cm) due to the lack of ne tactile sensation [1]. In addition, due to the limitation of laparoscopic instruments, it is
more difcult to assess the posterior wall of the gastroduodenum and intraluminal tumors during exploration, which easily leads to the omission of lesion resection and procedure
X. Zeng · Q. Shen
Department of Gastrointestinal Surgery, Union Hospital, Tongji
Medical College, Huazhong University of Science and Technology,
Wuhan, China
e-mail: zengxy@hust.edu.cn; m202175880@hust.edu.cn
M. Wang (*) · G. Zhao
Department of Gastrointestinal Surgery, Renji Hospital, Shanghai
Jiaotong University School of Medicine, Shanghai, China
H. Chu (*)
Department of Gastroenterology, Union Hospital, Tongji Medical
College, Huazhong University of Science and Technology,
Wuhan, China
e-mail: 2012XH0827@hust.edu.cn
conversion to laparotomy [2]. In this case, intraoperative
gastroscopy to locate the lesion was particularly necessary to
ensure the smooth progress of laparoscopic surgery. In addition, as GIST lesions found under gastroscopy generally
originate from the muscularis propria, the risks of treatment
using gastroscopy alone are greater, and the operation time is
increased. The use of laparoscopy can assist endoscopic procedures, through timely detection and management of complications arising from endoscopic resection, therefore
increasing surgical safety and efciency [3]. Laparoscopic
and endoscopic cooperative surgery combines the advantages of laparoscopy and endoscopy, counteracts the disadvantages of laparoscopy or endoscopy alone, and further
expands the scope of application for minimally invasive surgical techniques.
2.1.2 Case Background
A 41-year-old woman presented with abdominal distension
accompanied by nausea without vomiting, dizziness, headache, fatigue, and blackouts after eating greasy food in July
2018. Upon coughing, the patient produced a small amount
of white sputum, but the patient did not report hemoptysis,
chest pain, chest tightness, or other symptoms. The patient
had a normal high-salt diet. The patient then visited a local
hospital on August 10, 2018. Gastroscopy showed atrophic
gastritis, a local gastric bulge (this was described as a submucosal lesion and endoscopic ultrasonography was recommended) and antral polypoid change. Gastric mucosal
biopsy pathology showed chronic non-atrophic gastritis
(acute active stage) in the antrum and Helicobacter pylori
(HP) infection. Anti-HP treatment was administered at
another hospital, and the patient’s subjective symptoms
were relieved 2 weeks later. For further treatment, the
patient visited Renji Hospital, Shanghai Jiaotong University
School of Medicine. On August 20, 2018, ultrasonic gastroscopy showed possible gastric GIST. On August 25,
© People’s Medical Publishing House, PR of China 2024
K. Tao, H. Cao (eds.), Clinical Management of Gastrointestinal Stromal Tumor, https://doi.org/10.1007/978-981-99-9392-5_2
9