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GASTROINTESTINAL STROMAL TUMOR PADA PASIEN DEWASA: SEBUAH

LAPORAN KASUS
Yohanes Basco Panji, S. Ked1, dr. Lie Adityo Hansen, Sp. Rad2
Universitas Kristen Duta Wacana, Yogyakarta, Indonesia
Rumah Sakit Bethesda, Yogyakarta, Indonesia

Korespondensi: yohanesboscopanjipradana@yahoo.com

ABSTRAK

Latar belakang: Gastrointestinal stromal tumors (GIST) merupakan tumor


non epitelial yang secara khas tumbuh di dinding traktus gastrointestinal, biasanya
muncul dari lapisan muskularis propria atau muskularis mukosa dan berasal dari
sel intersisial Cajal. Di Amerika Serikat, terdapat sekitar 5000 kasus baru tiap
tahunnya dan diperkirakan 15-20 kasus per satu juta penduduk. Sekitar 90% dari
penderita GIST merupakan usia (40 tahun keatas) dengan rata-rata usia 63 tahun
Tujuan: Tujuan penulisan ini untuk melaporkan kasus Gastrointestinal
Stromal Tumor pada seorang pasien pria berusia 56 tahun di RS Bethesda Yogyakarta.
Deskripsi Kasus: Seorang pasien laki-laki berusia 56 tahun datang dengan
keluhan BAB darah disertai lemas. Keluhan ini sudah berlangsung selama 5 hari .
sebelum pada akirnya pasien periksa ke rumah sakit dan didapatkan HB 6,4 dibawah
batas normal dari hasil pemeriksaan darah. Pada pasien ini ditemukan riwayat
penyakit dahulu berupa hemoroid dan BAB darah pada tahun 2017 sedangkan
riwayat penyakit keluarga tidak ada yang spesifik. Pada pemeriksaan non kontras CT
scan abdomen didapatlan filling defect regio curvature minor gaster mengarah proses
malignancy intralumen gaster, disertai penyempitan lumen gaster dengan diagnosis
GIST. Lalu lakukan Tindakan laparotomy reseksi gaster pada 8 agustus 2020 dengan
diagnosis post op adalah ca gaster ,lalu sediaan di periksa di lab PA dan di dapat kan
hasil PA adalah polip gaster
Kesimpulan:. Gastrointestinal stromal tumors (GIST) merupakan tumor non
epitelial yang secara khas tumbuh di dinding traktus gastrointestinal, biasanya
muncul dari lapisan muskularis propria atau muskularis mukosa dan berasal dari
sel intersisial Cajal. Perdarahan tractus gastrointestinal merupakan gejala yang
paling umum ditemukan akibat erosi dari lumen saluran gastrointestinal.
Pemeriksaan CT scan dapat menegakkan diagnosis GIST. Tatalaksana dari GIST
primer terlokalisasi dan tidak terdapat metastasis adalah reseksi radikal tanpa
reseksi limfadenopati. Pada kondisi GIST sudah tidak dapat direseksi, dilakukan
kemoterapi dengan target terapi dan Imatinib mesylate digunakan sebagai agent aktif
untuk mengontrol pertumbuhan tumor pada stadium lanjut maupun metastasis.
Kata Kunci: Gastrointestinal stromal tumors (GIST), CT scan, Gaster, filling
defect
GASTROINTESTINAL STROMA TUMOR IN ADULT PATIENTS: A CASE REPORT
Yohanes Basco Panji Pradana, S. Ked1, dr. Lie Adityo Hansen, Sp. Rad2
Duta Wacana Christian University, Yogyakarta, Indonesia
Bethesda Hospital, Yogyakarta, Indonesia
Contact: yohanesboscopanjipradana@yahoo.com

ABSTRACT
Background: Gastrointestinal stromal tumors are non-epithelial tumors that
typically grow on the walls of the gastrointestinal tract, usually arise from the
muscularis propria or mucous mucosa and originate from Cajal intersisial cells. In
the United States, there are about 5,000 new cases each year and an estimated 1520
cases per one million population. About 90% of people with GIST are adults (40 years
and over) with an average age of 63 years
Purpose: The purpose of this paper is to report the case of gastrointestinal
stroma tumor in a 56-year-old male patient at Bethesda Hospital Yogyakarta.
Case description: A 56-year-old male patient presented with complaints of
blood stools accompanied by weakness. This complaint has been going on for 5 days.
before the patient finally checked into the hospital and found HB 6.4 below the normal
limit from the results of blood tests. In this patient, a history of previous disease in
the form of hemorrhoids and blood stool was found in 2017, while there was no
specific family history of disease. On the non-contrast CT scan of the abdomen, it was
found that the filling defect of the minor curvature region of the stomach leads to
intralumen malignancy process, accompanied by narrowing of the gastric lumen with
a diagnosis of GIST. Then do the gastric resection laparotomy action on 8 August 2020
with a post-op diagnosis is gastric caes, then the preparation is checked in the PA lab
and the PA results get is gastric polyps
Conclusion: Gastrointestinal stromal tumors (GIST) are non-epithelial tumors
that typically grow on the walls of the gastrointestinal tract, usually arise from the
muscularis propria or mucous mucosa and originate from intersisial Cajal cells.
Gastrointestinal tract bleeding is the most common symptom found due to erosion of
the lumen of the gastrointestinal tract. A CT scan can confirm a GIST diagnosis. The
treatment of localized primary GIST and no metastases is radical resection without
resection lymphadenopathy. In conditions where GIST cannot be resected,
chemotherapy is performed with targeted therapy and Imatinib mesylate is used as
an active agent to control tumor growth at an advanced or metastatic stage.

Keywords: Gastrointestinal stromal tumors (GIST), CT scan, Gaster, filling


defect
INTRODUCTION

Gastrointestinal stromal tumors (GIST) are non-epithelial tumors that


typically arise in the walls of the gastrointestinal tract, usually arising from
the muscularis propria or muscularis mucosae and originating from the
interstitial cells of Cajal. Tumors can arise in the esophagus, stomach, small
intestine, colon, mesentery, and omentum. Gaster is the most common
location (60-70%). Sometimes the origin of the tumor cannot be determined,
because of the extensive peritoneal spread. The clinical symptoms of GIST
depend on the size and location of the tumor. Small tumors are often
asymptomatic and often go unnoticed, and by the time symptoms appear, the
tumor is large or has spread to other organs. The clinical symptom that often
occurs is gastrointestinal bleeding due to mucosal ulceration. The purpose of
this paper is to report a case of gastrointestinal stromal tumors (GIST) in a 56-
year-old male patient with complaints of bloody stools and weakness
CASE DESCRIPTION
A 56-year-old male patient came with complaints of bloody stools accompanied
by weakness. This complaint has been going on for 5 days. before finally the patient
checked into the hospital and found HB 6.4 below the normal limit from the results
of blood tests. In this patient, there was a history of previous illness in the form of
hemorrhoids and blood stools in 2017 while there was no specific family history of
disease. On non-contrast examination, a CT scan of the abdomen revealed a filling
defect in the minor curvature region of the stomach leading to a gastric intraluminal
malignancy, accompanied by narrowing of the gastric lumen.
Discussion of etiology and pathophysiology
GIST is known to have changes in genes that control cells, the cause of these
gene changes is not known. The gene change in GIST is a change in an oncogene
called c-kit. The ckit gene is found in all body cells. This gene directs cells to make a
protein called KIT. KIT is a type 3 receptor tyrosine kinase which is important for the
adhesion, apoptosis and differentiation of melanocytes, germ cells, mast cells,
hematopoietic stem cells, Cajal interstitial cells. Normally the c-kit gene in Cajal
interstitial cells (ICC) is inactive. In about 85-90% of GIST patients, the c-kit gene
mutation becomes active. This results in uninhibited cell proliferation and resistance
to apoptosis. In about 5%-10% of GISTs, mutations occur in a different gene called
PDGFRA. This gene causes cells to make too much of the protein PDGFRA which has
the same effect as KIT on cells. Most GISTs have mutations in the c-kit or gene
PDGFRA, but not both at the same time
Clinical Manifestations
The clinical picture is atypical, depending on the size and location of the tumor.
Small tumors are usually discovered incidentally during radiological examination or
surgery for other purposes. Large tumors usually show symptoms. The most common
symptom is gastrointestinal tract bleeding due to mucosal ulceration in the form of
hematemesis, melene, hematochezia, or signs and symptoms of anemia due to occult
bleeding. Other symptoms include nausea, vomiting, abdominal pain, weight loss,
abdominal distension, intestinal obstruction, palpable abdominal masses. In certain
cases abdominal pain is a frequent symptom. Tumors in the duodenum may present
with obstructive jaundice and may be confused with pancreatic cancer.

Medication
The mainstay of treatment for localized primary GIST in the absence of
metastases is radical resection without resection of lymphadenopathy. This method
gives the greatest hope of recovery. Resection of lymphadenopathy is usually not
necessary because GISTs very rarely spread lymphatics. However, despite complete
resection with clear margins, the recurrence rate remains high; Recurrence in the
liver or mesentery occurs in 40-90% of patients undergoing curative surgery. This is
caused by the occurrence of tumor rupture which leads to implantation in the
mesentery. The risk of recurrence requires careful surgical technique and
percutaneous biopsy should be avoided. Under certain conditions and when the GIST
cannot be resected, chemotherapy with targeted therapy is performed. An effective
drug for treating GIST, which works by selectively inhibiting the tyrosine kinase
enzyme using the tyrosine kinase inhibitor STI-671. This drug was recently approved
for clinical use in the United States as imatinib mesylate. It is a new molecular therapy
that has minimal toxicity.
Prognosis
Gastrointestinal stromal tumors (GIST) usually occur at the age above 50 years
of life, and the prognosis depends on the poor period if metastases occur to other
organs so that resection cannot be done and can only be done with chemotherapy
with targeted therapy. The survival of individuals suffering from GIST depends on the
extent of metastases .
DISCUSSION
A 56-year-old male patient came with complaints of bloody stools accompanied by
weakness. This complaint has been going on for 5 days. before finally the patient
checked into the hospital and found HB 6.4 below the normal limit from the results
of blood tests. In this patient, there was a history of previous illness in the form of
hemorrhoids and blood stools in 2017 while there was no specific family history of
disease. On non-contrast examination, a CT scan of the abdomen revealed a filling
defect in the minor curvature of the stomach leading to a gastric intraluminal
malignancy, accompanied by narrowing of the gastric lumen with a diagnosis of GIST.
Then do. The action of gastric resection laparotomy on August 8, 2020 with a
postoperative diagnosis of gastric cancer, then the preparation was checked in the PA
lab and the PA results were gastric polyps

Figure 1 CT scan of the abdomen (Coronal). The gastric contour appears filled
with a contrast marker, Im.8-20, with a minor curvature filling defect, and
luminal narrowing.

Figure 2 CT scan of the abdomen (Sagittal) filling defect in the region of the
minor curvature of the stomach indicating a gastric intraluminal malignancy
process, accompanied by narrowing of the gastric lumen
Figure 3 CT scan of the abdomen (Axial). The gastric contour appears filled with
contrast markers, with a minor filling defect in the curvature region, and a
narrowing of the lumen suggesting a malignancy process.

From the picture above, the imaging examination is a CT scan of the abdomen.
Gastric contour appears filled with contrast marker, Im.8-20, with a minor curvature
filling defect, and narrowing of the lumen leading to gastric intraluminal malignancy,
this is in accordance with the theory. Clinically, the complaints in this patient are
also in accordance with the theory, namely the patient comes with complaints of
bloody stools and weakness on a complete blood examination obtained HB 6.4 then
a non-contrast abdominal CT scan is the best examination to see the organs in the
abdomen around it
CONCLUSION
Gastrointestinal stromal tumors (GISTs) are non-epithelial tumors that
typically arise in the walls of the gastrointestinal tract, usually arising from the
muscularis propria or muscularis mucosae and originate from the interstitial cells of
Cajal. Gastrointestinal tract bleeding is the most common symptom due to erosion of
the lumen of the gastrointestinal tract. A CT scan can confirm the diagnosis of GIST.
Management of localized primary GIST and no metastases is radical resection without
resection of lymphadenopathy. In the condition that the GIST cannot be resected,
chemotherapy with targeted therapy is performed and Imatinib mesylate is used as
an active agent to control tumor growth at an advanced stage or metastases.
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