doiSerbia

Gastrointestinalni tumor želuca (GIST) kao uzrok masivnog krvarenja iz gornjih partija digestivnog trakta

Đukić V.R. (Centar za hirurgiju, Urgentni Centar, Klinički Centar Srbije, Beograd)
Karamarković A.R. (Centar za hirurgiju, Urgentni Centar, Klinički Centar Srbije, Beograd)
Mijatović S. (Centar za hirurgiju, Urgentni Centar, Klinički Centar Srbije, Beograd)
Micev M. (Centar za hirurgiju, Urgentni Centar, Klinički Centar Srbije, Beograd)
Bumbaširević V.M. (Centar za hirurgiju, Urgentni Centar, Klinički Centar Srbije, Beograd)
Đurović M. (Centar za hirurgiju, Urgentni Centar, Klinički Centar Srbije, Beograd)
Stepić D. (Centar za hirurgiju, Urgentni Centar, Klinički Centar Srbije, Beograd)
Jeremić V.M. (Centar za hirurgiju, Urgentni Centar, Klinički Centar Srbije, Beograd)
Popović N.M. (Centar za hirurgiju, Urgentni Centar, Klinički Centar Srbije, Beograd)
Šijački A. (Centar za hirurgiju, Urgentni Centar, Klinički Centar Srbije, Beograd)
Krstić S.N. (Centar za hirurgiju, Urgentni Centar, Klinički Centar Srbije, Beograd)
Gregorić P. (Centar za hirurgiju, Urgentni Centar, Klinički Centar Srbije, Beograd)

Gastrointestinal stromal tumors GIST are rare mesenchymal tumors of the gastrointestinal tract characterized by expression of a receptor that activates tyrosine kinase called C- kit. Since malignant GIST has an extremely poor prognosis even after surgical resection. The development of a tyrosine kinase inhibitor, STI571/imatinib mesylate/Gleevec, Glivec which inhibits the BCR-ABL, PDGF-R alpha, and C-Kit receptors, has changed the management of unrespectable malignant GIST and has improved the survival of patients with metastaic disease. We report a 32 year old male patient with subcardiale gastric GIST and massive gastrointestinale bleeding. The patient underwent total gastrectomy, D2 lymphadenestomy, distal pancreatectomy and splenectomy on 02.02. 2004. Histopathology examination of the primary tumor revealed a strong C-Kit expression and CD 34 +++, Ki67 20 and so called "Pure GIST" was approved Liver metastasis was detected on ultrasound and CT 12 months later and segmentectomy S7 was performed on 23.03.2005. Postoperative course was uneventful. HP examination - malignant 35 x 30 mm sarcoma like tumor of mesenchymal origin. The patient received adjuvant imatinib -mesylate Gleevec Novartis Pharma Basel 400 mg a day. The initial complete response to treatment continued to 24 months postoperatively Imatinib is a recent and very promising treatment extirpation remains the only curative treatment of malignant GIST as evidenced by our patient.

Keywords: gastrointestinal stromal tumors, total gastrektomy, segmentektomy of liver, tyrosine kinase inhibitor