Surprising histological findings on the resected specimen of the omentum due to a strangulated umbilical hernia

Abstract

Introduction: Gastrointestinal stromal tumor, GIST, is the most common mesenchymal tumor of the digestive system. It most often grows from the stomach or the small intestine and tends to be asymptomatic. The basic and the only curative therapy is an attempt at R0 resection. If the tumor is inoperable, metastatic or when neoadjuvant or adjuvant therapy is needed, patients are treated with a tyrosine kinase inhibitor - imatinib. It was discovered in 2000 on the basis of GIST molecular behavior.
Case report: The case report describes a female patient who had been without any clinical symptoms for a long time until she presented with acute abdominal pain due to squeezed umbilical hernia. She underwent an acute operation, resection of the strangulated omentum and reconstruction of the abdominal wall. The omentum was sent for definitive histology. However, the pathologist described nonspecific sarcoma. A subsequent CT scan showed a large tumor mass in the abdominal cavity and in the small pelvis. A multidisciplinary team of the Motol Teaching Hospital indicated the patient for an attempt at radical tumor extirpation. Omentectomy, resection of the jejunum, hysterectomy, right adnexectomy, low anterior resection of the rectum and omphalectomy were performed. The result of the definitive histological examination was high-risk, malignant GIST, c-kit-positive, growing from the jejunum.