ROBOTIC EXCISION OF HETEROTOPIC LIVER MASQUERADING AS A GIST OF THE STOMACH

Saturday, February 11, 2023

3:00pm – 4:00pm East Coast USA Time

Presenter(s)

Stephen Weathersby, MS

Medical Student (M3)
University of Mississippi Medical Center
Madison, Mississippi, United States

Principal Contact(s)

WO

W. Shannon Orr, MD

Chief of Division of Surgical Oncology
University of Mississippi Medical Center, United States

Objectives: Gastrointestinal stromal tumors (GISTs) are rare, representing less than 5% of all gastrointestinal neoplasms. GISTs are often asymptomatic, largely due to their submucosal location. These tumors are typically diagnosed based off computed tomography or endoscopy. The mass seen in this case resembled many of the findings that come with GISTs without the pathological confirmation on biopsy. Tumors like these are frequently resected by minimally invasive techniques, with robotic surgery most recently making more challenging resections of these tumors more feasible.

Here we will present the case of a 27-year-old female with a pre-operative diagnosis of gastric GIST. She presented three months pre-operatively to an outside emergency department with shortness of breath and was found to have an unprovoked pulmonary embolism. The patient was taking rivaroxaban at that time. On outside hospital imaging, she was incidentally found to have a mass along the greater curvature of the stomach. After an esophagogastroduodenoscopy, endoscopic ultrasound, and a repeat computed tomography scan of the abdomen, there was evidence to suggest the mass was an exophytic gastric GIST. After these findings, she was referred to our care to evaluate for surgical resection.

Intra-operatively, the lesion was found along the posterior aspect of the fundus adjacent to the superior pole of the spleen. First, the short gastric vessels were taken down to widely identify the mass. At this point, it was noted that the mass was abutting the pancreas, spleen, and stomach without evidence of invasion. The mass was resected in an R0 fashion without any need for resection of surrounding structures. Although many of the preliminary findings suggested that this could be a GIST, the final pathology was consistent with extrahepatic liver parenchyma without evidence of malignancy.

This case is an example of why it is important to keep a broad differential diagnosis in the management of tumors which have not been biopsy proven prior to surgical resection.

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