Laparoscopic Endoscopic Cooperative Surgery for Multiple Gastrointestinal Stromal Tumors Associated with Incomplete...

Gastrointestinal stromal tumor (GIST) associated with Carney triad differs clinically, pathologically, and behaviorally from sporadic GIST. Surgical resection is the main form of treatment.

A 15-year-old female patient with an unremarkable medical history and family history was hospitalized for COVID-19. A chest X-ray incidentally revealed a pulmonary, nodular shadow. CT revealed a 55-mm pulmonary nodule with coarse calcification in the left lower lobe and gastric tumors in the upper body, on the basis of which pulmonary chondroma was diagnosed. Upper gastrointestinal endoscopy revealed 3 tumors, including a 10-mm tumor in the fornix and a 10- and 30-mm tumor in the upper gastric body. An endoscopic ultrasonography-guided fine needle biopsy revealed multiple GIST. On the basis of these findings, incomplete Carney triad was diagnosed. A partial gastrectomy via laparoscopic endoscopic cooperative surgery was performed for the GIST. Laparoscopy-assisted endoscopic full-thickness resection was performed first for the tumor in the fornix. Then, the 2 tumors in the upper gastric body were resected via a combination of laparoscopic and endoscopic approaches for neoplasia with non-exposure technique. The postoperative course was uneventful, and the patient was discharged on POD 11. Three months after the partial gastrectomy, a thoracoscopic left lower lobectomy was performed for the pulmonary chondroma. To date, 3 years after the surgery, there is no evidence of a recurrence.

When resecting multiple GIST associated with Carney triad, surgeons should choose a surgical approach optimized for the individual patient and prioritize curability and preservation of the gastric function.