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Erschienen in:
27.01.2022 | The Last Image
Transvaginal excision of a rectovaginal septum GIST: a minimally invasive and safe surgical approach
Erschienen in: Techniques in Coloproctology | Ausgabe 4/2022
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Gastrointestinal stromal tumors (GISTs) of the rectovaginal septum are extremely rare and challenging to manage due to the need to ensure complete tumor eradication and organ preservation [1, 2]. We report the case of a 69-year-old woman with a neoplasm filling the rectovaginal space without involvement of the rectal or vaginal mucosa. The mass was located 40 mm from the dentate line. As an alternative to an ultralow anterior resection of the rectum, the patient underwent transvaginal excision of the lesion. The histopathological features were consistent with spindle cell type GIST. The postoperative course was uneventful. The patient received adjuvant imatinib therapy and, after 6 months of follow-up, there has been no recurrence of the disease (Figs. 1, 2, 3, 4, 5, 6, 7).
Fig. 1
Bulging of the posterior vaginal wall due to the protrusion of the lesion
Fig. 2
Absorbable stitches were placed around the mass to pull and facilitate lifting of the vaginal mucosa
Fig. 3
After longitudinal incision of the vaginal mucosa, the tumor was fully enucleated without rupture using the Ligasure Exact dissector
Fig. 4
After verifying the absence of full-thickness lacerations of the rectal wall by trans-anal injection of methylene blue, the vaginal defect was closed by layers
Fig. 5
Appearance of the resected specimen measuring 2.8 × 20 × 15 mm
Fig. 6
Hematoxylin and Eosin stain showing spindle cells with a fascicular growth pattern. This high-magnification image shows increased mitotic activity (> 5 mitoses per 50 high-power fields). Mitotic count is one of the prognostic factors to be evaluated, in addition to the site and size, according to the Miettinem and Lasota criteria
Fig. 7
Diffuse and strong membranous and cytoplasmic immuno-histochemical staining of DOG1 (a), CD117 (b) and CD34 (c). (20 × magnification)
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