隱藏的胃腸道間質瘤：在疑似嗜鉻細胞瘤病例中達文西手術揭示偽裝成左腎上腺腫塊的胃腫瘤

黃國倫¹、吳振宇^1、2、吳俊賢^1、2、林嘉祥^1、2

¹義大醫療財團法人義大醫院 泌尿科；

²義守大學 醫學系

The Hidden GIST: Robotic Surgery Unveils Gastric Tumor Masquerading as Left Adrenal Mass in Suspected Pheochromocytoma
Allen, Guo-Lun Huang¹, Richard C. Wu^1,2, Chun-Hsien Wu^1,2, Victor C. Lin^1,2

Department of Urology¹, E-Da Hospital, Kaohsiung, Taiwan;

School of Medicine, College of Medicine², I-Shou University, Kaohsiung, Taiwan

Introduction: Imaging studies may sometimes reveal lesions that originate from adjacent structures, masquerading as adrenal tumors. This case report highlights the diagnostic and surgical challenges posed by an incidental adrenal mass that was later discovered to be a gastrointestinal stromal tumor (GIST), an uncommon entity in this context. The report emphasizes the importance of intraoperative flexibility and the role of robotic-assisted surgery in managing complex cases.

Case report: A 72-year-old woman with a medical history of Parkinsonism, hypertension, type 2 diabetes mellitus, coronary artery disease, and anxiety disorder presented with an incidental finding of a left adrenal mass on imaging. Laboratory investigations revealed hypokalemia, but her hormonal profile was grossly unremarkable except for an elevated 24-hour urinary dopamine level of 4391.6 µg/day. Abdominal computed tomography (CT) identified two abnormal masses in the left adrenal region, measuring approximately 6.6 x 5.2 cm and 3.2 x 1.6 cm, raising suspicion for pheochromocytoma with a differential diagnosis of adrenocortical carcinoma (ACC) (Fig. 1). Given the functional nature of the tumor and its potential for malignancy, the patient was scheduled for a robotic-assisted laparoscopic left adrenalectomy. During the procedure, however, an unexpected mass originating from the gastric wall was identified. This prompted a partial gastrectomy to remove the tumor. Additionally, a separate mass near the left adrenal gland was discovered and excised along with partial adrenalectomy. The total operative time was 221 minutes with an estimated blood loss of 100 mL. Histopathological examination revealed that the gastric wall mass, measuring 7.0 x 6.0 x 4.5 cm, was GIST, classified as pT3 with low malignant potential. The adrenal mass, measuring 1.5 x 1.4 x 0.9 cm, was confirmed to be an adrenal cortical adenoma. The rare finding of a GIST mimicking an adrenal tumor on imaging highlights the diagnostic challenges in such cases.

Conclusion: This case underscores the complexity of diagnosing and managing adrenal incidentalomas, particularly when imaging findings are suggestive of pheochromocytoma or ACC but ultimately reveal an unexpected pathology. The intraoperative discovery of a gastric GIST, initially misinterpreted as an adrenal mass, demonstrates the importance of adaptability during surgery. Robotic-assisted laparoscopic surgery played a pivotal role in facilitating precise excision of the tumors with safety and efficacy.