# Laparoscopic Endoscopic Cooperative Surgery for Multiple Gastrointestinal Stromal Tumors Associated with Incomplete Carney Triad: A Case Report

## TL;DR

A 15-year-old girl with multiple gastrointestinal stromal tumors and incomplete Carney triad underwent successful laparoscopic endoscopic surgery with no recurrence after three years.

## Contribution

A novel surgical approach combining laparoscopic and endoscopic techniques for resecting multiple GISTs in Carney triad is described.

## Key findings

- Laparoscopic endoscopic cooperative surgery successfully resected multiple GISTs with preserved gastric function.
- The patient remained recurrence-free for three years post-surgery.
- Combining thoracoscopic lobectomy with prior gastric surgery provided complete treatment.

## Abstract

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.