A Rare Case of Gastrointestinal Stromal Tumor with a Liver Metastasis Infiltrating the Inferior Vena Cava and Extending to the Right Atrium with an Early Recurrence after Surgical Extraction

A Case Report on Pulmonary Tumor Embolism in a Patient With a Metastatic Gastrointestinal Stromal Tumor Invading the Inferior Vena Cava: Tumor or Thrombus?

Pulmonary tumor embolism is a highly underdiagnosed entity involving the embolism of tumor fragments into the pulmonary vasculature. The vast majority of cases are diagnosed post-mortem. Here we discuss a rare case of a patient with a long-standing history of metastatic gastrointestinal stromal tumor (GIST) that progressed into a direct invasion of the inferior vena cava. The patient presented with shortness of breath and chest pain and was found to have a pulmonary embolism while on anticoagulation. Clinical and imaging findings strongly suggested tumor embolism. Due to its similarity to venous thromboembolism, pulmonary tumor embolism is challenging to diagnose antemortem. Clues to the diagnosis include the presence of intravascular invasion by the tumor (tumor thrombus), recurrent embolisms on anticoagulation, chronic vascular occlusion, and pulmonary infarction.

A Huge Pelvic-Abdominal Malignant GIST Tumour in a Patient with Neurofibromatosis Type 1: Case Report and Literature Review

Gastrointestinal stromal tumours are rare tumours of the gastrointestinal tract (GIT) accounting for 0.1%–3% of all gastrointestinal tumours. The most common location is the stomach (55%) followed by the small bowel (31.8%), colon (6%), other various locations (5.5%), and the oesophagus (0.7%). They may also occur in extraintestinal locations. The signs and symptoms of GIST depend on the tumour's location and size. Gastrointestinal bleeding is one of the most common symptoms. Other signs and symptoms include abdominal discomfort, pain or distention; intestinal obstruction, and weight loss. The association between the development of GISTs and neurofibromatosis 1 (NF1) has been established. NF1-associated GISTs tend to have a distinct phenotype, and the absence of KIT/PDGRFα mutations in turn has implications on further management when they do not respond well to imatinib treatment. Here, we present one of the largest GISTs reported in the literature with a total volume of 25.3 × 20 × 14 cm + 27.9 × 23 × 8 cm and an overall weight of 7.3 kg, which developed in a 43-year-old female patient with NF1 and was resected on an emergency basis due to the rapid deterioration and development of abdominal compartment syndrome. Pathology assessment showed a malignant GIST composed of spindle cells with elongated nuclei with necrosis, marked pleomorphism and numerous giant cell. The mitotic count was >15/50 HPF, Ki 67 was 80%, and the lymphovascular invasion was clear. Immunohistochemistry investigations showed that Vimentin, CD117, and DOG1 were positive, while BCL-2 and CD99 were focal positives. Pan-CK, S-100, CD34, Desmin, SMA, and HMB-45 were negatives.