Gastrointestinal stromal tumors: a case report

An unusual and life-threatening presentation of a large GIST

Introduction

Case presentation

Clinical discussion

Conclusion

•

Although an acute presentation of GIST is rare, it must be recognised early to prevent further morbidity and mortality.

•

The overlap between the symptoms of GIST and other GI disorders could lead to an uncertain diagnosis and thus unfavourable outcome.

•

Imaging modalities along with immunohistochemical studies have eased the diagnosis of GIST

•

The characteristics of the tumor largely influence the treatment pathway.

Jejunal Gastrointestinal Stromal Tumor (GIST) as a Rare Cause of GI Bleed: A Case Report

Jejunal gastrointestinal stromal tumor (GIST) is a rare cause of recurrent gastrointestinal bleeding (GIB). Early diagnosis for patients with jejunal GIST is often challenging, which can lead to delays in treatment. We present a case of a 32-year-old male patient with persistent abdominal pain and hematemesis despite treatment for gastroesophageal reflux disease (GERD). Upon initial ER visit, CT result was consistent with intra-abdominal abscess and the patient underwent interventional radiology (IR) drainage. On a second ER visit three weeks later, CT showed a suspicious lesion in the small bowel. The patient underwent exploratory laparoscopy which revealed a mass in the jejunum. The lesion was resected successfully and pathology report confirmed the diagnosis of GIST with positive immunohistochemistry marker cluster of differentiation (CD)117. The patient was discharged with no complications post-operatively. In conclusion, recurrent GIB and unusual imaging findings should raise clinical suspicion for alternative causes for GIB, including tumors such as GIST.

Multiple, large intra-abdominal cystic lesions and iron deficiency anaemia as the presenting symptoms of SDHD gastrointestinal stromal tumour (GIST) in a young sub-Saharan woman

We report the case of a 27-year-old female patient from sub-Saharan Africa who presented with non-specific abdominal complaints, iron deficiency anaemia and multiple, large intra-abdominal cystic lesions on imaging. The lesions appeared to be a most unusual presentation of gastrointestinal stromal tumour (GIST). GIST is a sarcomatous tumour that comprises only 0.2% of all gastrointestinal (GI) tumours; it is the most common mesenchymal malignancy of the GI tract. Our patient had the succinate dehydrogenase-deficient (SDHD) subtype, identified in some 5%-10% of patients with GIST only, commonly found in women and younger patients. The differential diagnosis of intra-abdominal cystic lesions is briefly discussed, including the relevance of a correct pathological diagnosis. This impacts medical and surgical management decisions, including predicting response to targeted therapy. Tyrosine kinase inhibitor therapy has been a breakthrough in the treatment of GISTs, although with extensive disease, and certainly in case of the SDHD subtype, long-term outcome remains disappointing.

Perirectal Extragastrointestinal Stromal Tumor: An Unusual Presentation

Gastrointestinal stromal tumors (GISTs), even though rare, remain the most common mesenchymal tumors of the gastrointestinal (GI) tract. When GISTs occur outside of the GI tract, they are termed extragastrointestinal stromal tumors (EGISTs). Most GISTs arise from the stomach (50-70%) and small intestine (20-30%). A smaller percentage of these tumors also occurs in the large intestine (5%) and esophagus (2-5%). EGISTs have histopathological and molecular characteristics that are similar to GISTs. However, the precise incidence and tumor behavior of EGISTs are not fully understood. EGISTs have no specific symptoms or radiologic features, and in most cases, the presenting complaint is abdominal pain or discomfort. Yet, they tend to be more aggressive and have a worse prognosis than GISTs. Morphologic diagnosis based on microscopic examination of histological sections is the standard diagnostic procedure for GIST/EGIST. In this patient-centered study, we present a case of EGIST that originated in the anterior perirectal space, an extremely rare location; we also describe the endoscopic approach that was used to biopsy the tumor.

Get the GIST: A Case Study of Detection and Treatment of Gastrointestinal Stromal Tumors

Gastrointestinal stromal tumors (GISTs) are soft tissue sarcomas that can occur anywhere in the GI tract. There are roughly 4,000 to 6,000 cases diagnosed in the United States annually. GISTs are often asymptomatic early on and can evade detection, occasionally resulting in malignancy. Due to their insidious growth and location, it is suspected that they are more common than currently reported. It is important to know how difficult it is to identify a GIST and the various methods to treat it in a patient. Our case presents a 62-year-old male with incidental findings of multiple GISTs during workup for kidney stones. The patient was fortunate that these tumors were detected before developing into a greater health concern and this case highlights the insidious nature with which they develop.

Gastrointestinal Stromal Tumors Incidentalomas: A Case Series

BACKGROUND

Gastrointestinal stromal tumors (GISTs) represent approximately 0.2% of all gastrointestinal tumors. GISTs can occur anywhere along the length of the gastrointestinal tract. Most common clinical manifestations of GISTs include GI bleeding, abdominal discomfort, distention and pain. Small lesions can be found incidentally during imaging studies, endoscopy, surgery and post-mortem. The progression of disease from incidentally found indolent to symptomatic disease is unknown.

CASE SERIES

Here we describe a series of cases of incidentally found GIST and their management. The first patient was a 38-years old morbid obese female with an incidentally found GIST in the stomach following an elective laparoscopic vertical sleeve gastrectomy. The second patient was a 69-year-old male who underwent elective sleeve gastrectomy for his obesity and associated refractory acid reflux. On pathologic examination of the gastrectomy specimen, GIST was diagnosed in the gastric fundus.

DISCUSSION

Coexistence of GIST with other malignancies is higher than previously reported and should draw attention of clinicians towards these incidental findings. Prognosis in these patients is usually determined by other malignancy and not significantly influenced by GIST. Therefore, treatment algorithms should be focused on prognostically relevant malignancy.

Primary prostatic extragastrointestinal stromal tumor: a case report and literature review

Objective

This study was performed to discuss the characteristics, diagnosis, and treatment of primary prostatic extragastrointestinal stromal tumor (EGIST).

Methods

The case history data of a patient with an EGIST were analyzed and discussed with a literature review.

Results

The patient was diagnosed with a pelvic tumor, possibly malignant. We ascertained the diagnosis by exploratory surgery and pathological biopsy. The tumor was present in the prostate and infiltrated and pressed against the anterior rectal wall. Pathological biopsy showed that the tumor comprised spindle cells, which were also present at the junction of the tumor and prostate tissue. Immunohistochemically, the tumor cells were positive for CD117, DOG-1, CD34, and smooth muscle actin and negative for S100 and desmin; Ki-67LI was about 10%. These results support the diagnosis of primary prostatic EGIST.

Conclusion

The rarity and nonspecific clinical manifestation of prostatic EGIST facilitate misdiagnosis. Diagnosis mainly depends on imaging examination and characteristic histopathological and immunohistochemical features, and GIST must be excluded. Surgery is the main treatment method, and imatinib is suggested for unresectable and malignant EGISTs.

Giant and high-risk gastrointestinal stromal tumor in the abdomino-pelvic cavity: A case report

Gastrointestinal stromal tumors (GISTs) are benign mesenchymal tumors of the gastrointestinal tract. The clinical presentations of patients with GIST are variable and may be non-specific. The current study reports the case of a 66-year-old man that presented with a gradual enlargement of the abdomen, emaciation, hyperhidrosis and frequent and urgent micturition. A computed tomography (CT) scan of the abdomen revealed a large, heterogeneous, low density mass that occupied the entire abdomino-pelvic cavity. Magnetic resonance imaging (MRI) identified a high signal intensity on the T2 weighted image and an intermediate signal intensity on the T1 weighted image. A contrast enhanced CT scan and MRI demonstrated the uptake of contrast material. A biopsy revealed that the tumor was composed of spindle cells, and immunohistochemical analysis identified the presence of mast/stem cell growth factor receptors. Together, these results lead to a diagnosis of GIST. The clinical findings, imaging modalities and pathological studies suggested that the GIST was a large and high-risk tumor located in the abdomino-pelvic cavity. The final surgical results confirmed these findings. Following conservative treatment with imatnib (400 mg, daily) for 6 months, the tumor became smaller and was suitable for surgery, which the patient received in December 2014. The final surgery confirmed the high-risk GIST. Subsequent to the surgery, the patient was recommended to continue the use of imatnib with regular CT or MRI reexaminations every 3 months, which are planned to continue for 3 years.