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Radiation-induced pelvic bone complications are not uncommon, and knowledge of characteristic imaging patterns is essential in order to rule out bone metastases and to avoid inaccurate or excessive treatment.

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Abstract.Gastrointestinal stromal tumors (GISTs) are the most prevalent mesenchymal tumors of the gastrointestinal tract. GISTs are considered to originate from the interstitial cells of Cajal, the pacemakers of the peristaltic activity of the gastrointestinal tract. More than 95% of GISTs express KIT protein and discovered on GIST-1. GISTs may also be encountered in locations outside the gastrointestinal tract, in which case they are referred to as extra-GISTs (EGISTs) and often behave more aggressively. This is the case report of a primary pericardial EGIST in a 53-year-old male patient, confirmed by immunohistochemistry. To the best of our knowledge, this is the third case of EGIST diagnosed above the diaphragm, without being associated with the esophageal wall. Two cases of primary EGIST arising from the pleura were reported previously. In addition, this is the first reported case of an EGIST originating from the pericardium. IntroductionGastrointestinal stromal tumors (GISTs) are the most prevalent mesenchymal tumors of the gastrointestinal tract (1). GISTs are considered to originate from the interstitial cells of Cajal (ICC), which are the pacemakers of the peristaltic activity of the gastrointestinal tract. GISTs mainly emerge in the stomach (60%), jejunum and ileum (30%), colorectum, duodenum, esophagus and appendix (10%). However, they may also be encountered in locations outside the gastrointestinal tract, such as the omentum, mesentery and retroperitoneum, in which case they are referred to extra-GISTs (EGISTs) (2). More than 95% of GISTs express KIT protein and discovered on GIST-1 (DOG-1), which are considered to be the most specific and sensitive diagnostic markers for GISTs. Approximately 80% of GISTs harbor a KIT mutation and 8-10% express mutations in the platelet-derived growth factor receptor, α polypeptide (PDGFRα). Imatinib, a selective inhibitor of KIT and PDGFRα, is a treatment agent effective against EGISTs (1,2). Case reportA 53-year-old male patient with severe dyspnea was admitted to the Acibadem Adana Hospital (Adana, Turkey). A chest computed tomography (CT) scan revealed a massive pericardial effusion and pericardiocentesis was performed. A positron emission tomography (PET)/CT scan performed following recurrence of pericardial effusion revealed right pericardial hypermetabolic mass lesions [maximum standardized uptake value (SUV), 12.1], pericardial effusion, right hilar lymphadenopathy (maximum SUV, 4.9) and multiple metastatic nodules in both lungs. There was no evidence of a primary malignancy originating from the abdominopelvic cavity. The chest CT and coronary CT angiography revealed that the pericardial mass involved the right atrium and exhibited peripheral contrast enhancement. There was no association between the pericardial mass and esophagus (Fig. 1). The lesion was considered to be inoperable; a right thoracotomy and wedge resection were performed and a small number of lung nodules were resected. Microscopically, the tumor was composed of spindle or ovoid cells with eo...