Characteristic of extra luminal gastric stromal tumor arising from the lesser curvature of the stomach

Abstract

Rationale: Gastrointestinal stromal tumor (GIST) is one of the most common malignant mesenchymal tumors of the gastrointestinal tract. They generally arise from the fourth layer (muscularis propria) and rarely from the second or third layer. Although the manifestations of gastric stromal tumors are diverse, to our knowledge, there are only several cases of an extra-gastric stromal tumor in the literature appearing with a pedunculation. Pedunculated large GISTs are not frequent and compress the neighboring organs. When they were huge, it is difficult to differentiate the origin of the masses. Thus, in the clinical setting, physicians should pay more attention to the pattern of manifestation of the gastric stromal tumor.Patient concerns: A 62-year-old man had no gastrointestinal symptoms or significant medical and family histories. During the health examination with US, a cystic-solid tumor was found below liver. The results of the physical examination were unremarkable, and routine laboratory data on admission did not show any abnormal findings.Diagnosis: Computed tomography of the abdomen showed a mixed echoic mass measuring 10 Â 8 Â 8 cm and located below the liver, adjacent to the gastric antrum. After endoscopic ultrasound-guided fine-needle aspiration, cytopathology showed that the specimen was filled with red blood cells, and it had no malignant cells. Histopathology revealed that the mass was a GIST, and immunohistochemical analysis showed the following: CD117(+), CD34(+), desmin(À), Dog-1(+), Ki-67% <1%, and smooth muscle actin(À).Interventions: Surgical resection was performed on the patient.Outcomes: The lesion was diagnosed as a gastric stromal tumor with a pedicle and an old hemorrhage. The patient's recovery was uneventful. After surgery, computed tomography at the 6-month and 1-year postoperative follow-up visits did not reveal relapse or any metastasis.Lessons: In the clinical setting, physicians should pay more attention to the pattern of manifestation of the extra-gastric stromal tumor in patients with a pedicle or hemorrhage. Additionally, endoscopic ultrasound-guided fine-needle aspiration can be used to make an accurate preoperative diagnosis of such diseases, and its findings can serve as an important basis for surgical excision of the lesions.

A giant gastrointestinal stromal tumor revealed by a life-threatening hematemesis: A case report of a rare entity and a challenging management

“…Large gastric GISTs, due to their anatomical proximity, may exhibit distinct patterns of invasion into adjacent organs: tumors of the posterior wall may extend towards the pancreas [ 17 ]. Tumors of the lesser curvature may invade neighboring structures like the liver, gallbladder, and small intestine [ 21 ]. Additionally, tumors in the subcardial and fundic regions have the potential to invade the spleen [ 19 ].…”

Unusual Gastrointestinal Hemorrhaging Mimicking a Rupture of Solitary Gastric Varices Due to a Gastric Gastrointestinal Stromal Tumor with Exogenous Growth

“…As many as 79% of GISTs show exogenous growth with clinical symptoms occurring later ( 16 ), and most exogenously pedunculated gastric GISTs are huge masses (12-15 cm) with these patients presenting with delayed complaints of abdominal masses ( 17 - 19 ). Therefore, in some studies, these GISTs were misdiagnosed as pancreatic ( 17 ) or liver ( 20 ) tumors. In gastric GIST-related emergencies, manifestations other than UGIH include spontaneous rupture, massive intra-abdominal bleeding, and peritonitis ( 7 ).…”

Abdominal bronchogenic cyst: A rare case report

“…No enhancement is found on contrast-enhanced CT, except that the thickened cystic wall shows annular enhancement. CT and MRI can provide more valuable imaging characteristics of the lesion, while EUS-FNA is an effective technique for obtaining tissue samples[ 3 - 6 ], which could cause minimal injury to the patients. This technique can assist surgeons to clarify the tissue source of the tumor and determine the benign or malignant nature of the tumor.…”