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

Abstract

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.

Risk Factors and Prognostic Analysis of Gastrointestinal Stromal Tumor Recurrence-Metastasis

“…Additionally, survival curve analysis exhibited that different mitotic count (P < 0:0001), tumor rupture (P = 0:0003), risk classification (P < 0:0001), tumor location (P = 0:0006), and tumor diameter (P < 0:0001) all affected DFS in patients with GIST. Generally, the diameter of GIST ranges from 0.6 to 25.5 cm, with an average diameter of 8.78 ± 5.6 cm and a median diameter of 6.8 cm; however, giant GIST with a diameter of 34 cm have also been reported [25]. Therefore, some studies have selected 10 cm as the cut-off value Computational and Mathematical Methods in Medicine affecting the prognosis [26].…”

Metastatic Gastrointestinal Stromal Tumor to the Omentum and Endometrium: A Case Report

“…The best prognostic features are tumor size and mitotic activity; however, it does not predict the risk for disease progression and malignant potential accurately because of the scarcity of primary omental GIST [7][8][9][10]. There are a few reported cases of GISTs that involved gynecologic tract and presented as pelvic or omental masses, therefore mimicking primary omental or ovarian neoplasm [8,9,[11][12][13][14].…”

“…Other useful immunohistochemical stains, in this case, were chromogranin and synaptophysin, to rule out neuroendocrine tumors, along with inhibin and calretinin to rule out sex cord stromal tumors. Wherever possible, complete removal of tumor and/or imatinib therapy are the primary alternatives for the patient, although the response is slightly worse than with GIST of the tubular gastrointestinal tract [11][12]14]. New therapies and/or clinical trials are under assessment; more studies are required to further elaborate these cases which primarily occur in the omentum and/or gynecologic tract to better understand the pathophysiology and prognosis of these "metastatic cases with unknown primaries".…”

Laparoscopic total gastrectomy for a giant gastrointestinal stromal tumor (GIST) with acute massive gastrointestinal bleeding: a case report.

“…The presentation of GISTs is related to the size and location of the tumor, and the most common features are gastrointestinal bleeding (GIB), abdominal pain, nausea, vomiting, weight loss, and palpable mass [ 8 , 12 , 16 , 18 ]. The GIB is usually intraluminal and chronic and massive GIB is a rare presentation [ 19 ].…”

“…The GIB is usually intraluminal and chronic and massive GIB is a rare presentation [ 19 ]. Multi-slice computed tomography scan (MSCT) can show a diagnostic large and heterogeneous mass with low attenuation area of bleeding, necrosis or cystic degeneration [ 16 ].…”