Lower GI bleeding secondary to a stromal rectal tumor (rectal GIST)

Abstract

We present the case of a 64-year-old woman without any known allergies to drugs, who had smoked 20 cigarettes a day for more than thirty years, and with no other relevant history, who presented to our Department of Gastroenterology complaining of rectal bleeding and secondary ferropenic anemia with a hemodynamic repercussion. A colonoscopy was made to reveal the presence of a polypoid, submucous, ulcerated lesion in its vertex (8 cm from the anal margin) (Fig. 1).An endoanal ultrasound scan showed a heterogeneous mass located in the posterior wall of the rectum, approximately 7 cm in size, with no infiltration of perirectal fat (Fig. 2). A biopsy was made with a tru-cut needle, and the pathological study showed a proliferation of fusiform cells, with no mitoses or atypias, and strongly positive for the CD-117 marker; staining by other markers (CD-34, desmine, actine, and S-100) was negative, except for one slight ki-67-related positivity, less than 10%. An abdominal CAT scan revealed no metastases at all levels. With a preoperative diagnosis of rectal stromal tumor, the mass was removed by local excision with preservation of the rectum. The patient is currently in the eighteenth month of follow-up, and has no signs or symptoms of relapse, neither locally nor distally. DISCUSSIONThe incidence of GISTs is greatest in the fifth and sixth decades of life. Histologically they are made up of fusiform, epitheloid, or mixed cells. The diagnosis is confirmed by immuno-histochemical techniques, and by the expression of a

Gastrointestinal stromal tumors (GISTs) of the colon

“…Tumors smaller than 2 cm are often asymptomatic, usually limited to the colonic wall and appearing as submucosal masses in endoscopic studies. Bleeding due to mucosal ulceration is the most common complication (7).…”

Tumores del estroma gastrointestinal (GIST): factores pronósticos de supervivencia tras citorreducción R0

“…En nuestra serie, los resultados encontrados con respecto a edad y sexo concuerdan con la literatura, reflejando una incidencia poco frecuente antes de los 40 años (4), así como igualdad entre ambos sexos (5). En cuanto a la forma de presentación clínica, tampoco se mostraron grandes diferencias con respecto a otras series publicadas, predominando los pacientes sintomáticos con hemorragia digestiva, dolor abdominal y sensación de masa abdominal frente a los casos incidentales (6,7). Por otra parte, es conocido que los GIST tienen similar predilección por originarse en estómago e intestino delgado (8) y aunque existen estudios que describen un mejor pronóstico para tumores de localización gástrica, a igualdad de tamaño y número de mitosis (9)¸nosotros no evidenciamos diferencias significativas entre los distintos grupos.…”

Tumores de la estroma gastrointestinal (GIST): aspectos clínicos

“…En nuestra serie, además de la hemorragia digestiva o el dolor abdominal que son junto con el efecto de masa abdominal las manifestaciones clínicas más frecuentes, también hay casos de hemoperitoneo, de abdomen agudo y un diagnóstico a partir de la detección de metástasis hepáticas que son formas descritas por otros autores (14)(15)(16)(17)(18) La característica inmunohistoquímica principal de los tumores GIST es la positividad frente al antígeno c-KIT / CD 117 en el 90-95% de los casos. El CD 34 se expresa en el 60 al 70% de los tumores y la actina de músculo liso en el 30 al 40%.…”