Malignant Gastrointestinal Stromal Tumour at Jejunum- A Case Report

Abstract

A 44 years female, labourer by occupation, presented to our hospital with complaints of abdominal lump for 5 years, recurrent pain abdomen for past 2 years, nausea and vomiting for 2 months with generalised weakness. There was no history of constipation. She is having six live children. All were full-term normal deliveries. She has undergone hysterectomy 5 years back, but detailed documents are not available for the same. Complete haemogram showed anaemia and other routine blood and biochemistry parameters were within normal limits. USG done outside revealed hypervascular and hypoechoic mass in the left lumbar region measuring 10 x 8 x 8 cm. Upper and lower endoscopy showed no mucosal lesions. Computed tomography (CT) showed a large heterogeneously enhancing soft tissue mass showing air specks in the left lumbar region abutting jejunum medially. No lymphadenopathy was noted. Surgical resection of the tumour was done, and operative finding revealed a mass measuring 10 x 10 x 9 cm arising from serosal surface of jejunal junction at the antimesenteric border. Grossly, the received specimen was a segment of gut measuring 6 cm in length and 3 cm in diameter. On cut, the mucosa was largely unremarkable. Externally, on the serosal surface, a large encapsulated and well-circumscribed tumour mass was seen measuring 9 x 9 x 7 cm. Outer surface was nodular. On cut, unilocular cyst with maximum diameter 9 cm and wall thickness 2 cm was seen. The cyst cavity was filled with necrotic material and surface was irregular. Microscopically, the overlying mucosa was unremarkable; however, tumour was pushing the mucosa focally. Tumour was composed of interlacing bundles and fascicles of oval to spindle atypical cells. These atypical cells show moderately pleomorphic nuclei, vesicular chromatin and indistinct cytoplasm. The underlying submucosa and muscularis propria was infiltrated by the tumour cells. Areas of cystic degeneration were seen.