The epithelioid gastrointestinal stromal tumor with pulmonary metastasis

Abstract

Rationale: Available literature states that the histological subtype of the gastrointestinal stromal tumor (GIST) with pulmonary metastasis is often spindle cell type. To our knowledge, this is the first report of the GIST with pulmonary metastasis of very uncommon epithelioid subtype. Patient concerns: We report a 63-year-old male presenting with the symptom of bloodstained sputum without obvious inducement. The patient had no chest pain, low back pain, fatigue, fever or night sweats symptoms. Diagnoses: Combined chest digital radiography and the history of the patient who presented with the colon GIST of the epithelioid subtype two years ago that the mass may be a metastasis tumor. Combined with morphological and immunohistochemical staining results, a pathological diagnosis of the GIST with pulmonary metastasis was considered. Interventions: Right lobectomy and partial upper lobectomy were performed. Outcomes: The patient had not experienced any noticeable symptom and recurrent tumors at 6 months follow-up. Lessons: We report a rare case of the GIST with pulmonary metastasis of epithelioid subtype. This case is of great significance to the pathologist's clinical work. For pathologists, if an epithelioid tumor in the lung is found, it is necessary to check whether the gastrointestinal tract also has the tumor, which may be an epithelioid GIST with pulmonary metastasis.

Clinical characteristics and prognosis of gastrointestinal stromal tumors with rare site metastasis (Review)

“…In cases of bone metastasis, pain manifests in the affected bone area (29,37,48,52,53,63,69,75,80,94,95), in cases of skeletal muscle involvement, a mass can be palpated in the affected area (34,49,71,72,79), and when metastasis occurs deep in the bone marrow, anemia may be present (96). Furthermore, when GIST metastasizes to the lungs, signs and symptoms that may be observed include dyspnea, blood in the sputum, coughing and shortness of breath (18,85,88,97). When metastasis to superficial lymph nodes, skin or subcutaneous tissue occurs, a mass may be superficially palpable (28,42,45,55,68,68,73,98).…”

“…In cases with the involvement of skeletal muscle, T2-weighted images show a mass with high signal intensity (71,72). When GIST metastasizes to the lungs, a dense mass is visible in one or both lungs (18,85,88,97), and in the lymph nodes, GIST metastasis appears on CT images as a hypodense mass with no enhancement when examined using enhanced MRI (39,57,58) and as a hypoechoic cystic or solid mass when examined using ultrasound (28,33,29). No enhancement is seen on chest enhancement CT images when GIST metastasizes to the heart (85,100), and PET-CT reveals high 18 F-fluorodeoxyglucose accumulation in the mass (24,83), with echocardiograms showing a hypoechoic mass in the ventricle or atrium (24,83,99,100).…”

Gastrointestinal stromal tumors - treatment and diagnostic algorithm

“…К моменту диагностирования заболевания у 15-50% больных уже имеются метастазы опухоли. Преимущественный тип метастазирования ГИСО -гематогенный, опухоль метастазирует в печень (65% случаев), брюшину (21% случаев), кости, легкие [15,16,17]. Регионарные лимфатические узлы поражаются метастазами редко.…”