An Interesting and Very Rare Presentation of Extraluminal GIST in a Middle Aged Woman


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Yılmaz Ürün Y., Üstündağ Y., Gültekin F. A. , Kozan R. , Bahadır B.

8. International Gastrointestinal Cancer Conference, İstanbul, Turkey, 7 - 09 December 2018

  • Publication Type: Conference Paper / Summary Text
  • City: İstanbul
  • Country: Turkey

Abstract

A 44 year old woman presented with signs of mild fever, epigastric pain and tenderness in April 2018. Her past medical history was uneventful except for a short duration of mild depression. She was using an antidepressant olanzapine and there was no previous history of any kind of surgery and or allergy. Her vital signs were normal and her physical examination revealed mild abdominal tenderness. Her routine blood test were normal except for mild to moderate elevation of c reactive protein (20 mg/dl) and slightly decreased hemoglobin Hmg 10.9 g/dl with a hypochromic micrositer peripheral blood smear. An upper abdominal ultrasonography revealed a 8x7.5 cm thick walled mass lesion located at the upper right quadrant extending inferiorly to the level of umbilicus. An abdominal computerized tomography revealed similar findings, but additionally CT depicted a connection of the mass with the lumen of 2nd part of the duodenum. There was also appearance of air inside the lesion. An upper endoscopy showed a fistulous opening in the 2nd part of the duodenum on the lateral side with a purulent drainage coming from this opening. A preliminary diagnosis was intra-abdominal abscess and or fistulizing eGIST (extraluminal gastrointestinal stromal tumor). Surgery was undertaken and nearly 8x7 cm tumoral mass lesion was easily removed from the second part of the duodenum and the small defect in the duodenum wall was primarily repaired. Pathology on macroscopy documented tumoral mass with a necrotic core and on microscopy, the tumor was consisted of highly proliferative spindle cells with a mitotic index more than 10. It was positive for vimentin and CD117 and negative for S100 immunostains. Thus, a diagnosis of eGIST fistulising into the duodenum was made and she was put on adjuvant imatinib treatment during her uneventful follow up period.