Gastrointestinal stromal tumor (GIST) Clinical and surgical case presentation.

Abstract

Introduction: Gastrointestinal stromal tumors (GISTs) are rare tumors. It originates in the interstitial cells of Cajal, and a mutation in the kit gene (growth factor receptor tyrosine kinase) appears to be the leading cause of tumor growth. The clinical manifestations depend on the location of the primary tumor. There was no difference between the sexes; the average reported age was approximately 60–70. A high proportion of GISTs are asymptomatic and are often discovered incidentally during an endoscopic study or on radiological images obtained for another purpose.

Clinical case: This is a 68-year-old man with a history of type 2 diabetes mellitus, ischemic heart disease, and high blood pressure. An ultrasound examination revealed a solid mass measuring approximately 10 × 9 cm at the head of the pancreas. The patient was asymptomatic.

Diagnostic workshop: The complete blood count, blood chemistry, liver, and pancreas function tests were normal. Abdominal CT revealed a highly vascular soft tissue mass measuring 11 × 10 × 10 cm, located in the posterior wall of the stomach, extending into the omental cavity and in contact with the head of the pancreas.

Treatment: The vascularized tumor involving the lesser curvature of the stomach at the level of the gastric antrum was removed via exploratory laparotomy. Pathology revealed a spindle cell and epithelioid mesenchymal neoplasm, which was consistent with an intermediate-risk gastrointestinal stromal tumor (GIST). Immunohistochemistry revealed CD117, CD34, SMA, S-100 protein, and Ki-67.

Evolution: A PET scan contrasted with 18F-FDG was requested, which was normal. The evaluation was favorable, with no tumor activity at the presentation time.

Conclusions: GISTs are potentially malignant tumors, and gastric tumors are usually positive for CD117 and DOG-1. Surgical resection is the standard of care.