CASE REPORT
A 55-year-old man with no significant medical history presented with progressive bloating, early satiety, and weight loss. Computed tomography visualized a large left upper-quadrant abdominal cystic mass, measuring >20 cm with evidence of mass effect (Figure 1). Endoscopic ultrasonography revealed extrinsic compression in the gastric fundus and body (Figure 2) because of a hypoechoic collection. A fine-needle biopsy was attempted with color Doppler guidance confirming a lack of vascular structures in the needle path; however, only blood was aspirated with no visible core of tissue (Figure 2). Cytology was nondiagnostic. He underwent partial gastrectomy, partial hepatectomy, and partial diaphragm resection and repair. Surgical pathology demonstrated hemorrhagic content and gastrointestinal stromal tumor (GIST), mixed spindle cell, and epithelioid cell type. Genetic analysis was positive for KIT (CD117) mutation (Figure 3). He was initiated on imatinib. At a 6-month follow-up, the patient was healed from surgery and was regaining weight. GIST represents approximately 3% of gastrointestinal tumors, which possesses a malignant potential.1–4 We observed this interesting presentation of a large (>20-cm) hemorrhagic GIST in which bloating was the key presenting symptom. In addition, a nondiagnostic endoscopic ultrasonography for a large gastric mass does not exclude the diagnosis malignancy.
Figure 1.
Computed tomography scan showing a large left upper-quadrant abdominal mass, measuring >20 cm with evidence of a mass effect.
Figure 2.
Endoscopic view reveals extrinsic compression in the gastric (A) fundus and (B) body because of a hypoechoic collection. (C) Endoscopic ultrasound image of the mass confirms a lack of vascular structures in the needle path.
Figure 3.
The hematoxylin and eosin stain (A) and positive CD117 immunostaining (B) confirm the diagnosis of gastrointestinal stromal tumor.
DISCLOSURES
Author contributions: G. Perez Del Nogal and C. Okwara wrote and edited the manuscript. C. Okwara reviewed and edited the final manuscript. P. Gopal provided and analyzed the pathology imaging. G. Perez Del Nogal is the article guarantor.
Financial disclosure: None to report.
Informed consent was obtained for this case report.
Contributor Information
Purva Gopal, Email: Purva.Gopal@utsouthwestern.edu.
Chinemerem Okwara, Email: chinemerem.okwara@utsouthwestern.edu.
REFERENCES
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