An unusual presentation of a Gastrointestinal stromal tumour (GIST)

Abstract

Background: Gastrointestinal stromal tumours (GIST) are rare tumours, now more frequently identified with the new imaging modalities like computerised tomography (CT) and magnetic resonance imaging (MRI). We report a rare presentation of a GIST with an unusual diagnostic workup in a multidisciplinary setting leading to a definitive diagnosis and treatment.

Case presentation: A 55-year-old lady was admitted under the general surgeons, with 3-day history of abdominal pain, three-week history of loss of appetite and weight. The patient was sequentially investigated with ultrasonography, computerised tomography and finally selective angiogram in a multidisciplinary setting. The selective angiogram showed a GIST with intratumour bleed, leading to successful surgical excision and being recurrence free at 22 month follow up.

Conclusion: Clinical presentation of these tumours can be varied and gastrointestinal bleeding is the commonest mode described in the literature. The clinician needs to be aware of much more rare presentations of the GIST including an intra tumour bleed. A structured multidisciplinary approach would lead to successful diagnosis and treatment.

Figure 1

CT scan picture of the GIST close to liver and distinctly separate from gastric lumen.

Figure 2

CT scan picture of enhancing lower extent of GIST visualized in relation to hepatic flexure of colon.

Figure 3

Tumour neo-vascularisation on distal gastro duodenal and gastro-epiploic catheterisation during angiogram (White arrow as pointer).