The inside mystery of jejunal gastrointestinal stromal tumor: a rare case report and review of the literature

Abstract

Gastrointestinal stromal tumors (GISTs) are malignant and rare form of soft tissue sarcoma of the digestive tract. The incidence of gastrointestinal stromal tumors is very low Kramer et al. 2005 Jejunal GISTs are extremely rare. Here we present a rare case of jejunal GIST with unusually large size at presentation. The patient presented with severe abdomen pain, exophytic growth, and dimorphic anemia. Surgical resection of the tumor was carried out, and operative findings revealed a 15 × 10 cm growth, arising from serosal surface of jejunum, at the antimesenteric surface. Diagnosis in this case was made by subjecting the resected specimen to immunohistochemical analysis. In view of large size of the resected tumor, and high-risk histopathological features, imatinib mesylate 400 mg once daily was given as adjuvant chemotherapy. Patient is asymptomatic without any evidence of tumor recurrence after six months of postoperative followup. Imatinib as such is recommended in metastatic, residual or recurrent cases of GISTs or which are surgically not removable; however, recent recommendations suggests the use of imatinib mesylate after radical surgery in high-risk cases, because it has shown a significant decrease in the recurrence rate, and the Food and Drug Administration (FDA) has also approved the use of imatinib as adjuvant therapy after complete resection of localized, primary GIST.

Figure 1

Computed tomography enteroclysis showing a large well-defined heterodense ovoid space occupying lesion measuring 15 × 10 cm with clumped bowel loops seen in right iliac fossa.

Figure 2

Photomicrograph (IHC stain; original magnification ×400) of immunohistochemical study showing tumor cells positive for KIT (CD117).

Figure 3

Photomicrograph (H&E stain; original magnification ×40) showing unremarkable overlying mucosa, submucosa, muscularis propria, and serosa showing infiltration by tumor.

Figure 4

Photomicrograph (H&E stain; original magnification ×40) showing oval to spindle cells arranged in fascicles.