Spontaneous intratumoral bleeding and rupture of giant gastric stromal tumor (> 30 cm) in a young patient

<p>Abstract</p> <p>Background</p> <p>Few cases of GIST bigger than 15 cm have been reported in medical literature, all primarily in elderly patients. We report an unusual case, in which a giant gastric GIST – in a young patient – presented as spontaneous intratumoral bl...

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Main Authors: Cecilio Andre L, Ketzer Bernardo M, Vincenzi Rodrigo, Cruz Ruy J, Cepeda Lourdes A
Format: Article
Language:English
Published: BMC 2008-07-01
Series:World Journal of Surgical Oncology
Online Access:http://www.wjso.com/content/6/1/76
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spelling doaj-ebc4e51c05714813bff59407570420552020-11-24T20:51:29ZengBMCWorld Journal of Surgical Oncology1477-78192008-07-01617610.1186/1477-7819-6-76Spontaneous intratumoral bleeding and rupture of giant gastric stromal tumor (> 30 cm) in a young patientCecilio Andre LKetzer Bernardo MVincenzi RodrigoCruz Ruy JCepeda Lourdes A<p>Abstract</p> <p>Background</p> <p>Few cases of GIST bigger than 15 cm have been reported in medical literature, all primarily in elderly patients. We report an unusual case, in which a giant gastric GIST – in a young patient – presented as spontaneous intratumoral bleeding followed by intraluminal rupture.</p> <p>Case presentation</p> <p>A 37-year-old man was admitted with an acute onset of abdominal pain. CT showed a 32 × 25 cm mass with some cystic lesions and areas of calcification. Twelve hours after admission the patient presented with an episode of upper GI bleeding, and a significant decrease of tumor size and hemoglobin level. An upper endoscopy showed a large bulge in the posterior aspect of the gastric wall, and a small ulcer with continuous bleeding coming from a central orifice. A subtotal gastrectomy was carried out. Pathological examination showed a giant gastric GIST measuring 32 × 25 × 21 cm and weighing 3.750 g. Immunohistochemical staining demonstrated positive reactivity to C-kit protein, CD34, and α-smooth muscle actin; but negative reactivity to S-100 protein.</p> <p>Conclusion</p> <p>Intratumoral bleeding is a very rare presentation of GIST; preoperative diagnosis is always made difficult by the absence of pathognomonic signs or symptoms. Emergency local excision with negative margins associated with adjuvant therapy with imatinib mesylate remains the main modality of treatment for high risk GISTs.</p> http://www.wjso.com/content/6/1/76
collection DOAJ
language English
format Article
sources DOAJ
author Cecilio Andre L
Ketzer Bernardo M
Vincenzi Rodrigo
Cruz Ruy J
Cepeda Lourdes A
spellingShingle Cecilio Andre L
Ketzer Bernardo M
Vincenzi Rodrigo
Cruz Ruy J
Cepeda Lourdes A
Spontaneous intratumoral bleeding and rupture of giant gastric stromal tumor (> 30 cm) in a young patient
World Journal of Surgical Oncology
author_facet Cecilio Andre L
Ketzer Bernardo M
Vincenzi Rodrigo
Cruz Ruy J
Cepeda Lourdes A
author_sort Cecilio Andre L
title Spontaneous intratumoral bleeding and rupture of giant gastric stromal tumor (> 30 cm) in a young patient
title_short Spontaneous intratumoral bleeding and rupture of giant gastric stromal tumor (> 30 cm) in a young patient
title_full Spontaneous intratumoral bleeding and rupture of giant gastric stromal tumor (> 30 cm) in a young patient
title_fullStr Spontaneous intratumoral bleeding and rupture of giant gastric stromal tumor (> 30 cm) in a young patient
title_full_unstemmed Spontaneous intratumoral bleeding and rupture of giant gastric stromal tumor (> 30 cm) in a young patient
title_sort spontaneous intratumoral bleeding and rupture of giant gastric stromal tumor (> 30 cm) in a young patient
publisher BMC
series World Journal of Surgical Oncology
issn 1477-7819
publishDate 2008-07-01
description <p>Abstract</p> <p>Background</p> <p>Few cases of GIST bigger than 15 cm have been reported in medical literature, all primarily in elderly patients. We report an unusual case, in which a giant gastric GIST – in a young patient – presented as spontaneous intratumoral bleeding followed by intraluminal rupture.</p> <p>Case presentation</p> <p>A 37-year-old man was admitted with an acute onset of abdominal pain. CT showed a 32 × 25 cm mass with some cystic lesions and areas of calcification. Twelve hours after admission the patient presented with an episode of upper GI bleeding, and a significant decrease of tumor size and hemoglobin level. An upper endoscopy showed a large bulge in the posterior aspect of the gastric wall, and a small ulcer with continuous bleeding coming from a central orifice. A subtotal gastrectomy was carried out. Pathological examination showed a giant gastric GIST measuring 32 × 25 × 21 cm and weighing 3.750 g. Immunohistochemical staining demonstrated positive reactivity to C-kit protein, CD34, and α-smooth muscle actin; but negative reactivity to S-100 protein.</p> <p>Conclusion</p> <p>Intratumoral bleeding is a very rare presentation of GIST; preoperative diagnosis is always made difficult by the absence of pathognomonic signs or symptoms. Emergency local excision with negative margins associated with adjuvant therapy with imatinib mesylate remains the main modality of treatment for high risk GISTs.</p>
url http://www.wjso.com/content/6/1/76
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