Upper gastrointestinal bleeding due to a gastrointestinal stromal tumor with a high degree of aggressiveness

Abstract

Gastrointestinal stromal tumors (GIST) are common mesenchymal neoplasias of the digestive tube. In spite of this, a certain diagnosis can be difficult, mainly if we take into account the lack of specific endoscopic signs. The clinical manifestations depend on the size and location of the tumor. We describe the diagnosis of a highly aggressive tumor of the gastric stroma, which presents with manifestations of profuse gastrointestinal bleeding. It is a 72-year-old female patient who is admitted to department of surgery of the institution presenting hematemesis and melena. Lab studies were ordered as well as a diagnostic upper gastrointestinal endoscopy, which report an ulcerated submucosal gastric tumor. The differential diagnosis ranged between GIST and gastric leiomyosarcoma. Abdominal contrasted CT scan confirms a gastric tumor with a probable hepatic metastasis. Surgery is scheduled. During operation all the tumoral area is resected, with a Billroth Type II reconstruction, and resection of the hepatic III segment is performed, as it suggested a region of metastatic growths. The results of the pathologic tests confirm the diagnosis of GIST with a high degree of malignancy. The patient progressed satisfactorily after surgery and was discharged a week later. At six month oncological follow-up the patient is asymptomatic.