Gastrointestinal Stromal Tumor (GIST) Presenting as a Huge Pelvic Mass

Abstract

Gastrointestinal stromal tumors (GISTs) are rare tumors that can arise anywhere in the tubular gastrointestinal tract. These tumors occasionally present as a pelvic mass, leading to a misdiagnosis of gynecological disease. A 47-year-old woman presented with a pelvic mass measuring 30 cm in diameter and highly elevated CA-125 levels. She underwent exploratory laparotomy with resection of the pelvic mass. The mass mimicking ovarian malignancy was found in the sigmoid colon and was correctly diagnosed as a GIST at surgery. It should be noted that preoperative diagnosis of GIST is uncommon, due to its rarity and the varying clinical presentation. However, non-gynecological tumors should be included in the differential diagnosis of a pelvic mass with atypical presentation. Gynecologists need to be cognizant of extra-ovarian pathology in patients presenting with an atypical pelvic mass.

Zusammenfassung

Der gastrointestinale Stromatumor (GIST) ist ein seltener Tumor des Magen-Darm-Trakts. Diese Tumoren treten gelegentlich als Raumforderung im Becken auf, was zur Fehldiagnose eines Ovarialkarzinoms führen kann. Wir berichten hier von einer 47-jährigen Patientin mit einer Raumforderung im Becken mit einem Durchmesser von 30 cm und stark erhöhten CA-125-Werten. Sie wurde einer Laparotomie zu diagnostischen Zwecken unterzogen mit nachfolgender Resektion der Masse. Vor der Operation wurde die vorläufige Diagnose eines Ovarialkarzinoms gestellt. Bei der Operation wurde aber ein GIST im Sigma diagnostiziert. Es sei hier darauf hingewiesen, dass die präoperative Diagnostik gastrointestinaler Stromatumoren sehr schwierig ist, aufgrund der Seltenheit dieser Entität und der unspezifischen klinischen Präsentation. Es ist daher wichtig, auch andere, nicht ovarspezifische Pathologien in die Differenzialdiagnose einer Raumforderung im Becken einzubeziehen.

Key words

gastrointestinal stromal tumors (GISTs) - ovarian carcinoma - pelvic mass - sigmoid colon

Schlüsselwörter

gastrointestinaler Stromatumor (GIST) - Ovarialkarzinom - Raumforderung im Becken - Sigma

• References

• 1 Antonescu C. Gastrointestinal stromal tumors. Curr Top Microbiol Immunol 2011;
• 2 Burkill GJ, Badran M, Al-Muderis O et al. Malignant gastrointestinal stromal tumor: distribution, imaging features, and pattern of metastatic spread. Radiology 2003; 226: 527-532
• 3 Zighelboim I, Henao G, Kunda A et al. Gastrointestinal stromal tumours presenting as a pelvic mass. Gynaecol Oncol 2003; 91: 630-635
• 4 Pidhorecky I, Cheney RT, Kraybill WG et al. Gastrointestinal stromal tumors: current diagnosis, biologic behavior, and management. Ann Surg Oncol 2000; 7: 705-712
• 5 De Silva MVC, Reid R. Gastrointestinal stromal tumors (GIST): C-kit mutations, CD 117 expression, differential diagnosis and targeted cancer therapy with imatinib. Pathol Oncol Res 2003; 9: 13-19
• 6 Patil S, Jain S, Kaza RC et al. Giant gastrointestinal stromal tumor presenting as a palpable abdominal mass: an unusual presentation. ISRN Surg 2011; 2011: 894829
• 7 Morimura Y, Yamashita N, Koyama N et al. Gastrointestinal stromal tumor mimicking gynecological disease. Fukushima J Med Sci 2006; 52: 21-28
• 8 Matteo D, Dandolu V, Lembert L et al. Unusually large extraintestinal GIST presenting as an abdomino-pelvic tumor. Arch Gynecol Obstet 2008; 278: 89-92
• 9 Wingen CB, Pauwels PA, Debiec-Rychter M et al. Uterine gastrointestinal stromal tumour (GIST). Gynecol Oncol 2005; 97: 970-972
• 10 Fletcher CD, Berman JJ, Corless C et al. Diagnosis of gastrointestinal stromal tumors: a consensus approach. Int J Surg Pathol 2002; 10: 81-89
• 11 Carlomagno G, Beneduce P. A gastrointestinal stromal tumor masquerading as an ovarian mass. World J Surg Oncol 2004; 2: 15
• 12 Dorfman DM, Bui MM, Tubbs RR et al. The CD117 immunohistochemistry tissue microarray survey for quality assurance and interlaboratory comparison: a College of American Pathologists Cell Markers Committee Study. Arch Pathol Lab Med 2006; 130: 779-782
• 13 Da Ronch T, Modesto A, Bazzocchi M. Gastrointestinal stromal tumour: spiral computed tomography features and pathologic correlation. Radiol Med 2006; 111: 661-673
• 14 Takahashi O, Sato N, Miura Y et al. Surgical indications for combined partial rectosigmoidectomy in ovarian cancer. J Obstet Gynaecol Res 2005; 31: 556-561