GIST tumours with unusual presentations – report on three cases

The most frequent localisation of gastrointestinal stromal cell tumours (GIST) are the stomach, duodenum, the large bowel, however, there are reports on GIST of the oesophagus and the retroperitoneal space, too. The typical chronic clinical symptoms associated with GIST are abdominal pain, fullness, anaemia due to occult blood loss. Rarely these tumours can cause acute bleeding, obstruction and perforation of the GI tract.

Aim: These case reports rise attention to three unusual presentation of GIST. Case 1: The 75 year-old man with a history of partial gastrectomy and splenectomy because of gastric Schwannoma, presented with upper abdominal colic pain and vomiting. The CT-scan followed by endoscopic ultrasound disclosed the large tumour arising from the wall of the stomach occupying the entire upper retroperitoneal space. Ultrasound-guided biopsy with Chiba-needle was carried out. The c-kit positivity of the biopsy specimens leaded to the diagnosis of GIST. Because the tumour proved to be inoperable, the patient was placed on Glivec therapy alone. Case 2: The 70 year-old men with unremarkable previous medical history was admitted because of severe upper GI bleeding. The gastroscopy disclosed a large polyp-like lesion, showing sprouting bleeding, on the anterior wall of the proximal gastric fundus. Endoscopic haemostasis with injection sclerotherapy of the bleeding point with epinephrine was successful. The CT-scan showed a large tumour with substantial extension into the retroperitoneum. Total gastrectomy was performed, histology and the c-kit positive histology specimen proved a spindle cell variant of GIST. Case 3: The 67-year old woman was referred for further evaluation of consistently elevated cholestatic liver enzymes. Abdominal CT-scan showed only slight dilatation of the common bile duct. At ERCP a large, friable tumour at the immediate vicinity of the main duodenal papilla was seen. Cholangiogram disclosed distal bile duct stricture possibly caused by the tumour. Endoscopic sphincterotomy and placement of stent were performed.

Conclusion: The three cases of GIST show that possibility of GIST should be considered as an underlying disease for various GI symptoms.