Case Presentation F.P.B, a 66-year-old male, was admitted to the emergency department with a two-week
history of melena. On physical examination, significant cutaneous pallor was observed.
A complete blood count revealed a hemoglobin level of 6.9 g/dl. An urgent upper gastrointestinal
endoscopy was performed, which did not show signs of active bleeding. Abdominal angiography
(CT angiography) revealed circumferential wall thickening of a jejunal loop near the
left flank, adjacent to the descending colon, with irregular contours, calcification
foci, and slight contrast enhancement, suggesting a primary neoplasm. A surgical approach
was undertaken, involving enterectomy and enteroanastomosis. From admission to surgery,
the patient received 7 units of red blood cell concentrates. Pathological examination
of the enterectomy specimen revealed a gastrointestinal stromal tumor (GIST) with
a mixed histological pattern. Immunohistochemical studies for diagnostic confirmation
showed positive CD-117 expression in the cells of interest, supporting the diagnosis
of GIST.
Discussion GISTs are rare neoplasms, accounting for approximately 1-2% of primary gastrointestinal
cancers. Their estimated incidence is 10 to 20 cases per million people. The most
common site of occurrence is the stomach (40-60%), followed by the jejunum/ileum (25-30%).
The most common presentation of GIST is gastrointestinal bleeding, as seen in this
case. Therefore, the manifestations of the disease are closely related to the tumor's
location. Upper gastrointestinal tract involvement is typically accompanied by melena
or dysphagia, while lower gastrointestinal tract neoplasms may present with constipation
or intestinal obstruction. Regarding the risk of progression of GISTs, factors such
as mitotic index, tumor size, and location are considered. In this case, the risk
of tumor progression was considered high, with a mitotic index above 5 mitoses/5 mm,
a size of 3.6 cm, and jejunal involvement.
Conclusion Although jejunal GISTs are rare and often challenging to diagnose, it is important
to maintain a high level of suspicion for the condition, especially in the context
of gastrointestinal bleeding combined with suspicious radiological findings. Early
detection increases the likelihood of employing surgical treatment, which offers higher
cure rates.
