Gastrointestinal stromal tumour of the stomach mimicking a hepatic tumour: a case report
© Subasinghe et al.; licensee BioMed Central Ltd. 2014
Received: 29 September 2013
Accepted: 7 March 2014
Published: 14 March 2014
Gastrointestinal stromal tumours are the commonest mesenchymal tumours of the gastrointestinal tract. The stomach and small intestine are the favoured sites of occurrence. The symptoms of these depend on the site, size of the tumour and may include abdominal pain, gastrointestinal bleeding or signs of obstruction. We describe a woman with extra luminal gastrointestinal stromal tumour of the stomach that mimicked a left hepatic tumour presenting as an abdominal mass.
A 51-year-old woman presented with a history of increasing epigastric pain for two-months duration. Her contrast-enhanced computed tomography of the abdomen revealed a large mass in relation to left lobe of the liver. On laparoscopy there was a large tumour arising from the lesser curvature of the stomach. The tumour was resected and histology was suggestive of gastrointestinal stromal tumour.
This case shows new evidence for the presentation of extra luminal gastric gastrointestinal stromal tumour that are very rare and can mimic hepatic tumour.
Gastrointestinal stromal tumours (GISTs) are rare , but represent the most common type of mesenchymal neoplasms that arises from the gastrointestinal (GI) tract. They account for 1–3% of all gastric neoplasms, 20% of all small bowel tumours, and 0.2– 1.0% of all colorectal tumours [2–4]. Symptoms due to GIST are not typical and depend on the localization and the tumour size. About 10-30% of GIST are completely asymptomatic, and are discovered accidentally during the endoscopy or radiological evaluation as well as during surgical interventions performed for various other reasons. GIST usually appears in patients above 50 years of age, whereas the maximum incidence is observed in the 5th and the 6th decade of life. The mean age at the diagnosis is 55–63 years . The diagnostic evaluation of GIST is based on imaging techniques, with a special role of endoscopic examination, because it is commonly accessible, however the most important diagnostic tools are the histological and immunohistochemical examinations.
Some gastric sub mucosal tumours that are considered to be gastrointestinal stromal tumor (GIST). Extra gastric compression may mimic the symptoms and endoscopic findings of gastric submucosal tumours. Computed tomography (CT) scan can accurately differentiate extra gastric compression from true sub mucosal tumours. However, cases may arise that cannot be differentiated even after various methods are used. We describe a Sri Lankan female patient with an extra luminal GIST presented as an abdominal mass which was misdiagnosed as a hepatocellular carcinoma. She underwent various investigations including endoscopy and abdominal CT scan.
Gastrointestinal stromal tumours are believed to be originated from the interstitial cells of Cajal, a pace-maker cell that controls gastrointestinal peristalsis. The clinical manifestations of GISTs depend on the location and size of the tumours. Patients may present with pain, dysphagia, weight loss, gastrointestinal bleeding, bowel obstruction, or a palpable abdominal mass . Surgical resection is the most effective treatment option for GIST. The 5 year survival rate after surgery amounts to 28–65% [6–8]. Tumour resection is the treatment of choice for GISTs. According to Lupescu et al. CT abdomen is sufficient to diagnose the location, extension, size, contours, structure of the tumours, hepatic metastasis of GIST . Thus, it is important to be able to diagnose GISTs from pre-operative CT. According to Rosch et al. the sensitivity and specificity of endoscopy are 87% and 29%, respectively for distinguishing intramural lesion from extramural compression . According to the best of authors knowledge there were no published case reports describes GIST of stomach mimicked hepatic tumour. But there are reports on extra gastro intestinal GIST involving lesser omentum [11–14]. Baskiran et al. described a large pedunculated GIST of posterior gastric wall mimicked a pancreatic tumour. Our patient’s upper gastro intestinal endoscopy showed a normal gastric mucosa. Therefore we didn’t plan for a upper GI endosonography for this patient. Here, our preoperative diagnosis was not GIST of stomach. Radiologically the wall of the stomach was not thickened and there was no intramural tumour in the gastric wall. Park et al. has described a left hepatic cyst may rarely mimic a submucosal tumour arising from the gastric cardia and fundus . Our patient had a GIST of a stomach mimicking left hepatic tumour. In the best of our knowledge, this is the first report of a patient with gastric extra mucosal GIST that was misdiagnosed as a hepatocellular carcinoma of left lobe of liver and diagnosed by laparoscopy and treated by surgery.
We conclude that extra mucosal gastric GISTS are rare and can present as mass abdomen. An Extra mucosal GIST of stomach may mimic a tumour arising from the left lobe of liver and cause nonspecific abdominal symptoms. For such a case, laparoscopic procedure is a useful option for making the accurate diagnosis and treatment.
Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
BGNR is a Senior Consultant General Surgeon, DS is a Registrar in Surgery, USM is a Registrar in Surgery, BT is a Senior Registrar in General Surgery.
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