--- a
+++ b/processing/MACCROBAT/21527041.txt
@@ -0,0 +1,21 @@
+An 81-year-old female with hypertension and gout was admitted to Taichung Veterans General Hospital due to abdominal pain and hematemesis.
+She began to suffer from intermittent epigastralgia more than 10 years ago, and a 4 cm gastric tumor was found.
+The abdominal pain got worse 2 years before admission, and she went to a local hospital where abdominal CT scan revealed a gastric tumor about 6 cm in length with well-circumscribed calcification(figure ​1).
+Surgical intervention was suggested, but she declined.
+About 10 days before admission, tarry stool passage was noted, and bloody vomitus was found 1 day later.
+UGI scope revealed submucosal gastric tumor with central ulceration and she was then transferred to our hospital.
+Physical examination showed upper abdominal tenderness with mild muscle guarding.
+The plain radiography showed an irregular shape calcification over upper abdomen.
+UGI scope revealed deep gastric ulcer with foreign body.
+CT scan showed an irregularly shaped space-occupying lesion in front of the stomach with plate calcifications and localized free air (figures 2 and 3).
+Under the impression of perforated gastric tumor, emergent laparotomy was performed.
+An infiltrative mass between the stomach and transverse colon was noted during operation.
+A sharp, bone-like and thick calcified plate penetrating into the gastric mucosa and pericolic soft tissue was observed.
+A submucosal tumor about 2.3 cm in size adherent to the calcified plate was also noted (figures ​4 and 5).
+Distal subtotal gastrectomy and partial colectomy were performed.
+The patient was discharged 13 days after operation uneventfully.
+Microscopically, spindle-shaped tumor cells with low mitotic frequency (4/50 HPF) were found.
+Immunohistochemical staining of the tumor demonstrated diffusely strong positive reactivity for CD 117, positive reactivity for CD34, but negative reactivity for S100 protein and desmin.
+The diagnosis of the tumor was established as GIST.
+Due to the small size and the paucity of mitotic figures of the tumor located in the stomach, it was classified as very low risk[4].
+Sporadic GIST was impressed due to no family history of GIST nor other GIST presented in this patient.