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.