21527041 Visualization

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