Publication:

Gastrointestinal stromal tumor at an unusual site with an unusual presentation

Gastrointestinal tumors (GIST) are malignant and rare forms of soft tissue sarcoma arising from interstitial cells of Cajal. With most common site of origin being stomach, Jejunal GIST accounts for 0.1–3% of all GIST. Due to non specific signs and symptoms diagnosis is often delayed and patient mostly presents in advanced stage. 50 year old female presented with decreased appetite from 5 months and lump in upper abdomen from 3 months associated with dull abdominal pain from 15 days. CECT abdomen showed a large soft tissue mass in left lumbar region. Exploratory laparotomy showed a highly vascular mass of size 12x10x8 cm abutting mesentery of transverse colon lodged between middle colic artery and superior mesenteric artery. Resection of mass with a segment of jejunum was done. Histopathological examination showed spindle cell tumor with high mitotic index with CD 117+. Adjuvant chemotherapy was given and patient is currently asymptomatic after 9 months of postoperative follow up. Spectrum of clinical presentation is broad so a preoperative diagnosis is difficult. GIST primarily presenting as an abdominal lump is rare and only 25 cases have been reported so far. Surgery is the primary mode of treatment but imatinib has transformed the treatment. Newer drugs are under phase II trials and hopefully will change the course of management in near future.