Presentation
The patient presented with epigastric pain for one year, anorexia, a 10 kg weight loss, and had undergone OGD twice, both of which were normal.
Patient Data
There is a large well defined hypodense heterogeneous solid mass lesion with cystic necrosis sited between the stomach and pancreatic body and tail. Loss of fat planes with both organs. The mass lesion is most likely an exophytic tumour from the gastric body, greater curvature with a large ulcerative defect into the gastric lumen. No gastric outflow obstruction.
Mass encasement of the splenic artery and splenic vein with resultant portal hypertension suggested by splenomegaly and main portal vein prominence.
Degenerative loss of disc space L4/5 with endplate erosions.
Case Discussion
Gastrointestinal stromal tumours most frequently arise in the stomach (60-70%) and small intestine (20-30%) 1. Other less common sites include the colon, rectum, and oesophagus. Primary extra-gastrointestinal GISTs (EGISTs) can also occur in the omentum, mesentery, and retroperitoneum, but these are rare.
The CT characteristics of GISTs, while suggestive, are not pathognomonic. Overlapping imaging features can be seen in other mesenchymal tumours, lymphomas, and metastatic lesions. Therefore, while CT can provide a high suspicion of GIST based on location, size, and enhancement patterns, definitive diagnosis requires histopathological confirmation 2.
A biopsy is crucial for a definitive diagnosis of GIST. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) or percutaneous biopsy under CT or ultrasound guidance is often employed. Histopathological examination 3, including immuno-histochemical staining for markers such as CD117 (c-KIT), DOG1, and CD34, is essential. CD117 positivity is a hallmark of GIST, present in approximately 95% of cases.
Unfortunately, additional clinical or imaging follow-up for this case is not available.
Unable to process the form. Check for errors and try again.