Presentation
Patient referred for further evaluation of an epigastric abdominal mass found on ultrasound examination.
Patient Data
There is a heterogeneously enhancing exophytic soft tissue mass, arising from the lesser curvature of the stomach with ulceration of the overlying mucosa.
It is exerting mass effect on the body of the pancreas and the left lobe of the liver, without any evidence of invasion to adjacent structures.
No distant, peritoneal, or omental metastasis is evident. No lymphadenopathy is evident.
Findings are in keeping with a diagnosis of a gastrointestinal stromal tumor.
Annotated image showing mucosal ulceration communicating with the necrotic areas of the lesion.
Also, note the air bubbles within the ulcer tract.
Case Discussion
Gastrointestinal stromal tumors are the most common sarcomas of the GI tract with stomach and small intestine being the first and second most common site of their origin, respectively.
Aggressive lesions may exhibit direct invasion to adjacent structures or metastasize to distant organs (e.g. the liver), peritoneum, and omentum. Metastatic lymphadenopathy is not a feature.
Most of these lesions are asymptomatic but may present with a variety of nonspecific gastrointestinal symptoms (e.g. abdominal pain, nausea, and vomiting) or symptoms related to complications (e.g. gastrointestinal bleeding from associated mucosal ulceration) and local invasion or distant metastasis.
The mainstay of treatment is surgical resection and adjuvant chemotherapy with imatinib.