Gastrointestinal stromal tumour

Case contributed by Dr Brendon Friesen

Presentation

Melena

Patient Data

Age: 60
Gender: Male
Modality: CT

There is a 11 x 10 x 12 cm mass which is inseparable from the posterior margin of gastric fundus. The mass demonstrates central fluid attenuation, and peripheral delayed enhancement. Associated mass effect on the left kidney and spleen. Several tortuous arteries noted near the junction of the mass and stomach, possibly feeding arteries, however no definite extravasation of contrast at the time of study. No free intraperitoneal gas. No significant free intraperitoneal fluid. No adenopathy.

Pathology:

MACROSCOPIC DESCRIPTION:
    (A) Stomach tumour ? GIST:  A nodular tumour 140 x 135 x 115mm. The serosal
    surface is irregular with a small amount of gastric mucosa attached at one  edge
    50 x 40 x up to 6mm thick. There are  disruption  in  the  capsule  that  appear
    consistent with removal of adhesions but there is one irregular area 35  x  25mm
    where the tumour appears to become adherent  to  brown  tissue.  The  tumour  is
    partly necrotic with haemorrhagic material in the centre.  There  is  a  rim  of
    viable tumour at the periphery of the lesion up to 20mm thick.
    Representative section A1-A6.  A1-A2: viable areas  of  tumour.  A3-A4:  gastric
    mucosa attached. A5: adhesion. A6: tumour.
   
    MICROSCOPIC DESCRIPTION:
    A spindle cell growth, with striking nuclear palisading. In  certain  areas  the
    spindle cell palisades appear to be oriented around a central blood vessel.  The
    spindle cells otherwise form nests and  fascicles.  The  spindle  cells  possess
    delicate cytoplasmic processes, most evident in areas of oedema. The  growth  is
    accompanied by a rich vasculature, many vessels thrombosed, and  multiple  areas
    of necrosis or haemorrhage in various stages of organisation. The tumour is seen
    to have expanded subserosally, with fibrous adhesion of spleen (slide A5). Fatty
    tissue is also attached to the outer gastric  surface.  Little  inflammation  is
    seen in the gastric mucosa. 10 - 15 mitotic figures per 50 high power fields are
    seen in the tumour.
    Immunohistochemistry (block A6):
    ckit: intense cytoplasmic expression, including paranuclear accentuation of  the
    signal.
    actin: negative.
            
    DIAGNOSIS:
    
    Gastrointestinal stromal tumour. According to tumour size and mitotic rate,  the
    expected chance of recurrence is high

Case Discussion

Conclusion:

Necrotic gastrointestinal stromal tumour with haemorrhage.

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Case Information

rID: 32116
Case created: 14th Nov 2014
Last edited: 30th Jan 2016
Inclusion in quiz mode: Included

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