Gastrointestinal stromal tumor (GIST)

Case contributed by Hani Makky Al Salam
Diagnosis almost certain

CT Abdomen and pelvis

  • there is a large, heterogeneously enhancing soft tissue lesion, arising from the distal stomach (antral) /proximal duodenum and extending anteriorly, with central low attenuation in keeping with necrosis. The lesion is extering mass effect on the adjacent ascending and transverse colon and hepatic flexure as well as the gallbladder
  • few small retroperitoneal prominent lymph nodes are seen, but no obvious lymph node enlargement in the mesentery. No pelvic or inguinal lymphadenopathy
  • the stomach is no distended and the oral contrast appears to be well passed through the small bowel, reaching the large intestine
  • bilateral, variable sized renal cysts are seen
  • no convincing peritoneal/omental deposits seen, no ascites
  • incidental note of the left-sided IVC, which ends at the left renal vein and crosses the aorta anteriorly to join the pre-hepatic IVC
  • portal, splenic and SMV are patent
  • liver, spleen, adrenals, and pancreas are unremarkable

Interpretation: Based on the imaging features, a large gastrointestinal stromal tumor is high on the differential list. Gastric lymphoma thought less likely given the lack of associated lymph node enlargement. Incidental note of left-sided IVC is made.

Case Discussion

Path proven case of GIST.

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