Presentation
Abdominal pain, dyspepsia, and epigastric palpable mass on physical exam
Patient Data
A 75 × 45 × 50 mm well-defined polypoid mass with a small calcification focus and heterogeneous enhancement is noted in the proximal of the lesser curvature. Most of the mass is bulged into the gastric lumen; however, a small part about 30 mm in diameter is extraluminal, without frank surrounding fat stranding, regional lymphadenopathy, or signs of local invasion.
The left kidney is relatively small and shows uneven parenchymal thinning, which suggests scar. A 10 mm stone in the lower pole of the left kidney, accompanied by mild to moderate hydronephrosis.
Case Discussion
The patient underwent gastric mass resection, and histopathology with IHC evaluation confirmed a gastrointestinal stromal tumor without evidence of malignancy transformation.
The stomach is the most common site for GIST, followed by the small intestine, colon, rectum, and esophagus. Most GISTs are benign; however, in the case of large exophytic masses more than 5 cm in diameter, heterogeneous enhancement due to central degeneration, ulceration, and local invasion should be considered malignant transformation.
Regional and metastatic lymphadenopathy are not common in the malignant GISTs, and the liver is the most common site for metastasis.
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