Presentation
The patient presented with abdominal pain.
Patient Data
There is huge intraperitoneal, multiloculated, heterogenous cystic and solid mass lesion causing mass-effect upon kidneys, pancreas, stomach, and colon. It appears to be arising from the wall of distal jejunal loops where the wall appears embedded in the mass at the contact surface. In post-contrast images it shows heterogenous (mainly peripheral) septal enhancement with enhancement of the solid component and non-enhancing central areas (likely necrosis), it measures 25 x 14 x 20 cm (in TV, AP and CC dimensions respectively).
There is a very thin cleavage line noted between the lesion and the pancreas.
There is well-defined hypodense lesion seen within segment VII of the liver, it shows mild enhancement on postcontrast images with washout in delayed images, however, the liver shows regular outlines with normal size.
Gastrointestinal stromal tumor (GIST) is in the top of differential diagnosis of this mass.
Case Discussion
This mass is biopsy-proven GIST.
Necrosis a common feature of GIST, so enhancement is typically peripheral. Calcification is uncommon.
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