Malignant gastrointestinal stromal tumor (GIST) of stomach
45 year female presented with anorexia, nausea, repeated vomiting and dull abdominal pain.
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There is a large, lobulated, heterogeneously enhancing mass arising from the submucosa of the fundus of stomach, with areas of necrosis and cystic degeneration within.The mass has both intraluninal and exophytic components. There are central areas of ulceration/ cavitation within this lesion which communicate with the gastric lumen. Multiple air foci are also noted in the cavitatory portion. The exophytic component shows necrotic areas within and is abutting the pancreas and spleen and encasing the splenic artery. Splenic vein in the region of mass is not well visualized with multiple perigastric and mesenteric collaterals.Rest of the overlying mucosa is normal. The imaging features are suggestive of malignant GIST.
The liver shows multiple large round iso to hypodense lesions with variable enhancement on arterial phase, suggestive of metastatic liver lesions.
There is mild ascites, however the peritoneum is unremarkable.
More than 50% patients with GISTs have metastasis at the time of presentation. Most common sites of metastasis are liver and peritoneum followed by lungs and bones. Presence of metastasis, heterogeneous enhancement, tumor size more than 5 cm, necrotic changes, ulceration, cystic changes and hemorrhage are signs of malignancy in GISTs.
GIST is resistant to a standard chemo- and radiotherapy. The only curative treatment is radical surgical excision. The effects of treatment of inoperative or metastatic GISTs were, until recently, very poor (median survival after recurrence was 9–20 months). However, in recent years there have appeared radical changes in the therapy of advanced tumors due to the discovery and implementation of treatment with tyrosine-kinase inhibitors. GIST has been the first solid tumor treated with an advanced molecular targeting therapy since 2001, when Imatinib was introduced.