Ulcerated gastrointestinal stromal tumor of the stomach

Case contributed by Dr Yair Glick

Presentation

Gastric mass discovered at gastroscopy.

Patient Data

Age: 65 years
Gender: Female

Ulcerated mass in the small gastric curvature, apparently extending to the cardia and featuring the Toricelli-Bernoulli sign.

Slightly enlarged gastrohepatic lymph nodes up to 8 mm thick.

Case Discussion

The Toricelli-Bernoulli sign, in this case, denotes an air-fluid level in the ulcer crater due to trapping of air when the patient changes position from upright to supine.

Pathology report as follows:

MACROSCOPIC DESCRIPTION:

A stomach was received measuring: small curvature 15 cm long, large curvature 24 cm long.
Located 4 cm from the proximal end and 9 cm from the distal end is a brown, ulcerated area with a raised rim measuring 4.5 x 4 x 2 cm. The rest of the mucosa is granulated.
On dissection of the fatty tissue, lymph nodes with a diameter of 0.4-2 cm were found.
Additionally, two anastomotic rings with a diameter of 1.5 cm and 2 cm.
Attached to the preparation is an omentum measuring 30 x 28 x 1.5 cm. Dissection showed no masses.

MICROSCOPIC DESCRIPTION:

Diagnosis:
Total gastrectomy shows ulcerated gastric stromal tumor (GIST), measuring 4.5 cm in maximum diameter, positive for c-kit and CD34 markers with a mitotic rate of 5 mitoses/50 HPF.
Ki-67 stain shows a proliferative index of about 5%/50 HPFs.
No vascular involvement.
The surgical margins are free of tumor.
Both anastomotic rings and the omentum are free of tumor.
26 regional lymph nodes were examined, all of them free of tumor.
Note:
Based on tumor size and the mitotic rate, the tumor belongs to group 2 (size >2 <=5 cm and mitotic rate <=5/50 HPFs) with a very low risk (1.9%) for progressive disease/risk for metastasis.

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Case information

rID: 67049
Published: 17th Mar 2019
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included
Institution: Laniado Hospital

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