The endoscopic appearance of a gastrointestinal stromal tumor in a pediatric patient

Gastrointestinal stromal tumor (GIST) is a mesenchymal tumor that is rare in children. We report a case of GIST in a pediatric patient. A 16-year-old adolescent girl presented after an episode of syncope preceded by one episode of melena. Physical examination results were normal except for Hemoccult-positive stool. Laboratory studies included a hemoglobin level of 6.1 g/dL; complete metabolism profile and coagulation studies revealed normal results. She was transfused with 2 units of packed red blood cells, and an urgent esophagogastroduodenoscopy was performed. Esophagogastroduodenoscopy demonstrated 3 submucosal sessile masses in the gastric antrum ranging from 1 to 3 cm with normal overlying mucosa except for one of the lesions, which was ulcerated. Endoscopic biopsies stained positive for CD117 and were consistent with GIST. Radiologic imaging demonstrated the endoscopically visualized masses and also showed a solitary 1-cm lesion within the liver. She underwent partial gastrectomy and open biopsy of the hepatic lesion. Histologic examination confirmed GIST with hepatic metastasis. Typically with GIST, esophagogastroduodenoscopy will demonstrate a normal surface mucosa and a firm, smooth yellowish submucosal mass, which can be ulcerated. In some cases these tumors can be missed because of their frequent submucosal and extraluminal growth. This case, to our knowledge, is one of the first reports of the endoscopic appearance of GIST in a pediatric patient. Although a rare entity in children, GIST should be considered in pediatric patients with endoscopically visualized submucosal gastric masses.