Giant gastric gastrointestinal stromal tumor: A case report

Gastrointestinal stromal tumor is the most common mesenchymal tumor of the digestive tract. With occurrence in <5 % of all gastrointestinal tract tumors, they encompass 60 % of all gastric stromal tumors.

A 60-year-old man presented to the emergency department with pain abdomen and lump for the past 4 months. Contrast enhanced computed tomography (CECT) abdomen showed a large (largest dimension-25 cm), well-defined, soft tissue lesion on left side of abdominal cavity, crossing the midline to the right side. En-bloc tumor resection with wedge resection of the gastric body was performed. On histopathological examination, definitive diagnosis of giant gastric gastrointestinal stromal tumor (GIST) was established. Postoperatively, the patient received adjuvant oral Imatinib therapy, and is recurrence free at 3-years of follow-up.

The clinical manifestations of GIST are non-specific and vary from being asymptomatic to several signs and symptoms such as abdominal pain, a palpable mass, bleeding, intestinal occlusion, and perforation. Surgical resection is the treatment of choice for GISTs, and neoadjuvant imatinib mesylate therapy for locally advanced GISTs confers good prognosis.

Despite the fact that luminal bleeding is the most common presentation, sometimes the tumor may grow exophytically without any symptoms. If large enough as observed in the present case, they may present to emergency department as intra-tumoral bleed. Surgical resection and neoadjuvant therapy with imatinib is equally advantageous even for giant GIST. Diagnosis and therapeutical protocol of GISTs should be established by a trans-disciplinary team.