[A Case of Gastric GIST Concomitant with Early Gastric Cancer and Leiomyoma]

A 76-year-old man with a history of chronic obstructive pulmonary disease(COPD)presented with exertional dyspnea and melena. Detailed examination revealed a 10-cm heterogeneous, contrast-enhancing mass on the posterior wall of the upper gastric body. Endoscopy showed a submucosal tumor-like elevation with ulceration. Biopsy of the ulcerative lesion indicated well-differentiated adenocarcinoma. Based on these findings, the coexistence of gastric gastrointestinal stromal tumor(GIST)and gastric cancer was clinically suspected. Considering the patient's poor general condition, partial gastrectomy of the upper gastric body was performed. Intraoperatively, a 12-mm white nodule was also found on the anterior wall of the lower gastric body and was enucleated simultaneously. Histopathological examination revealed discontinuous high- and low-grade GISTs, a 5-mm intramucosal well-differentiated adenocarcinoma, and the white nodule was diagnosed as a leiomyoma. Although adjuvant imatinib was initiated postoperatively, it was discontinued due to adverse effects. Peritoneal dissemination and liver metastases developed 4 years and 8 months after surgery, and the patient passed away 5 years and 6 months postoperatively. The coexistence of multiple gastric GISTs with early gastric cancer and gastric leiomyoma is extremely rare. We report this case with a brief review of the literature.