A Giant Exophytic Gastric GIST Mimicking Ovarian Cancer: A Diagnostic Pitfall on CT and [¹⁸F]FDG PET/CT

A 66-year-old woman was referred for evaluation of a large pelvic mass suspected to be ovarian cancer. Contrast-enhanced computed tomography (CECT) revealed a giant multiseptated cystic pelvic mass with enhancing solid components; although its superior aspect closely abutted the gastric serosa, its predominant pelvic location raised concern for an adnexal malignancy. Subsequent [¹⁸F]fluorodeoxyglucose positron emission tomography/computed tomography ([¹⁸F]FDG PET/CT) demonstrated mild uptake confined to the viable solid portion (SUVmax 2.72) without hypermetabolic nodal or distant metastases. Exploratory laparotomy revealed a giant pedunculated tumor arising from the gastric antrum and descending into the pelvis. Histopathology confirmed an epithelioid gastrointestinal stromal tumor positive for CD117, DOG1, and CD34. This case highlights an important diagnostic pitfall in which a giant exophytic gastric GIST may mimic ovarian cancer because of its pelvic location and cystic-solid appearance. Careful correlation of CECT, fused [¹⁸F]FDG PET/CT, and pathologic findings is essential for accurate assessment of the organ of origin in large abdominopelvic masses.