Extragastrointestinal Stromal Tumor Presenting as a Recurrent Vaginal Mass: Case Report

Abstract

Gastrointestinal stromal tumors (GISTs) are the dominant mesenchymal tumors of the digestive tract. Extragastrointestinal stromal tumors (EGISTs) usually originate outside the gastrointestinal tract without connection to the gastric or intestinal wall. However, EGISTs arising from the vaginal wall are very rare. Here, we report a case of EGIST that occurred in the vagina of a 60-year-old woman. The tumor was present in the posterior vaginal wall. It was surgically excised, and histological examination revealed spindle cell morphology with up to 14 mitoses per 50 high power field (HPF) and necrosis with the tumor-negative margins. Immunohistochemical analyses showed strongly positive CD34, CD117, and DOG-1 expression, but negative SMA, S-100, CD10, desmin, and actin expression. The patient underwent surgery and is currently being followed up. A literature review of EGSTs and treatments is also discussed in this report.

Clinical Assessment Limitation in Extragastrointestinal Stromal Tumour of Rectovaginal Septum Diagnosis: A Case Report

“…rvGIST is a rare type of eGIST. Gynaecological symptoms in rvGIST vary from incidental finding of vaginal tumour at routine pelvic examination, to per vaginal bleeding (1) and bulging vaginal mass (2). Patients with rvGIST also presented with abdominal discomfort (1), and constipation reported in current case.…”

“…Gastrointestinal stromal tumour (GIST) is soft tissue sarcoma that originates from mesenchyme, and constitute 1% of primary gastrointestinal malignancy (1). All segments of the gastrointestinal tract can be affected by GIST with greater preponderance towards the stomach (60%), small intestine (30%) and large colon (10%) (2). GIST is hypothesised to originate from pacemaker of the intestinal cells namely cells of Cajal which is found in between the muscularis propria (1).…”

“…GIST is hypothesised to originate from pacemaker of the intestinal cells namely cells of Cajal which is found in between the muscularis propria (1). Ninety-five percent of GIST shows positive expression for CD117 and CD34; these markers are also used to diagnose extragastrointestinal stromal tumour (eGIST) (2). GIST is distinctive from the other mesenchymal growth as it shows positive immunohistochemistry for DOG1 (Discovered on GIST-1) in 98% of the cases (3).…”

“…Table I showed the differential diagnosis of GIST based on the immunohistochemistry as illustrated by Hirota et al (4). GIST can also occur outside of the alimentary tract, also known as extragastrointestinal stromal tumour (eGIST) (2). eGIST has been reported to occur at the mesentery, omentum, bladder and rectovaginal septum (RVS), to name a few (1).…”

“…Typically, rvGIST size ranges between 2 to 8 cm (2). The variation of rvGIST size and ability of the RVS to harbour the tumour until larger size is due to the fact that RVS of patient with previous multiple vaginal delivery was found to be significantly greater in length and thickness compared to the nulliparous patient (5).…”