Gastrointestinal stromal tumour (GIST) in a young man with unprovoked haematemesis

Abstract

This case involves a 27-year-old Hispanic man who presented to the emergency department with two episodes of haematemesis with no other associated symptoms. In addition, he has no medical history, denies alcohol abuse, denies non-steroidal anti-inflammatory drug use and has never experienced these episodes before. Esophagogastroduodenoscopy evaluation showed a large gastric mass, and histological results obtained from several biopsies of the mass supported a diagnosis of gastrointestinal stromal tumour. His abdominal CT scan also supported this finding. However, the unprovoked haematemesis and young age of the patient does not fit the typical presentation of a gastrointestinal stromal tumour.

Upper Gastro-Intestinal Bleeding in the Young - Gastric Gist Tumor or Peptic Ulcer Disease?

“…Gastrointestinal stromal tumors (GIST), albeit uncommon gastrointestinal malignancies, are the most frequent mesenchymal tumors of the GI tract. The average worldwide incidence of these tumors is five to twenty per one million people per year [1,3]. In the United States, newly discovered cases of GIST tumors are about 3000 -5000 cases annually [1,4]).…”

“…The average worldwide incidence of these tumors is five to twenty per one million people per year [1,3]. In the United States, newly discovered cases of GIST tumors are about 3000 -5000 cases annually [1,4]). GIST tumors typically express the gain -of -function proto-oncogenes C-KIT (CD-117) (85%) or PDGFRA (5-10%) with activation of receptor tyrosine kinase.…”

“…GIST tumors typically express the gain -of -function proto-oncogenes C-KIT (CD-117) (85%) or PDGFRA (5-10%) with activation of receptor tyrosine kinase. They manifest as mutually exclusive sporadic or hereditary mutations [1][2][3] or infrequently as wild-types that do not express C-KIT or PDGFRA [1,5].…”

“…Massive life-threatening hematemesis from Gastric GIST tumor may be arterial from bleeding submucosal vessels that may be visualized as a Dieulafoy-type vascular lesion on endoscopy. It might occur from tumor ulceration [1,14] or hemorrhagic tumor necrosis [5 -8]. Massive hematemesis from tumor mucosal ulceration is probably the etiology of bleed in the case presented above.…”

“…Gastric GIST tumor size is highly variable, and sizes ranging from half a centimeter to 40 centimeters has been reported [1]. Gastric GISTs are the most frequently occurring tumors in the GI tract (approx.…”