Hemorragia digestiva alta causada por GIST

Abstract

Gastrointestinal stromal tumors (GIST) are rare neoplasms that mostly affect patients over the age of 50, with no gender predilection 1,2 . The diagnosis of GIST is made by means of immunohistochemistry testing for CD117 (c-kit), and combination treatment with surgical intervention and adjuvant chemotherapy has produced good outcomes 3 . We report a case of gastric GIST diagnosed after an episode of upper gastrointestinal bleeding and successfully treated by subtotal gastrectomy. case reportA 51-year-old male presented with a 5-day history of moderately intense, crampy abdominal pain in the periumbilical region associated with nausea, dizziness, and melena. One day prior to seeking care, the patient developed hematemesis and lightheadedness. Upper GI endoscopy showed an ulcerated submucosal gastric lesion with signs of recent bleeding and an overlying clot, mild duodenitis, and two well-healed chronic duodenal ulcers. The initial diagnostic hypothesis was leiomyoma. A CT scan of the abdomen showed a mass lesion on the anterior wall of the stomach (Figure 1). The patient underwent subtotal central gastrectomy on the fourth hospital day. Intraoperatively, a tumor roughly 8 cm long at the largest axis was found on the anterior wall of the stomach, approximately 6 cm from the cardia (Figures 2 and 3).Anatomic pathology showed a mesenchymal spindle cell neoplasm with slight pleomorphism, a mitotic index of zero, necrosis and hyaline degeneration, and confirmed tumor-free margins.Immunohistochemical testing was diffusely positive for CD117, leading to a final diagnosis of intermediate-risk GIST. The patient had an uneventful clinical course and was discharged on the fifth postoperative day.