Malignant gastrointestinal stromal tumor presenting with hemoperitoneum in puerperium: report of a case with review of the literature

Abstract

BackgroundGastrointestinal stromal tumors (GISTs) are mesenchymal tumors that develop in the wall of the gastrointestinal tract and their diagnosis during pregnancy or puerperium is extremely rare.CaseA 28-year old patient presented with acute abdomen due to hemoperitoneum from a large mass arising of the small intestine with distended vessels on its top and a ruptured superficial vessel bleeding into the peritoneal cavity. The patient was at the tenth postpartum day of her first pregnancy. The preoperative diagnosis was a possible ovarian or uterine mass. After an emergency exploratory laparotomy a segmental bowel resection was performed, removing the tumor with a part of 3-cm of the small intestine. Histology revealed GIST with maximum diameter of 13 cm and mitotic rates more than 5 mitoses per 50 high power fields with some atypical forms, indicating a high risk malignancy. Immunohistochemical staining of the tumor tissue demonstrated strongly positive reactivity to CD 117 (c-kit) and CD34 in almost all the tumor cells. The patient was treated with oral imatinib mesylate (Gleevec) 400 mg daily for one year. Three years after surgery, the patient was alive without evidence of metastases or local recurrence.ConclusionConsidering that only few patients with gastrointestinal stromal tumors have been reported in the obstetrical and gynecological literature, the awareness of such an entity by the obstetricians-gynecologists is necessary in order to facilitate coordinated approach with the general surgeons and oncologists for the optimal care of the patients.

Bone and soft tissue sarcomas during pregnancy: A narrative review of the literature

“…Imatinib treatment during pregnancy or breast feeding is contra-indicated since spontaneous miscarriages and birth defects have been reported. Prognosis of women with gestational GIST remains favorable [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] .…”

Gastrointestinal stromal tumors during pregnancy: a systematic review of an uncommon but treatable malignancy

“…A total of 12 cases were retrieved from the literature regarding women who were diagnosed with GIST during the gestational period [5][6][7][8][9][10][11][12][13][14][15][16]. The median maternal age and the median gestational age during GIST diagnosis were 31 years old (range 21-42 years) and 18 weeks (range 10-28 years), respectively.…”

Small, spontaneously ruptured gastrointestinal stromal tumor in the small intestine causing hemoperitoneum: A case report

“…In this study, we report an extremely rare case of a patient with a spontaneously ruptured GIST in the small intestine, only 2 cm in size, causing hemoperitoneum. Table 1 shows 13 cases of spontaneously ruptured GISTs in the small intestine causing hemoperitoneum previously reported in the English literature, including this report [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] . Nine of the 13 patients (69.2%) were male, with a median age of 54 years (range, 28–87 years).…”