BACKGROUND Gastrointestinal stromal tumors(GISTs)are rare mesenchymal tumors that rarely present with gastrointestinal(GI)bleeding due to tumor erosion.GISTs com-Core Tip:Gastrointestinal stromal tumors(GISTs)are rare...BACKGROUND Gastrointestinal stromal tumors(GISTs)are rare mesenchymal tumors that rarely present with gastrointestinal(GI)bleeding due to tumor erosion.GISTs com-Core Tip:Gastrointestinal stromal tumors(GISTs)are rare mesenchymal tumors that rarely cause gastrointestinal(GI)bleeding.Mucosal ulceration and unfavorable tumor locations are risk factors for tumor progression and malignancy.We present a case of GI bleeding in a 42-year-old man complaining of melena over five days,which was diagnosed as a benign,ulcerated,jejunal GIST on histopathology and immunohistochemistry.Prompt evaluation using specialized diagnostic tools to locate obscure bleeding sources and complete surgical resection are key to favorable outcomes.GI bleeding in GIST is associated with a poor prognosis.Hence,detailed follow-ups are essential to detect and prevent tumor recurrence.INTRODUCTION Gastrointestinal stromal tumors(GISTs)are generally recognized as spindle cell,epithelioid,or occasionally pleomorphic tumors that usually develop in the gastrointestinal(GI)tract.Originating from mesenchymal cells of the GI tract,GISTs make up 1%-3%of all GI malignancies and progress to malignancy in approximately 10%to 30%of cases[1,2].A greater risk of tumor progression is linked to GISTs associated with mucosal ulceration and those that develop outside of the stomach[1,3].Many GISTs carry mutations in the genes encoding type III receptor tyrosine kinases,particularly KIT or PDGFRA,which is the case in up to 85%of instances.A significant majority,about 95%,of these tumors are positive for the KIT protein when tested with immunohistochemistry[4].The most common places where GIST arises are the stomach,followed by the small bowel[2].In 19%of cases,GISTs manifest asymptomatically,particularly in cases of smaller tumors of the intestinal tract.Studies show that around 10%of these cases were caught at autopsy and 20%during abdominal surgery for other conditions,making them a common incidental finding rather than a clinical suspicion[5,6].Patients who are symptomatic may exhibit non-specific symptoms such as nausea,vomiting,abdominal distension,early satiety,abdominal pain,and,in rare cases,a palpable abdominal mass.Obstruction of the GI lumen by endophytic growth or compression of the GI tract by exophytic growth may result in dysphagia,obstructive jaundice,or constipation in larger tumors,contingent upon the mass's specific location[1].Very rarely do these tumors present as an acute,severe,life-threatening GI bleeding[7].Herein,we describe a case report of a rather unusual presentation of GIST,i.e.,symptomatic GI bleeding caused by an ulcerated jejunal GIST,which was found to be benign in nature.This case report emphasizes the importance of maintaining a high suspicion of this disease when all routine workups for GI bleeding show no obvious findings.展开更多
文摘BACKGROUND Gastrointestinal stromal tumors(GISTs)are rare mesenchymal tumors that rarely present with gastrointestinal(GI)bleeding due to tumor erosion.GISTs com-Core Tip:Gastrointestinal stromal tumors(GISTs)are rare mesenchymal tumors that rarely cause gastrointestinal(GI)bleeding.Mucosal ulceration and unfavorable tumor locations are risk factors for tumor progression and malignancy.We present a case of GI bleeding in a 42-year-old man complaining of melena over five days,which was diagnosed as a benign,ulcerated,jejunal GIST on histopathology and immunohistochemistry.Prompt evaluation using specialized diagnostic tools to locate obscure bleeding sources and complete surgical resection are key to favorable outcomes.GI bleeding in GIST is associated with a poor prognosis.Hence,detailed follow-ups are essential to detect and prevent tumor recurrence.INTRODUCTION Gastrointestinal stromal tumors(GISTs)are generally recognized as spindle cell,epithelioid,or occasionally pleomorphic tumors that usually develop in the gastrointestinal(GI)tract.Originating from mesenchymal cells of the GI tract,GISTs make up 1%-3%of all GI malignancies and progress to malignancy in approximately 10%to 30%of cases[1,2].A greater risk of tumor progression is linked to GISTs associated with mucosal ulceration and those that develop outside of the stomach[1,3].Many GISTs carry mutations in the genes encoding type III receptor tyrosine kinases,particularly KIT or PDGFRA,which is the case in up to 85%of instances.A significant majority,about 95%,of these tumors are positive for the KIT protein when tested with immunohistochemistry[4].The most common places where GIST arises are the stomach,followed by the small bowel[2].In 19%of cases,GISTs manifest asymptomatically,particularly in cases of smaller tumors of the intestinal tract.Studies show that around 10%of these cases were caught at autopsy and 20%during abdominal surgery for other conditions,making them a common incidental finding rather than a clinical suspicion[5,6].Patients who are symptomatic may exhibit non-specific symptoms such as nausea,vomiting,abdominal distension,early satiety,abdominal pain,and,in rare cases,a palpable abdominal mass.Obstruction of the GI lumen by endophytic growth or compression of the GI tract by exophytic growth may result in dysphagia,obstructive jaundice,or constipation in larger tumors,contingent upon the mass's specific location[1].Very rarely do these tumors present as an acute,severe,life-threatening GI bleeding[7].Herein,we describe a case report of a rather unusual presentation of GIST,i.e.,symptomatic GI bleeding caused by an ulcerated jejunal GIST,which was found to be benign in nature.This case report emphasizes the importance of maintaining a high suspicion of this disease when all routine workups for GI bleeding show no obvious findings.
