2733 Gastroduodenal Intussusception: An Interesting Presentation of a Gastrointestinal Stromal Tumor in a Bahamian Male

Abstract

INTRODUCTION: Gastrointestinal stromal tumors (GISTs) are a mesenchymal neoplasm considered to be the most common nonepithelial neoplasm of the gastrointestinal tract. GISTs occur with a frequency of about 0.68 per 100,000 in the United States, but the incidence of GIST in the Bahamas is unknown. These tumors arise from the interstitial cells of Cajal, which assist in motility via the myenteric plexus. Mutation to the c-kit oncogene is highly implicated in this process. Symptomatic GISTs are primarily a disease of the middle aged and elderly and have been found to be more frequent in males and minorities, especially in the black population. This case serves to highlight a presentation of GIST that is uncommon in current literature. CASE DESCRIPTION/METHODS: A 59 year old male with history of alcohol abuse and no known chronic liver disease presented with history of four episodes of coffee-ground vomitus and two episodes of melena stools over a one day period. The patient presented with an Hb of 8.2 mg/dl and at the time of endoscopy it had fallen further to 6.6 mg/dl. On endoscopy, it was noted that a portion of the mid stomach telescoped through the pyloric channel into the duodenum, causing obstruction the gastric outlet. On reduction of this intussusception, a mass with a central ulcer with stigmata of recent hemorrhage was observed at the greater curvature. Due to the nature of the significant, symptomatic bleeding that preceded presentation the decision was made not to use endoscopic ultrasound with fine needle aspiration, but rather proceed to surgical resection. A wide local excision was later performed with the lesion measuring 4.1 × 3.7 × 3.2 cm. Pathology confirmed suspicion of GIST, with chemical markers positive for CD117 and negative for S-100 and CD34, while the mitotic count was low (<5.5 mm2). DISCUSSION: This case report describes an interesting case of a GIST. Although GISTs most commonly present as gastrointestinal bleeding, the unexpected finding of an intussuseption is a rare finding of a relatively uncommon lesion. A 2018 literature review found that there were 28 reports of intussusception secondary to GIST, with only 18 having immunohistochemical confirmation of the tumor. The diagnosis of GIST should be entertained in adults who give history of melena with additional gastrointestinal symptoms. As diagnostic methods improve, further study of GISTs in the Bahamian population may be warranted to ascertain the incidence of the tumor compared to the current data of other populations.