Giant bleeding stromal tumor

Abstract

A 42-year-old woman presented to the emergency department with massive hematemesis. The medical history was unremarkable. Examination revealed pallor, a systolic blood pressure of 90 mm Hg, and a pulse of 138 beats per minute. The Hb was 6.3 g/dL (normal: 12-14.5 g/dL) and hematocrit 22.7% (38%-42%). After hemodynamic resuscitation by volume repletion and transfusion of 4 units of packed red blood cells, endoscopy demonstrated a giant polypoid submucosal lesion in the mid body of the stomach. There were multiple ulcers over the lesion, one of which contained a fresh clot (A). This ulcer was injected with 4 mL of a 1:10,000 solution of epinephrine. EUS the next day revealed a 6.8 × 4.4-cm hypoechoic mass arising from the fourth sonographic layer. It had a homogeneous echo pattern and regular extraluminal margins (B). The tumor was surgically resected. Histopathologic evaluation revealed an ulcerated tumor (C; H&E, orig. mag. ×100) that was composed of a proliferation of round cells with variable eosinophilic to clear cytoplasm (D; H&E, orig. mag. ×200), findings consistent with a diagnosis of epithelioid-type GI stromal tumor. Mitotic activity was negligible (<5/50 high power field). The postoperative course was uneventful, and there has been no further bleeding. View Large Image Figure Viewer View Large Image Figure Viewer View Large Image Figure Viewer