Abstract
BackgroundGastrointestinal stromal tumors (GISTs) grow relatively slowly and without specific symptoms; therefore, they are typically incidental findings. We report a rare gastric GIST in the mediastinum associated with chest discomfort and an esophageal hiatal hernia.Case presentationAn 81-year-old woman with chest discomfort was admitted to the hospital, where barium esophagography showed a sliding esophageal hiatal hernia and a tumor of the lower esophagus and gastric wall. Esophagogastroscopy confirmed the presence of a huge submucosal tumor that extended from the lower esophagus to the gastric fundus. According to computed tomography, the mediastinal mass measured 12.7 cm and had heterogeneous low-density areas. A submucosal gastric tumor, which we suspected to be a GIST, was diagnosed in association with an esophageal hiatal hernia. Using thoracolaparotomy, we performed a total gastrectomy, a lower esophagectomy, and a Roux-en-Y reconstruction with the jejunum. The presumptive diagnosis was confirmed through immunohistochemical examination; immunostaining yielded results positive for CD34 and c-kit. The patient was discharged from the hospital 13 days after surgery with no complications and remained disease-free at follow-up 24 months after surgery.ConclusionsGIST should be considered in the differential diagnosis of tumors growing in the mediastinum.
Highlights
Gastrointestinal stromal tumors (GISTs) grow relatively slowly and without specific symptoms; they are typically incidental findings
We report a rare gastric GIST in the mediastinum that was associated with chest discomfort and an esophageal hiatal hernia
Barium esophagography, ordered because of the clinical findings, revealed a sliding esophageal hiatal hernia associated with a defect of the lower esophagus and the gastric wall that was caused by a huge tumor (Fig. 1)
Summary
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract [1], they account for only 1–3% of all gastrointestinal tumors [2]. We report a rare gastric GIST in the mediastinum that was associated with chest discomfort and an esophageal hiatal hernia. Barium esophagography, ordered because of the clinical findings, revealed a sliding esophageal hiatal hernia associated with a defect of the lower esophagus and the gastric wall that was caused by a huge tumor (Fig. 1). Esophagogastroscopy revealed a severe hiatal hernia and a huge, hard, elastic submucosal tumor, extending from the lower esophagus to the gastric fundus (Fig. 2). The diagnosis was of a submucosal tumor of the stomach, complicated by an esophageal hiatal hernia. We first approached the tumor by dissection of the diaphragm (Fig. 4) This revealed a huge tumor that arose from the stomach wall and adhered to the lower lobe of the left lung, the mediastinal pleura, the diaphragm, and the esophagus. We continued to offer follow-up, and 24 months after surgery, she was still alive and had remained disease-free
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