Postpartum Diagnosis of a Recurrent Metastatic Gastrointestinal Stromal Tumor

Kasey Shepp,Elizabeth Martin,William Forehand,Diana Kozman,Thomas A Paterniti,Renee Page,Tania K Arora

doi:10.54053/001c.27424

Abstract

Background: Gastrointestinal stromal tumors are rare in pregnancy, and typically present in the second trimester with size-greater-than-dates, abdominal pain, or nonspecific symptoms. Case: A 31-year-old gravida 1 female presented in the postpartum period with weight loss, cachexia, an abdominal mass, and persistent unexplained tachycardia. She was found to have a recurrent metastatic gastrointestinal stromal tumor and pulmonary emboli. She was anticoagulated and treated with neoadjuvant imatinib therapy with excellent initial response. Unfortunately, she died one year later due to complications of her disease and treatment. Conclusion: Malignancy should be considered in a pregnant woman with size-greater-than-dates or with an abdominal mass, especially when associated with unexplained weight loss and a history of a gastrointestinal stromal tumor, as the recurrence rate is high without continued maintenance therapy. Delivery at 35 to 37 weeks is recommended, and involvement of a multidisciplinary team improves outcomes.

Highlights

Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of the gastrointestinal tract, arising from the interstitial cells of Cajal within the myenteric plexus of the muscularis propria.[1]
Malignancy should be considered in a pregnant woman with size-greater-than-dates or with an abdominal mass, especially when associated with unexplained weight loss and a history of a gastrointestinal stromal tumor, as the recurrence rate is high without continued maintenance therapy
5 We present the case of a recurrent metastatic GIST diagnosed in the postpartum period following unexplained malnourishment, weight loss, and tachycardia in the late third trimester

Summary

Conclusion

Malignancy should be considered in a pregnant woman with size-greater-than-dates or with an abdominal mass, especially when associated with unexplained weight loss and a history of a gastrointestinal stromal tumor, as the recurrence rate is high without continued maintenance therapy. Delivery at 35 to 37 weeks is recommended, and involvement of a multidisciplinary team improves outcomes

Introduction

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Discussion