Abstract
This is a case report of a ruptured gastrointestinal stromal tumor (GIST) presenting as spontaneous hemoperitoneum. The patient was a 63-year-old female with a past medical history of hypertension and ulcerative colitis who presented to the emergency department with worsening epigastric pain. The patient denied history of trauma, previous surgeries, or forceful vomiting. She was not on anticoagulation. Vital signs at presentation were stable. A CT scan of abdomen/pelvis revealed a large amount of fluid in the upper abdomen with high attenuation material adjacent to the greater curvature of the stomach concerning for hemoperitoneum. Diagnostic laparoscopy revealed a significant amount of blood along the upper abdominal viscera. The procedure was converted to an upper midline laparotomy after identifying a necrotic, extremely friable 7 x 6 x 3 cm pedunculated mass with active hemorrhage on the posterior aspect of the greater curvature. A wedge resection was performed to remove the mass with grossly negative margins. An intraoperative frozen section revealed a stromal tumor with spindle cells. Final pathology revealed a pT3N0M0 stromal tumor with histologic spindle cells and a high mitotic rate (24/5 mm2) consistent with a high-grade GIST. Given tumor rupture at presentation, the patient was started on imatinib therapy for a minimum duration of three years. GISTs are often asymptomatic or cause mild abdominal pain or GI bleeding. Rarely, an exophytic GIST may rupture leading to intraperitoneal bleeding. Surgical resection with negative margins is the mainstay of treatment although patients presenting with tumor rupture are at higher risk of dissemination and recurrence.
Highlights
Gastrointestinal stromal tumors (GISTs) comprise the largest subgroup of mesenchymal neoplasms [1]
We present a rare occurrence in which an undiagnosed GIST presented with tumor rupture and spontaneous hemoperitoneum
GISTs are neoplasms of mesenchymal origin that appear to be related to the interstitial cells of Cajal [1]
Summary
Gastrointestinal stromal tumors (GISTs) comprise the largest subgroup of mesenchymal neoplasms [1]. Many GISTs are asymptomatic and identified incidentally When symptoms occur, they commonly range from nonspecific nausea, bloating, and abdominal pain to gastrointestinal bleeding and rarely, intra-peritoneal hemorrhage [3,4]. They commonly range from nonspecific nausea, bloating, and abdominal pain to gastrointestinal bleeding and rarely, intra-peritoneal hemorrhage [3,4] In this case report, we present a rare occurrence in which an undiagnosed GIST presented with tumor rupture and spontaneous hemoperitoneum. Final pathology of the mass demonstrated a high-grade gastrointestinal stromal cell tumor with spindle cells with positive KIT and Discovered on GIST1 (DOG1) mutations She was admitted for observation and discharged without incident on postoperative day 3. The patient was referred to oncology and started on imatinib with planned duration of therapy of at least three years given tumor rupture at presentation
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