Case Presentation: 49-Year-Old Patient Who Underwent Partial Gastrectomy for a Gastrointestinal Stromal Tumor Case Presentation
Patient Case:
Patient is a 49-year-old woman with well controlled hypertension who presented to her PCP complaining of persistent epigastric pain. This was described as a dull ache, not relieved by antacids. She also noted early satiety, but no nausea or vomiting. These symptoms were associated with a 10-pound weight loss over 3 months. She has no family history of cancer. She reports drinking less than one drink per month and does not smoke tobacco. On examination, she appeared well. She has a normal heart and lung exam. Her abdomen was slightly tender in the epigastric region, but there were no palpable masses notable on deep palpation.
After several months of conservative management with diet modifications, omeprazole and antacids, she continued to have the same degree and frequency of pain. After further consultation with her PCP and a referral to a gastroenterologist, decision was made to perform an esophagogastroduodenoscopy (EGD).
EGD revealed a submucosal mass in the anterior wall of the stomach, measuring about 6cm in diameter. There were no signs of ulcerations or bleeding. Abdominal/pelvic CT confirmed a 6cm mass in the anterior wall of the stomach. There were no other abdominal masses or liver lesions.
She returned to the endoscopy suite and biopsies were taken from the mass using endoscopic ultrasound. This revealed a spindle cell proliferation of tumor cells with immunohistochemistry staining positively for CD117 (KIT) and DOG1 and negatively for desmin and S100. Mitotic activity was reported as 7 mitosis per 50 high-power fields (HPFs).
Further testing with PET showed FDG avidity of the gastric tumor, but it did not show any other areas of abnormal FDG uptake.
She was taken to the OR and underwent a partial gastrectomy. She tolerated this procedure well and recovered nicely in the post-operative setting. Pathologic analysis of the resected tumor confirmed GIST with > 5 mitosis per 50 HPFs. She met with a medical oncologist one month after surgery to discuss pros and cons of adjuvant therapy.
