Gastrointestinal stromal tumor – case report

Abstract

The authors present a clinical case report, of a 73 year-old female
patient, with hypochromic, microcytic anaemia and serum iron
deficiency, of two years duration. The out-patient colonoscopic and
upper gastro-duodenal endoscopic studies were inconclusive. She
presented with a decline in general status, asthenia and anorexia
of two months duration, as well as dark stools and tachycardia,
four days before hospitalization. Physical examination revealed
pallor of skin and mucosae and vital signs were stable. Analyses
showed a normochromic, normocytic anaemia (5.7 g/dl), without
signs of haemolysis, serum iron =7 ug/dl, transferrin saturation=
24.5 %, reticulocytes = 6%, RDW increased; normal levels
of serum electrolytes, normal renal and thyroid function tests;
negative tumour markers and increased ESR (124 mm/h). Stool
occult blood was positive in three samples. A repeat upper gastro-duodenal endoscopy and colonoscopy were negative. Barium
radiographic studies did not show images suggestive of tumour
or infiltrative injury. Abdominal and pelvic ultrasound showed an
image compatible with an intra-abdominal heterogeneous mass.
CT scan revealed a mass in the right lower abdominal, probably
an ileal lesion, with 6 cm of longitudinal diameter suggestive
of a tumour; a small amount of ascites but without evidence of
lymph node involvement in the main abdominal and pelvic chains.
She underwent a segmental enterectomy and appendicectomy.
Histological examination showed malignant Gastrointestinal
Stromal Tumour (GIST) with signs of muscular differentiation,
positive C-Kit. At present, after two years of follow-up, the patient
remains asymptomatic.