Neupane Durga, Pandit Narendra
Department of Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
Department of Surgical Gastroenterology, Birat Medical College Teaching Hospital (BMCTH), Biratnagar, Nepal.
Int J Surg Case Rep. 2025 Jun;131:111420. doi: 10.1016/j.ijscr.2025.111420. Epub 2025 May 9.
Gastrointestinal stromal tumor is the most common mesenchymal tumor of the digestive tract. With occurrence in <5 % of all gastrointestinal tract tumors, they encompass 60 % of all gastric stromal tumors.
A 60-year-old man presented to the emergency department with pain abdomen and lump for the past 4 months. Contrast enhanced computed tomography (CECT) abdomen showed a large (largest dimension-25 cm), well-defined, soft tissue lesion on left side of abdominal cavity, crossing the midline to the right side. En-bloc tumor resection with wedge resection of the gastric body was performed. On histopathological examination, definitive diagnosis of giant gastric gastrointestinal stromal tumor (GIST) was established. Postoperatively, the patient received adjuvant oral Imatinib therapy, and is recurrence free at 3-years of follow-up.
The clinical manifestations of GIST are non-specific and vary from being asymptomatic to several signs and symptoms such as abdominal pain, a palpable mass, bleeding, intestinal occlusion, and perforation. Surgical resection is the treatment of choice for GISTs, and neoadjuvant imatinib mesylate therapy for locally advanced GISTs confers good prognosis.
Despite the fact that luminal bleeding is the most common presentation, sometimes the tumor may grow exophytically without any symptoms. If large enough as observed in the present case, they may present to emergency department as intra-tumoral bleed. Surgical resection and neoadjuvant therapy with imatinib is equally advantageous even for giant GIST. Diagnosis and therapeutical protocol of GISTs should be established by a trans-disciplinary team.
胃肠道间质瘤是消化道最常见的间叶组织肿瘤。其在所有胃肠道肿瘤中的发生率低于5%，却占所有胃间质瘤的60%。
一名60岁男性因过去4个月的腹痛和肿块到急诊科就诊。腹部增强计算机断层扫描（CECT）显示腹腔左侧有一个大的（最大直径-25厘米）、边界清晰的软组织病变，越过中线至右侧。行肿瘤整块切除并楔形切除胃体。经组织病理学检查，确诊为巨大胃胃肠道间质瘤（GIST）。术后，患者接受辅助性口服伊马替尼治疗，随访3年无复发。
GIST的临床表现不具特异性，从无症状到出现多种体征和症状，如腹痛、可触及肿块、出血、肠梗阻和穿孔等。手术切除是GIST的首选治疗方法，对于局部晚期GIST，新辅助甲磺酸伊马替尼治疗预后良好。
尽管腔内出血是最常见的表现，但有时肿瘤可能向外生长而无任何症状。如本病例所见，如果肿瘤足够大，可能以瘤内出血的形式出现在急诊科。即使对于巨大GIST，手术切除和伊马替尼新辅助治疗同样具有优势。GIST的诊断和治疗方案应由跨学科团队制定。
