J Gastric Cancer.  2016 Mar;16(1):58-62. 10.5230/jgc.2016.16.1.58.

Gastrointestinal Stromal Tumor of the Stomach Presenting as Multilobular with Diffuse Calcifications

• Kim SH
• Lee MS
• Cho BS
• Park JS
• Han HY
• Kang DW

• KMID: 2372555
• DOI: http://doi.org/10.5230/jgc.2016.16.1.58

Abstract

Gastrointestinal stromal tumors (GISTs) are the most common primary mesenchymal neoplasms of the gastrointestinal tract and usually appear as a well-circumscribed mass. However, it may be difficult to confirm the extent of the disease for some GISTs. A 70-year-old asymptomatic female presented for a regular physical exam. An esophagogastroduodenoscopy showed a 2.0 cm protruding mass on the gastric fundus. Endoscopic ultrasound revealed an ill-defined heterogenous hypoechoic lesion (3.0×1.5 cm). A computed tomography (CT) scan demonstrated a 4.5 cm multifocal calcified mass at the gastric body as well as at the gastric fundus. Laparoscopic gastric wedge resection was performed according to the extent of multifocal calcifications that are shown on the CT. Intraoperative specimen mammography and intraoperative biopsy might be helpful to obtain a tumor-free margin. Final pathologic diagnosis was an intermediate risk GIST in multilobular form. In patients with diffuse multifocal calcifications in the stomach, the possibility of GIST should be considered.

Keyword

Gastrointestinal stromal tumors; Stomach; Calcinosis

MeSH Terms

Aged
Biopsy
Calcinosis
Diagnosis
Endoscopy, Digestive System
Female
Gastric Fundus
Gastrointestinal Stromal Tumors*
Gastrointestinal Tract
Humans
Mammography
Stomach*
Ultrasonography

Figure

• 

  Fig. 1 Endoscopic findings of the stomach. (A) Esophagogastroduodenoscopy image demonstrates a 2 cm subepithelial protruding mass located in the fundus of the stomach, covered by normal mucosa. (B) Endoscopic ultrasound revealed an ill-defined heterogenous hypoechoic lesion (3.0×1.5 cm) with multiple hyperechoic spots, arising from the muscularis propria layer.

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  Fig. 2 Radiologic findings of the stomach. (A, B) Contrast-enhanced axial and sagittal computed tomography examination demonstrating thick or patchy multifocal calcifications. (C) The schematic drawing of the gastric wedge resection showing the resected stomach (dotted line), calcifications (variable sized dots), stomach (S), spleen (SP), and short gastric vessels (SG). (D) Intraoperative specimen mammography showing diffuse multifocal variable sized calcifications of the gastric fundus and high body along the greater curvature.

• 

  Fig. 3 Pathologic findings. (A) Gross resection of the tumor revealed a solid, whitish-yellow parenchyma with multifocal diffuse calcifications (cut section of gastrointestinal stromal tumor). (B) Microscopically, the tumor originated from the muscularis propria and extended longitudinally in a multilobular form with diffuse calcifications (H&E, ×20). (C) The sliced surface of the tumor was characterized by spindled and epithelioid mixed tumor cells (H&E, ×40). (D) Immunohistochemically, the tumor cells were positive for CD117 (c-kit [CD117] immunohistochemical stain, ×200).

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