J Gastric Cancer.  2010 Sep;10(3):137-140.

A Case of Small Bowel GIST Initially Suspected as Peritoneal Seeding of Gastric Cancer

• Jo DH
• Song JY
• Kim YH

Abstract

Gastrointestinal stromal tumors (GISTs) constitute the most common primary mesenchymal tumors of the digestive tract and characteristically express c-kit (CD117). GISTs are the most common non-epithelial tumor of the GI tract and frequently originate from the stomach and small bowel. Specifically, the synchronous occurrence of a GIST with other epithelial tumors is rarely reported. Recently, we discovered one case of a concurrent gastric cancer and a small bowel GIST that was initially suspected to be peritoneal seeding from gastric cancer. The patient was initially admitted with epigastric pain. Gastric cancer with peritoneal seeding was suspected after an evaluation. Following a laparoscopic examination, a distal gastrectomy with D2 lymph node dissection and small-intestine segmental resection was performed. The final pathologic diagnosis was early gastric cancer and high-risk small bowel GIST. The patient refused adjuvant therapy for the GIST, and currently shows no other marked indisposition. He has been disease-free for 14 months.

Keyword

Gastrointestinal stromal tumor (GIST); Gastric cancer

MeSH Terms

Gastrectomy
Gastrointestinal Stromal Tumors
Gastrointestinal Tract
Humans
Lymph Node Excision
Seeds
Stomach
Stomach Neoplasms

Figure

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  Fig. 1 Gastroscopic finding showed a Bormann type III advanced gastric cancer in the anterior wall of the antrum.

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  Fig. 2 Abdominal computed tomo graphy suggestive of advanced gastric cancer in the antrum (A) with omental and mesenteric metastatic masses (B).

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  Fig. 3 (A) In the antrum of the stomach found, an ulcerating lesion. It measured 2×1.5 cm in size and is invaded the submucosa layer. (B) The serosal surface of the small bowel lesion showed a huge multi-lobulating mass, measuring 8×7×7 cm.

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  Fig. 4 (A) H&E staining of the gastric lesion showed poorly differentiated adenocarcinoma with signet ring cells (×200). (B) H&E staining of the small intestine lesion showed a well-circumscribed tumor tissue, consisted of interlacing or whorling of spindle cells with intervening hyalinized stroma (×200). It showed increased cellularity and frequent mitosis (more than 8/50 HPFs). (C) Immunohistochemical staining of the small bowel mass was positive for CD117.

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