Natasha Jones (Ashton-under-Lyne / GB), Ehtisham Zeb (Ashton-under-Lyne / GB), Shariq Sabri (Ashton-under-Lyne / GB), Andrei Mihailescu (Ashton-under-Lyne / GB)
Abstract text (incl. references and figure legends)
Case History
A 79 year old man presented to surgical clinic with left lower abdominal pain, weight loss, anorexia, mild anaemia and intermittent sweating for 2-3 months. Family showed concerns of pancreatic cancer due to the above.
Clinical Findings
On examination, a large vague mass was palpable in the lower abdomen.
Investigations/Results
Bloods were abnormal, showing raised inflammatory markers. Tumour markers were negative. First CT scan performed showed features of cavitating abdominal mass, maybe cavitating GIST or malignant GIST, with superimposed secondary infection, measuring 9.5x16.5x19cm. Staging CT-TAP did not show metastatic disease. Patient booked for MDT.
Diagnosis
Gastrointestinal stromal tumour.
Therapy and Progressions
Before patient could be discussed in the MDT, patient presented after 9 days with signs of intraabdominal sepsis and a repeat CT scan confirmed an increase in size and perforation of the GIST. An urgent decision was taken and the patient was operated within 90 minutes of presentation. An underwent damage control surgery with bowel resection and resection of the GIST. Patient was very unwell intraoperatively and taken to ITU for recovery. Unfortunately, the patient passed away on post-op day 3.
Comments
Since it is established that GIST tumours are a very rare entity of gastrointestinal tumours with low incidence, and literature review shows GIST tumours have a tendency to enlarge significantly with a high mitotic rate which tend to perforate causing catastrophic intraabdominal sepsis. The tumour in our patient showed a very aggressive behaviour and perforated within 10 days of initial presentation.
References
1) Mazur MT, Clark HB. Gastric Stromal Tumours: Reappriasal of Histogenesis. Am J Surg Pathol 1983;•••:7509-7519.
2) A.C. Sociedad Mexicana de Oncologia, Tumores del estroma gastrointestinal (GIST), avances en el conocimiento y manejo, Gaceta Mexicana de Oncología, 10 (2011 Jan-Feb)
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