Jejunal gastrointestinal stromal tumors masquerading as an appendicular mass: an unusual presentation

Authors

  • Rajat R. Choudhari Department of General surgery, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, Karnataka, India
  • Annagiri Raghavendra Department of General surgery, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, Karnataka, India
  • Harish Rao Kalbavi Department of General surgery, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, Karnataka, India

DOI:

https://doi.org/10.18203/2349-2902.isj20203275

Keywords:

Jejunal GIST, Appendicular abscess, RIF

Abstract

Gastrointestinal stromal tumors (GISTs) are a rare variety of tumors of mesenchymal origin found in the gastrointestinal (GI) tract forming about 1% of all GI tumors. These originate from the interstitial cells of Cajal. Small bowel GISTs have been shown to present as obscure GI bleeding, obstruction and perforation in literature. We report a 57 years old female patient presenting with pain abdomen, fever and vomiting and palpable right iliac fossa (RIF) mass diagnosed as an appendicular mass and managed conservatively. She was planned interval appendicectomy and was discovered to have a jejunal GIST at laparotomy treated with resection and anastomosis. There are case reports of small bowel GISTs presenting as sources of obscure or overt GI bleeding and luminal or extra luminal mass causing small bowel obstruction. Surgery is mainstay of treatment with imatinib for adjuvant or neoadjuvant therapy. This case highlights an unusual presentation of a jejunal GIST with a sealed off perforation mimicking an appendicular mass in the RIF treated by surgical resection followed by adjuvant Imatinib therapy. GIST being an uncommon tumor with varied presentations can lead to misdiagnosis and delays in treatment. This differential should be kept in mind while evaluating small bowel pathologies to aid a timely diagnosis.   

Author Biographies

Rajat R. Choudhari, Department of General surgery, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, Karnataka, India

Resident,

Department of General Surgery

Annagiri Raghavendra, Department of General surgery, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, Karnataka, India

Assistant Professor,

Department of General Surgery

Harish Rao Kalbavi, Department of General surgery, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, Karnataka, India

Professor and Unit Head,

Department of General Surgery

References

Rubin BP, Heinrich MC, Corless CL. Gastrointestinal stromal tumour. Lancet. 2007;369:1731-41.

Soreide K, Sandvik OM, Soreide JA, Giljaca V, Jureckova A, Bulusu VR. Global epidemiology of gastrointestinal stromal tumours (GIST): a systematic review of population-based cohort studies. Cancer Epidemiology. 2016;40:39-46.

Parab TM, Rogatis DMJ, Boaz AM, Grasso SA, Issack PS, Duarte DA, et al. Gastrointestinal stromal tumors: A comprehensive review. J Gastrointestinal Oncology. 2019;10:144-54.

Dualim DM, Loo GH, Rajan R, Mahmood NRK. Jejunal GIST: Hunting down an unusual cause of gastrointestinal bleed using double balloon enteroscopy: a case report. Int J Surg Case Rep. 2019;60:303-6.

Sankey RE, Maatouk M, Mahmood A, Raja M. Case Report: Jejunal gastrointestinal stromal tumour, a rare tumour, with a challenging diagnosis and a successful treatment. J Surg Case Reports. 2015;2015(5):50.

Pandit N, Das GP, Dahal M, Awale L. An unexpected extra-gastrointestinal stromal tumor (E-GIST) on the jejunal mesentery. J Surg Case Reports. 2018;2018(12).

Sripathi S, Srivastava R, Rajagopal K, Ayachit A. CT features, mimics and atypical presentations of gastrointestinal stromal tumor (GIST). Indian J Radiol Imaging. 2011;21(3):176.

Jaison J, Joshi SR, Pathak S, Tekwani D, Nagare M, Lecturer A. Gastrointestinal Stromal Tumour at An Unusual Site-Jejunum: A Case Report. Int J Scientific Study. 2014:1-5.

Feng F, Wang F, Wang Q, Zheng G, Xu G, Liu S, et al. Clinicopathological Features and Prognosis of Gastrointestinal Stromal Tumor Located in the Jejunum and Ileum. Dig Surg. 2019;36(2):153-7.

Matteo DRP, Ballman KV, Antonescu CR, Maki RG, Pisters PW, Demetri GD, et al. Adjuvant imatinib mesylate after resection of localised, primary gastrointestinal stromal tumour: a randomised, double-blind, placebo-controlled trial. Lancet. 2009;373(9669):1097-104.

Barnes G, Bulusu VR, Hardwick RH, Carroll N, Hatcher H, Earl HM, et al. A review of the surgical management of metastatic gastrointestinal stromal tumours (GISTs) on imatinib mesylate (Glivec TM). Int J Surg. 2005;3:206-12.

Wang D, Zhang Q, Blanke CD, Demetri GD, Heinrich MC, Watson JC, et al. Phase II trial of neoadjuvant/adjuvant imatinib mesylate for advanced primary and metastatic/recurrent operable gastrointestinal stromal tumors: long-term follow-up results of Radiation Therapy Oncology Group 0132. Ann Surg Oncol. 2012;19(4):1074-80.

Samit D, Cassidy A, StephenM, Robbins D. Jejunal GIST: It’s Hard to Get the GIST of It. Am J Gastroenterol. 2016;111:1070-1.

Mujawar P, Nikumbh D, Suryawanshi K, Pagare P, Thakur R. Malignant gastrointestinal stromal tumor (GIST) of the jejunum: the mysterious complex presentation. Int J Med Sci Public Heal. 2015;4(8):1168.

Dhull AK, Kaushal V, Dhankhar R, Atri R, Singh H, Marwah N. The Inside Mystery of Jejunal Gastrointestinal Stromal Tumor: A Rare Case Report and Review of the Literature. Case Rep Oncol Med. 2011;2011:1-4.

Downloads

Published

2020-07-23

Issue

Section

Case Reports