A rare case of gastrointestinal stromal tumor (GIST) extending outside the gastrointestinal tract to the mediastinum was recently reported in Cureus.
The patient, a 45-year-old Hispanic male, was admitted to the hospital with a 6-month history of intermittent, nonexertional, nonradiating abdominal and chest pain. He also complained of dysphagia when eating solids and liquids.
Imaging analysis revealed a very large mediastinal mass, which encompassed the esophageal hiatus, the left upper abdomen, and the greater curvature of the stomach. The mass showed signs of necrosis and a few scattered dystrophic calcifications.
The patient was referred to a gastroenterology department where he underwent an esophagoduodenoscopy to further analyze the mass. Biopsies of the mediastinal and abdominal masses suggested spindle cell neoplasm, with positive staining for CD117, CD34, and DOG-1. Since biopsies were positive for Helicobacter pylori infection, the patient initiated treatment with amoxicillin, clarithromycin, and pantoprazole.
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The patient underwent an exploratory laparotomy, which identified the origin of the mass in the gastroesophageal junction (GEJ). “The mass was noted to be coursing through the hiatus, very adherent at the GEJ, and involving a large portion of the medial diaphragm extending through the chest superiorly, just abutting the aorta at the arch, and was adherent to the lung parenchyma laterally,” the authors explained.
Therefore, the treatment approach included left thoracotomy and resection of the thoracoabdominal mass, esophagus, and stomach with gastroesophageal anastomosis.
The surgery went well and no metastasis was observed. However, the patient suffered from several postoperative complications and was pronounced deceased within 2 weeks after resection. The probable cause of death was a massive pulmonary embolism.
“With abdominal pain and GI bleed being the main presentation, it is important for physicians to keep GIST on their differential as early diagnosis can allow for timely management,” the authors recalled. The treatment for mediastinal GISTs has not been standardized yet.
Farraj KL, Kaliounji A, Desai J, Yeroushalmi K, Khan N. A mass in the thorax: a rare presentation of gastrointestinal stromal tumor. Cureus. Published online February 25, 2022. doi:10.7759/cureus.22601