A case study recently published in Cureus highlights the different signs and symptoms gastrointestinal stromal tumor (GIST) may present with. “Gastrointestinal bleeding harbors a broad differential with the potential for oversight by GIST. However, due to its indolent nature, it is often diagnosed when patients develop symptomatic complications,” the author wrote.

The case report published by Khan evaluated a 59-year-old female patient whose chief complaints were syncope and melena. She had no relevant past medical history. Hemoglobin levels were 5.5 g/dL, and esophagogastroduodenoscopy (EGD) and colonoscopy were normal. Packed red blood cells and fresh frozen plasma were administered, and in the presence of persisting melena, the decision was made to transfer her to a tertiary hospital.

A second EGD and colonoscopy were performed at this center, and no pathological findings were observed, aside from a small single sessile polyp in the sigmoid colon. The biopsy reported a tubular adenoma and adjacent colonic mucosa with melanosis coli. A subsequent capsule study revealed a submucosal mass in the small bowel with central ulceration. A computed tomography angiogram reported a mid-ileal mass of 3.3 x 2.6 x 2.7 cm, which raised the suspicion of GIST.


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After laparoscopic small bowel resection, the tumor was histologically classified as a stromal tumor, and the DOG1 and C-KIT genes that serve as biomarkers tested positive. After hemoglobin stabilization, the patient was discharged. There was no recurrence of gastrointestinal bleeding at the 1-month follow-up, and due to the KIT mutation on exon 9, a low risk of recurrence was determined. The clinicians hence recommended conservative management with continuous monitoring.

Patients with GIST most frequently present with abdominal pain, nausea, vomiting, fullness, and hyporexia. Gastrointestinal bleeding can also occur, and the worst outcome is associated with this symptom. Overall survival is dependent on tumor size, mitotic rate, and site of origin.

“Prognosis will help guide medical decisions on which treatment will be most beneficial. Early intervention is imperative to minimize the risk of patient deterioration,“ the study author concluded. “Early detection of symptomatic GIST provided high-quality care in avoiding severe complications in our case.”

Reference

Khan AS. Ileal gastrointestinal stromal tumor as a rare cause of gastrointestinal bleed: a case report and brief review of the literature. Cureus. 2022;14(3):e22856. doi:10.7759/cureus.22856