Researchers from China reported an educational case series of 3 patients with primary hepatic gastrointestinal stromal tumors who were misdiagnosed. They published their new findings in an article that appeared in the Asian Journal of Surgery.

Primary hepatic gastrointestinal stromal tumors are mostly misdiagnosed before surgery because they do not have specific symptoms and imaging features. They have vague characteristics on computed tomography (CT) or magnetic resonance imaging (MRI).

Researchers led by Bo Zhang from Sanya People’s Hospital in Hainan, China reported the first case, of a patient with a history of hepatitis B. The patient was wrongly diagnosed with hepatocellular carcinoma, and then following post-operative pathology was found to have primary hepatic gastrointestinal stromal tumors.

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The second patient presented with hepatalgia and fever and was misdiagnosed with hepatapostema based on CT.

For the third patient, a diagnosis of hepatocellular carcinoma was considered based on radiographic features and the fact that she was living in a schistosomiasis-infested area. However, following surgery, the tumor was identified as being a primary hepatic gastrointestinal stromal tumor.

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All 3 patients had radical resections, and hepatocellular carcinoma, hepatapostema, and metastatic tumors were all ruled out.

“When the diagnosis of [hepatocellular carcinoma] or hepatapostema is ready to be established on imaging, [primary hepatic gastrointestinal stromal tumors] should also be taken into consideration, even if the patient shows vague symptoms or high-risk factors,” the authors wrote.

The liver is the most common site of metastasis in cases of gastrointestinal stromal tumors, but more than 40 cases of primary hepatic gastrointestinal stromal tumors have also been reported to date.


Mu M, Cai Z, Shen C, Zhang B. Primary hepatic gastrointestinal stromal tumor: a case series. Asian J Surg. 2021;9(21):S1015-9584. doi:10.1016/j.asjsur.2021.09.003