Thick calcification from a GIST of the stomach penetrating into pericolic soft tissue - report of a case
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WORLD JOURNAL OF SURGICAL ONCOLOGY
CASE REPORT
Open Access
Thick calcification from a GIST of the stomach penetrating into pericolic soft tissue - report of a case Cheng-Chan Yu1*, Cheng-Chung Wu1, Jen-I Hwang2, John Wang3 and Chi-Sen Chang4
Abstract Thick calcification is a rare presentation of gastrointestinal stromal tumor (GIST). Penetration into gastric mucosa and pericolic soft tissue has never been reported. We report a case of gastric GIST with cystic degeneration and thick calcification in an 81-year old female, who presented with hematemesis and severe abdominal pain. Thick calcification of this tumor penetrating into pericolic soft tissue was noted and successfully treated by distal gastrectomy and partial colectomy. For gastrointestinal tumors with thick calcification, even with benign behavior, surgical intervention should be considered for both oncological considerations and prevention of catastrophes like perforation or penetration into surrounding soft tissue. Introduction Calcification within primary gastrointestinal stromal tumor(GIST) has been reported [1-3], but thick calcification within GIST is rare [1]. Thick calcification of a GIST penetrating into surrounding soft tissue has never been reported. Herein, we report the first case of thick calcification from a gastric GIST with cystic degeneration penetrating into pericolic soft tissue. Case presentation An 81-year-old female with hypertension and gout was admitted to Taichung Veterans General Hospital due to abdominal pain and hematemesis. She began to suffer from intermittent epigastralgia more than 10 years ago, and a 4 cm gastric tumor was found. The abdominal pain got worse 2 years before admission, and she went to a local hospital where abdominal CT scan revealed a gastric tumor about 6 cm in length with well-circumscribed calcification(figure 1). Surgical intervention was suggested, but she declined. About 10 days before admission, tarry stool passage was noted, and bloody vomitus was found 1 day later. UGI scope revealed submucosal gastric tumor with central ulceration and she was then transferred to our hospital. * Correspondence: [email protected] 1 Department of Surgery, Taichung Veterans General Hospital, No. 160, Sec. 3, Taichung-Kang Rd., Taichung, 40705, Taiwan Full list of author information is available at the end of the article
Physical examination showed upper abdominal tenderness with mild muscle guarding. The plain radiography showed an irregular shape calcification over upper abdomen. UGI scope revealed deep gastric ulcer with foreign body. CT scan showed an irregularly shaped space-occupying lesion in front of the stomach with plate calcifications and localized free air (figures 2 and 3). Under the impression of perforated gastric tumor, emergent laparotomy was performed. An infiltrative mass between the stomach and transverse colon was noted during operation. A sharp, bone-like and thick calcified plate penetrating into the gastric mucosa and pericolic soft tissue was observed. A submucosal tumor about 2.3 cm in s
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