A Hemorrhagic Small Intestinal Gastrointestinal Stromal Tumor(GIST)with Extraluminal Growth Which Demonstrated an Unusual Hemorrhage Mechanism, Report of a Case Yutaka Yano 1 , Takashi Nagahama 1 , Yousuke Kikuchi 1 1Department of Gastroenterology, Fukuoka University Chikushi Hospital Keyword: 小腸 , 出血 , 管外発育型 , gastrointestinal stromal tumor(GIST) pp.1081-1086
Published Date 2004/6/25
DOI https://doi.org/10.11477/mf.1403100532
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 A hemorrhagic GIST in the small intestine usually has erosions or ulcers on its surface. We describe a hemorrhagic jejunal GIST which manifested neither erosion nor ulcer on the surface. A59-year-old man was admitted because of recurring tarry stool and severe anemia. Upper GI endoscopy, total colonoscopy, and small intestinal radiography showed no abnormal findings, while abdominal angiography demonstrated a hypervascular lesion in the early phase of arteriography for the second branch of the jejunal artery. We examined the patient by double-balloon enteroscopy. The enteroscopic findings showed a submucosal tumor(SMT)without any erosion or ulcer, but with minute vessel-like redness on the surface, which was located15cm distal from Treitz's ligament. We diagnosed this SMT as the origin of the bleeding and performed a laparoscopy-assisted resection of the small intestine. The tumor showed extraluminal growth pattern, which was measured as4.5×3.5cm. Neither macroscopic nor microscopic findings revealed ulceration, erosion or hemorrhagic necrosis. In accordance with the histological findings using immunostain together with hematoxylin-eosin stain, the SMT was diagnosed as GIST, smooth muscle type with low-grade malignancy. The section also showed thrombus within the submucosal vessels, which suggested that the chronic ischemia was caused by mechanical stimuli such as distortion of the tumor. Futhermore, many dilated vessels proliferated in the lamina propria as well as in the submucosa. This phenomenon was thought to be a sign of neovascularization and hemosiderin-laden macrophages were observed to be present in the lamina propria. Based on these pathological investigations, we suggested that the hemorrhage from the present lesion could have been due to the rupture of these proliferated vessels, caused by mechanical stimulation(such as bolus of food)to the mucosa. There is no previous case report concerning such an unusual mechanism producing hemorrhage from GIST.

 1) Department of Gastroenterology, Fukuoka University Chikushi Hospital, Chikushino, Japan

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