Jejunal GIST with Atypical Presentation, Report of a Case Hirokazu Uejima 1 , Seiji Shimizu 1 , Eiwa Ishida 2, 3 , Hideo Tomioka 1 , Wataru Fukuda 1 , Chihiro Yokomizo 1 , Atsushi Matsumura 4 , Shinji Okano 4 1Division of Gastroenterology and Hepatology, Osaka General Hospital of West Japan Railway Company, Osaka, Japan 2Division of Pathology, Osaka General Hospital of West Japan Railway Company, Osaka, Japan 4Division of Surgery, Osaka General Hospital of West Japan Railway Company, Osaka, Japan Keyword: GIST(gastrointestinal stromal tumor) , 小腸腫瘍 , 小腸バルーン内視鏡 , OGIB(obscure gastrointestinal bleeding) , 生検 pp.951-958
Published Date 2017/6/25
DOI https://doi.org/10.11477/mf.1403201113
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 A 59-year-old man presented to our hospital with tarry stool and severe anemia. One year ago, he had undergone upper gastrointestinal endoscopy and colonoscopy to investigate the causes of iron-deficiency anemia, and the results disclosed colonic diverticula.

 When he presented this time, abdominal CT revealed a well-demarcated mass in the proximal jejunum measuring approximately 30mm ; a tiny calcification was also visualized in the mass. On contrast study, the lesion was remarkably enhanced in the arterial phase. Small-bowel barium X-ray also delineated a hemispherical mass of 35mm in diameter that almost occupied the jejunal lumen at a point 30cm distal to the ligament of Treitz. A small, hemispherical prominence was observed on the oral side of the lesion. Single-balloon enteroscopy was performed, and it revealed a large submucosal tumor occupying the lumen. A prominence without mucosa was observed on the lesion. Partial resection of the jejunum was performed laparoscopically. On histopathological examination, it was found that the tumor was composed of spindle-shaped tumor cells growing mainly in the submucosa and extended till the subserosa. A diagnosis of GIST(gastrointestinal stromal tumor)was confirmed from the results of immunohistochemical staining. This case was considered to be an atypical presentation of GIST because the tumor had mainly grown intraluminally and was accompanied by a prominence without mucosa on it.

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