Ewha Med J.  2011 Sep;34(2):47-50. 10.12771/emj.2011.34.2.47.

A Case of Gastrointestinal Stromal Tumor of the Rectum Presenting as Constipation

• Lee SA
• Shim KN
• Roh SH
• Lee MJ
• Kim HI
• Jun SJ
• Oh DY
• Hong SC
• Ryu JI
• Kim KH

• KMID: 2283969
• DOI: http://doi.org/10.12771/emj.2011.34.2.47

Abstract

A gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of the gastrointestinal tract and expresses CD117, a c-kit proto-oncogene, which can be detected immunohistochemically. We reported a GIST of the rectum of a 61-year-old-woman who had visited emergency room complaining of constipation over one week. Upon rectal examination, a round hard mass was palpated. Colonoscopy showed a 7x5 cm sized protruded lesion with surface ulceration on a rectum, adjacent the anus. And abdomen computed tomography revealed the soft tissue mass compressing anterolateral wall of the rectum and these findings suggest possibility of rectal submucosal tumor such as GIST. The patient had been treated with a ultra anorectal anastomosis with loop ileostomy. Immunohistochemical studies on the surgically resected specimen showed c-kit (+) and CD34 (+). The final diagnosis was a GIST of the rectum. She was grouped into high risk and she has been given adjuvant chemotherapy with Imatinib.

Keyword

Gastrointestinal stromal tumor; Rectum; Constipation

MeSH Terms

Abdomen
Anal Canal
Benzamides
Chemotherapy, Adjuvant
Colonoscopy
Constipation
Emergencies
Gastrointestinal Stromal Tumors
Gastrointestinal Tract
Humans
Ileostomy
Piperazines
Proto-Oncogenes
Pyrimidines
Rectum
Ulcer
Imatinib Mesylate
Benzamides
Piperazines
Pyrimidines

Figure

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  Fig. 1 Colonoscopic findings. There is a 7×5 cm sized protruded lesion with surface ulceration in the rectum, adjacent to the anus.

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  Fig. 2 Abdomen CT findings. Abdominal CT shows the soft tissue mass (arrows) compressing anterolateral wall of the rectum and these findings suggest possibility of rectal submucosal tumor such as GIST.

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  Fig. 3 Pathologic findings. (A) It shows hypercellular spindle cells with high mitotic count (9/50 HPF) (H&E, ×400). (B) It shows positive expression on immunochemical stain for c-kit (c-kit, ×400).

Reference

1. Suster S. Gastrointestinal stromal tumors. Semin Diagn Pathol. 1996. 13:297–313.

2. Fletcher CD, Berman JJ, Corless C, Gorstein F, Lasota J, Longley BJ, et al. Diagnosis of gastrointestinal stromal tumors: a consensus approach. Hum Pathol. 2002. 33:459–465.

3. Paral J, Slaninka I, Kalabova H, Hadzi-Nikolov D. Gastrointestinal stromal tumors: review on morphology, molecular pathology, diagnostics, prognosis and treatment options. Acta Gastroenterol Belg. 2010. 73:349–359.

4. Miettinen M, El-Rifai W, Sobin L, Lasota J. Evaluation of malignancy and prognosis of gastrointestinal stromal tumor: a review. Hum Pathol. 2002. 33:478–483.

5. Shin JA, Kim SJ, Shin WC, Lee JH, Choi WC, Kim WY, et al. A case of rectal gastrointestinal stromal tumor with bleeding. Korean J Gastrointest Endosc. 2005. 30:173–177.

6. Baik SH, Kim NK, Lee JH, Lee KY, Sohn SK, Cho CH, et al. Gastrointestinal stromal tumor of rectum. J Korean Surg Soc. 2005. 68:117–122.

7. Choi EY, Kil HO, Jeon WJ, Park SM, Kim SH, Park KS, et al. A case of rectal gastrointestinal stromal tumor presenting with hematochezia. Korean J Gastrointest Endosc. 2006. 33:110–115.

8. Lim BR, Kim TH, Jung KA, Lee KW, Kim HJ, Jung WT, et al. Two case of a rectal gastrointestinal stromal tumor. Korean J Med. 2007. 72:143–148.

9. Kim YK, Dong SH, Kim HJ, Kim BH, Lee JI, Chang YW, et al. Clinical and gastrosopic findings of gastric leimoyoma and leiomyosarcoma. Korean J Gastroenterol. 1992. 24:967–975.

10. Lim YJ, Kim JJ, Lim HK, Lee SJ, Kim GC, Jang WY, et al. Clinicopathological study of the gastrointestinal stromal tumor. Korean J Gastroenterol. 2001. 37:187–195.

11. Miettinen M, Sobin LH, Sarlomo-Rikala M. Immunohistochemical spectrum of GISTs at different sites and their differential diagnosis with a reference to CD117 (KIT). Mod Pathol. 2000. 13:1134–1142.

12. Duffaud F, Blay JY. Gastrointestinal stromal tumors. biology and treatment. Oncology. 2003. 65:187–197.

13. Pidhorecky I, Cheney RT, Kraybill WG, Gibbs JF. Gastrointestinal stromal tumors: current diagnosis, biologic behavior, and management. Ann Surg Oncol. 2000. 7:705–712.

14. Cipolla C, Fulfaro F, Sandonato L, Fricano S, Pantuso G, Grassi N, et al. Clinical presentation and treatment of gastrointestinal stromal tumors. Tumori. 2006. 92:279–284.

15. Machlenkin S, Pinsk I, Tulchinsky H, Ziv Y, Sayfan J, Duek D, et al. The effect of neoadjuvant imatinib therapy on rectal gastrointestinal stromal tumors outcome and survival. Colorectal Dis. 2010. 6:(Ahead of print).

16. Amato A. Colorectal gastrointestinal estromal tumor. Tech Coloproctol. 2010. 14:Suppl 1. S91–S95.