Korean J Gastroenterol.  2012 Mar;59(3):250-256. 10.4166/kjg.2012.59.3.250.

A Case of Multiple Gastrointestinal Stromal Tumor of the Jejunum Which Was Diagnosed by Capsule Endoscopy

• Kim SY
• Park CH
• Chun SY
• Kim SJ
• Kim JH
• Park CK
• Lim MS
• Seo JW

• KMID: 1245211
• DOI: http://doi.org/10.4166/kjg.2012.59.3.250

Abstract

More than 90% cases of chronic gastrointestinal bleeding can be diagnosed by upper endoscopy and/or colonoscopy, and therefore, obscure gastrointestinal bleeding has been defined as bleeding of unknown origin that persists after these conventional endoscopic evaluation. Gastrointestinal stromal tumors (GISTs) are rare tumors, but the most common form of mesenchymal tumors of the gastrointestinal tract. Small bowel is the second most common primary site for GISTs, and accounts for 2-10% of chronic bleeding sites. GISTs usually present as a sporadic and solitary tumor, and a minority of the cases of multiple GISTs are discovered as forms of hereditary or idiopathic tumor syndromes. Small bowel tumor has been difficult to diagnose because of absence of accurate and proper diagnostic tools. Recently developed wireless capsule endoscopy helps in the diagnostic work-up of small bowel diseases. We report a case of multiple jejunal GISTs presenting melena in a 39-year-old male, which was diagnosed with wireless capsule endoscopy.

Keyword

Gastrointestinal stromal tumors; Jejunum; Capsule endoscopy

MeSH Terms

Adult
Capsule Endoscopy
Gastrointestinal Stromal Tumors/*diagnosis/pathology/surgery
Humans
Jejunal Neoplasms/*diagnosis/pathology/surgery
Male
Positron-Emission Tomography and Computed Tomography
Tomography, X-Ray Computed

Figure

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  Fig. 1 Capsule endoscopic finding. Luminal protruding masses with central ulcerative lesion were observed at the jejunum, and each lesion is noted at 14 minutes (A), 16 minutes (B), 19 minutes (C), 21 minutes (D) after passage of the pylorus.

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  Fig. 2 Abdominal CT showed multiple exophytic homogeneous enhancing masses with intraluminal central ulcer at the jejunum (arrows).

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  Fig. 3 PET-CT demonstrated several enhancing masses with faint to mild increased fluoro-deoxyglucose (FDG) uptake (SUVmax=2.3) in the small bowel (arrows), and there was no abnormal enlarged lymph node or other lesion with FDG uptake.

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  Fig. 4 Gross findings of the surgical specimen. (A, B) About 3-4 cm sized two main masses and small multiple exophytic masses were located at the jejunum. (C) The cut surface showed a tan and multifocal hemorrhagic lesion with firm consistency, and it was well-demarcated.

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  Fig. 5 Microscopic findings of the resected specimen. (A) Spindle shaped nuclei with a fascicular pattern and low cellularity were seen (H&E, ×200). (B) In immunohistochemical staining, the tumor cells were positive for c-kit (c-kit stain, ×200).

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