Ewha Med J.  2015 Jul;38(2):72-75. 10.12771/emj.2015.38.2.72.

Fatal Small Bowel Bleeding with very Low Risk Gastrointestinal Stromal Tumor in Jejunum

• Kang JB
• Cha JM
• Lee JI
• Joo KR
• Hong IT
• Ki HJ

• KMID: 2052784
• DOI: http://doi.org/10.12771/emj.2015.38.2.72

Abstract

Gastrointestinal stromal tumor (GIST) is the most common mesenchymal neoplasm of the gastrointestinal (GI) tract. These tumors are frequently small, asymptomatic and found incidentally. GI bleeding is a common complication of these tumors, but small sized, very low risk GIST rarely complicated with fatal bleeding. In this report, we describe a 42-year-old woman with a jejunal GIST accompanied by severe GI bleeding. She presented with melena and an angiographic embolization was performed for a jejunal mass with bleeding. However, rebleeding was suspected after an angiographic embolization and an emergent segmental resection for the bleeding mass was performed. She was finally diagnosed as a 1.8 cm sized very low risk GIST in jejunum. In conclusion, physician should consider that even very low risk GIST can be the cause of GI bleeding when there is severe bleeding.

Keyword

Jejunum; Small bowel; Neoplasm; Gastrointestinal stromal tumor; Bleeding

MeSH Terms

Adult
Female
Gastrointestinal Stromal Tumors*
Hemorrhage*
Humans
Jejunum*
Melena

Figure

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  Fig. 1 Abdominal computed tomography finding. It shows extravasation of contrast agent with 1.5 cm sized filling detect (black arrow). It allows assessment of active bleeding in proximal jejunal loop with small mass.

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  Fig. 2 Superior mesenteric artery angiography. Active extravasation is noted from the 1st jejunal branch (black arrow).

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  Fig. 3 Gross findings of resected specimen. (A) It shows a 1.8×1.5×1.5 cm sized, encapsulated lobulating mass with hemorrhage. (B) The cut surface shows a gray-white solid tumor with multifocal hemorrhages (black arrow).

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  Fig. 4 Microscopic findings of resected specimen. (A) It reveals spindle shaped cells arranged in fascicular pattern (H&E, ×400). (B) In immunohistochemical staining, the tumor cells are positive for c-kit (c-kit stain, ×200).

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