Jejunal GIST masquerading as an ovarian mass: A case report. (May 2021)

• Record Type: Journal Article
• Authors: Shrestha, Suraj; Shrestha, Bibek Man; Kharel, Sanjeev; Rijal, Yasoda; Joshi, Janardan Prasad; Tiwari, Sansar Babu; Sah, Jayant Kumar; Ghimire, Bikal
• Is Part Of: International journal of surgery case reports. Volume 82(2021)
• Publication Date: 2021-05
• Subjects: Gastrointestinal stromal tumors -- GIST -- Ovarian neoplasm -- Case report; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2021.105960
• Languages: English
• ISSNs: 2210-2612

Abstract

Abstract: Introduction and importance: Gastrointestinal stromal tumors (GIST) are rare mesenchymal tumors originating in the wall of the gastrointestinal tract. Jejunal GIST is the rarest subtype. Large GIST can present with an abdominopelvic mass which can be preoperatively misdiagnosed as a gynecological tumor. Case history: A 44-year regularly menstruating woman presented with lower abdominal pain which was diagnosed as a malignant ovarian tumor preoperatively with an MRI. However, intraoperatively, a lobulated mass was present in the abdominal cavity arising from a jejunal portion of the small intestine. With an intraoperative diagnosis of jejunal GIST, the mass was excised and jejunum anastomosed. Histopathology examination report showed GIST which was further confirmed by immunohistochemistry. Discussion: GIST presenting as a large abdominopelvic mass can mimic a gynecological tumor. Contrast-enhanced CT scan is the preferred imaging modality for the evaluation of patients with suspected GIST to determine the extent of the tumor, the presence or absence of metastatic disease alongside evaluation of the possibility of complete resection. Adjuvant imatinib therapy following complete excision can decrease the disease recurrence. Conclusion: Gynecologists should keep in mind that primary gastrointestinal tumors can present as a pelvic mass. A proper histopathological examination helps to confirm the diagnosis. Complete surgical removal of the tumor should be obtained as it determines the prognosis of the disease. Highlights: If a pelvic mass is detected, a non-gynecological tumor like a gastrointestinal stromal tumor (GIST) has to be considered. Every effort should be made to identify the origin of the tumor and related anatomic structures, especially the ovaries. Misdiagnoses may have significant therapeutic implications because of the availability of targeted imatinib-based therapy.