Uncommon Finding of a Gastrointestinal Stromal Tumor in a Patient with Hyperechoic Liver Lesions - Case Report

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Introduction: Hyperechoic liver lesions identified by conventional ultrasonography are diverse in underlying pathology and most of the time require further investigations. Gastrointestinal stromal tumors (GIST) are rare neoplasms of the gastrointestinal tract which are uncommonly found in metastatic stages at first presentation.

Case report: We present the case of a 51 years old woman with nonspecific symptoms in which conventional ultrasonography showed hyperechoic lesions in the right lobe of the liver with a diameter up to 40 mm. Esophagogastroduodenoscopy revealed a submucosal tumor on the small curvature of the stomach, on the anterior wall, with central ulceration, with normal narrow band imaging (NBI) mucosal pattern and negative gastric biopsy. Contrast enhanced ultrasonography was performed, describing multiple lesions with inhomogeneous enhancement in the arterial phase and rapid washout at the end of arterial phase. Endoscopic ultrasound with fine needle aspiration (EUS-FNA) biopsy examination was definitive for the final diagnosis of epithelioid gastric gastrointestinal stromal tumor. The patient was diagnosed with T2N0M1 epithelioid gastric GIST, stage IV, and is currently under treatment with tyrosine kinase inhibitors.

Conclusions: GIST represent a diagnostic challenge in medical practice because of its size, unusual location in the submucosal layer and lack of symptoms. The role of EUS-FNA is of paramount importance in increasing the accuracy of diagnosis in the case of GIST. The particularity in our case consists of the unusual presentation with the lack of specific symptoms and signs associated with the presence of metastatic lesions at the moment of the diagnosis of GIST.

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  • 1. Liu J Wang D Li H et al - Clinical value of contrast-enhanced ultrasound in diagnosis of hyperechoic liver lesions. Med Sci Monit. 2015; 21:2845

  • 2. Casali PG Blay JY - ESMO/CONTICANET/EUROBONET Consensus Panel of Experts. Gastrointestinal stromal tumours: ESMO Clinical Practice Guidelines for diagnosis treatment and follow-up. Ann Oncol. 2010; 21:98-102

  • 3. Søreide K Sandvik OM Søreide JA Giljaca V Jureckova A Bulusu VR - Global epidemiology of gastrointestinal stromal tumours (GIST): A systematic review of population-based cohort studies. Cancer Epidemiol. 2016; 40:39-46

  • 4. Wozniak A Rutkowski P Piskorz A et al - Prognostic value of KIT/PDGFRA mutations in gastrointestinal stromal tumours (GIST): Polish Clinical GIST Registry experience. Ann Oncol. 2011; 23:353-360

  • 5. Ducimetière F Lurkin A Ranchere-Vince D et al - Incidence of sarcoma histotypes and molecular subtypes in a prospective epidemiological study with central pathology review and molecular testing. PloS one. 2011; 6: e20294.

  • 6. Hechtman JF DeMatteo R Nafa K et al - Additional primary malignancies in patients with gastrointestinal stromal tumor (GIST): a clinicopathologic study of 260 patients with molecular analysis and review of the literature. Ann Surg Oncol. 2015; 22:2633-39.

  • 7. D’Onofrio M Crosara S De Robertis R Canestrini S Mucelli RP - Contrast-enhanced ultrasound of focal liver lesions. AJR Am J Roentgenol. 2015; 205: W56-W66

  • 8. Hohmann J Muller A Skrok J et al - Detection of hepatocellular carcinoma and liver metastases with BR14: a multicenter phase IIA study. Ultrasound Med Biol. 2012; 37: 377-382.

  • 9. Claudon M Dietrich CF Choi BI et al - Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) in the liver–update 2012: a WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB AIUM ASUM FLAUS and ICUS. Ultrasound Med Biol. 2013; 39: 187-210.

  • 10. Nishida T - The Role of Endoscopy in the Diagnosis of Gastric Gastrointestinal Stromal Tumors. Ann Surg Oncol. 2015; 22: 2810-2811.

  • 11. Watson RR Binmoeller KF Hamerski CM et al - Yield and performance characteristics of endoscopic ultrasound-guided fine needle aspiration for diagnosing upper GI tract stromal tumors. Dig Dis Sci. 2011; 56: 1757-1762.

  • 12. Sarlomo-Rikala M Kovatich AJ Barusevicius A Miettinen M - CD117: a sensitive marker for gastrointestinal stromal tumors that is more specific than CD34. Mod Pathol. 1998; 11: 728-734

  • 13. West RB Corless CL Chen X et al - The novel marker DOG1 is expressed ubiquitously in gastrointestinal stromal tumors irrespective of KIT or PDGFRA mutation status. Am J Pathol. 2004; 165: 107-13.

  • 14. Shi YN LI Y Wang LP et al - Gastrointestinal stromal tumor (GIST) with liver metastases: An 18-year experience from the GIST cooperation group in North China. Medicine. 2017; 96: e8240.

  • 15. Abuzakhm SM Acre-Lara CE Zhao W et al. Unusual metastases of gastrointestinal stromal tumor and genotypic correlates: Case report and review of the literature. J Gastrointest Oncol. 2011 2.1: 45

  • 16. Burkill GJC Badran M Al-Muderis O et al. Malignant gastrointestinal stromal tumor: distribution imaging features and pattern of metastatic spread. Radiology 2003; 226.2: 527-532.

  • 17. Blanke CD Demetri GD von Mehren M et al - Long-term results from a randomized phase II trial of standard-versus higher-dose imatinib mesylate for patients with unresectable or metastatic gastrointestinal stromal tumors expressing KIT. J Clin Oncol. 2008; 26: 620–25.

  • 18. Blanke CD Rankin C Demetri GD et. al - Phase III randomized intergroup trial assessing imatinib mesylate at two dose levels in patients with unresectable or metastatic gastrointestinal stromal tumors expressing the kit receptor tyrosine kinase: S0033. J Clin Oncol. 2008; 26: 626–32.

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