2021 Volume 54 Issue 8 Pages 505-513
A 43-year-old male presented with dizziness due to severe anemia. Gastrointestinal endoscopy revealed a large submucosal tumor with bleeding from the ulcer in the anterior wall of the upper stomach. A biopsy specimen indicated a gastrointestinal stromal tumor (GIST). Abdominal enhanced CT revealed an extraluminal growth type GIST of 11.0 cm in diameter and a contrast defect in the left gastric vein extending to the splenic vein and portal vein trunk. FDG-PET/CT showed abnormal accumulation in the gastric main tumor (SUVmax 9.9) and intravascular contrast defect (SUVmax 5.6). These findings led to diagnosis of GIST with a tumor embolus in the portal vein. The patient underwent total gastrectomy with distal pancreatomy with splenectomy and removal of the tumor embolus in the portal vein. Pathological examination of the resected specimen revealed proliferation of spindle cells. Immunohistochemical staining was positive for CD117 (c-kit), DOG1 and CD34, and negative for S-100. Anticoagulant therapy was administered for postoperative portal thrombus. The patient was discharged on the 38th hospital day. Postoperative chemotherapy with imatinib mesylate was started, and the patient is presently alive without recurrence 12 months after surgery.
