Abstract
A 62-year-old man who had been receiving examinations for advanced cancer of the upper body of the stomach in the Department of Gastroenterology in our hospital visited the Emergency Clinic because of the abrupt onset of epigastric pain. Intra-abdominal bleeding from the gastric cancer was suspected and emergency laparotomy was performed. There were 350 cc of bloody ascites in the abdomen and a pedunculated hematoma like growth adhered to the anterior wall of the lower body of the stomach. Direct invasion into the pancreas tail from the gastric cancer was considered probable but the invasion into the hematoma like growth was absent. Total gastrectomy and resection of the pancreas tail associated with the spleen were thus performed. Histopathologically the gastric cancer showed findings of non-solid poorly differentiated adenocarcinoma and it had invaded into the fatty tissue in the anterior surface of the pancreas. The hematoma like growth partly continued to the abdominal wall and had a proliferating nest of spindle-shaped cells in it. Immunohistochemistry of the tumor cells showed positive for CD34 and KIT. Since ischemic necrosis and degeneration of the tumor cells and interstitial edema were observed, it was inferred that the pedunculated gastrointestinal stromal tumor (GIST) growing outward had twisted to cause epigastric pain and intraabdominal bleeding.
This paper deals with this case of gastric cancer associated with pedunculated GIST which caused abdominal symptoms demanding emergency operation, together with some bibliographic comments.
