Male patient 54 yo, with hemorrhagia due to gastric ulcer for 2 years. From late 2 months patient got pain from neck to epigastric area, loss of appetite and weight. (Weight=58 kg, height=160 mm).
Ultrasound detected some nodes in both 2 lobes=10-38mm with halo sign and without Doppler signal. No thrombus in portal vein, IVC and hepatic veins. None lymph node. Small amount fluid in pelvic area.
Stomach= Irregular thickening wall, d#27-69 mm of nearly total gastric wall of corpus and fundus that formed hypoechoic mass d# 161x166x163mm, hypervascular which takes wide place of lumen and compressed cardia. Though about Gastric GIST with hepatic metastases.
MSCT with contrast confirmed gastric GIST # 16 cm, adhesing around and liver metastases. Some low signal liver lesions 10-35 mm were in lower density than liver parenchyma. Corpus of stomach has lesion d= 16 cm with soft tissue density and has big ulcer at center. Lesion was adhesive and compressed around. Pelvic area has a little of fluid.
Blood tests= Severe anemia Hb 6.0 g/dl; Hct 25%; MCV 57.6 fL; MCH 13.9 pg; WBC slight raised=11.90 x 10^9/L; PLT high raised 794x10^9/L. HP Test-IgG (Elisa) POS 69.88 U/mL; HP Test-IgM (Elisa) POS 68.48 U/mL.
In Binh dan hospital, gastroendoscopy shows big gastric tumor in fundus with deep ulcer having hard border and compresses lower 1/3 part of esophagus.
Histopathologic results= Infiltrating of lymphocytes and plasmocytes gastric mucosa proliferates fiber tissue and fibrosis. Masses of cells line in band with fusiform nucleii on base of fiber tissue. Follow up GI GIST.
Waiting for histoimmunostaining.
CONCLUSION= Interesting diffuse appearance of entire gastric wall tumor helps diagnosing gastric GIST based on ultrasound and MSCT findings.
