MALIGNANT GIST OF STOMACH WITH SYNCHRONOUS GALL BLADDER ADENOCARCINOMA

Abstract

The coexistence of GIST with either synchronous or
metachronous gastrointestinal adenocarcinomas represents a
phenomenon with increasing number of relative reports in the
literature over the last 5 years. A 65 yr old female with
dyspeptic symptoms for the past 6 months and a normal OGD
was found to have a large heterodense exophytic lesion
arising from the stomach in the CECT Abdomen which was
suggestive of a GIST. On laparotomy, she was found to have
a tumor arising from posterior wall of stomach infiltrating into
the distal pancreas and an incidental Cholecysto duodenal
fistula. A subtotal gastrectomy with a distal pancreatectomy,
splenectomy and cholecystectomy was done with a Roux-en
Y gastrojejunostomy. The Histopathological examination of
the specimen revealed a high grade GIST of stomach, which
was CD 117 Positive and an INFILTRATING
ADENOCARCINOMA of the gall bladder. The Patient was
started on adjuvant chemotherapy with 5-FU and
subsequently she succumbed to the disease 3 months later.
In any case of GIST, the surgeon should be alert to recognize
a possible coexistent tumor with different histological origin
and perform a thorough preoperative and intraoperative
search. The correct diagnosis before and at the time of the
surgical procedure is the cornerstone that secures the
patients' best prognosis.