Shojaie M, Abbas Z, Sultan N, Kazi J.
Gastrointestinal stromal tumors: A Case Report and recent concepts.
J Pak Med Assoc Jan ;54(5):278-80.

A 40 years old female was referred for upper gastrointestinal endoscopy. Her complaint was recurrent haematemesis for the last 3 months. On examination she was severely anemic; rest of her examination was unremarkable. Endoscopy showed a hemispheric 5 cm swelling on greater curvature near the junction of body of stomach with antrum. There was a central area of ulceration. Endoscopic findings suggested a leiomyoma. Endoscopic biopsies were taken. Histopathological examination showed a tumor composed of round to ovoid cells arranged in diffuse sheets. No pleomorphism or mitosis was seen and diagnosis of gastrointestinal stromal tumour (GIST) of epitheloid leiomyoma type was made. Chest X-ray showed no tumour metastasis and ultrasound abdomen was unremarkable. Patient was operated, tumour was excised and partial gastrectomy with end to end anastomosis was performed. Gross examination of the surgical specimen showed part of wall of stomach containing a hemispheric nodule measuring 5.5 x 4.5cms with central area of ulceration. Histopathological examination revealed spindle to oval cells with abundant eosinophilic to clear cytoplasm. Nuclei were round to spindle shaped with moderate pleomorphism. Taking together the size, cellularity, pattern of invasion and mitotic count, a diagnosis of a malignant GIST (leiomyosarcoma) type was made.

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