Case of the month: Elderly male with abdominal mass

Contributed by

Dr Ali Al Ahmari Head of the dept of Gastroenterology AlHADA Military Hospital Saudi Arabia

A 67-year-old male, diabetic for the past ten years on oral hypoglycemic agents with well-controlled glucose levels, presented with severe epigastric pain and a palpable mass in the epigastric region, which he first noticed three weeks ago.

The pain was associated with anorexia but without any alarming symptoms—no reported weight loss, gastrointestinal bleeding, jaundice, fever, or significant nausea and vomiting. On examination, he was conscious, oriented, and not in severe distress.

A physical examination showed normal cardiovascular and chest findings, aside from fine crackles at the lung bases bilaterally. His abdomen was soft and non-tender There was a large palpable mass in the epigastrium, which was tender upon deep palpation, extending beneath the sternum. No bruit or venous hum was noted upon auscultation, and there was no evidence of hepatosplenomegaly or ascites. His neurological examination was unremarkable. CT scan as shown below showed mass lesion

An endoscopic ultrasound (EUS) revealed a large multi-cystic lesion near the pancreas and the right lobe of the liver. Fine-needle aspiration (FNA) was attempted but did not yield fluid. Cytological analysis identified fibroadipose tissue with congested blood vessels. A subsequent CT scan of the abdomen confirmed the findings.

Surgical resection of the mass was performed, with the tumour excised from the retro-gastric region. Histopathology demonstrated epithelioid cells, and immunohistochemistry was positive for CD117, CD34, and DOG-1 markers, confirming a diagnosis of gastrointestinal stromal tumor (GIST).

FURTHER READING

Gheorghe G, Bacalbasa N, Ceobanu G, Ilie M, Enache V, Constantinescu G, Bungau S, Diaconu CC. Gastrointestinal Stromal Tumors-A Mini Review. J Pers Med. 2021 Jul 22;11(8):694. doi: 10.3390/jpm11080694. PMID: 34442339; PMCID: PMC8400825.