Metastatic gastointenstinal stromal tumor presentinlog as Acute Appendicitis
Author(s):
Dabanjan Bandyopadhyay, University of Maryland Community Medical group; Hugo Bonatti, University of Maryland Shore Health; Julia Parsons, Osteopathic University of Pikeville
Background: Gastrointestinal Stromal Tumor (GIST) is an uncommon tumor of the GI tract usually seen in elderly patients, often difficult to diagnose because of it’s vague symptoms of non-specific abdominal pain and abdominal fullness.
Hypothesis: GIST may metastasize to intraabdominal organs causing acute abdomen requiring emergent surgery.
Methods: A 44-year-old female presented to the emergency room complaining of sharp pain in her RLQ shifting to the umbilicus for the past day, with associated nausea and vomiting. Clinically she was positive for McBurney’s, Rosving’s, Psoas, and Obturator signs. WBC was elevated at 16.5. CT-scan showed signs of appendicitis but also soft tissue masses suspicious for malignancy.
Results: Surgery was performed the same day for presumed appendicitis with possible perforation. Surgery included diagnostic laparotomy with biopsy, open appendectomy and excision of muliple masses in the terminal ileum and in the subfascial abdominal wall. Subsequently a narrow based Meckel’s diverticulum was also discovered and removed with multiple nodular lesions. Pathology report identified appendicitis and serosal involvement of GIST in each of the specimens. CD68, CD117, and Vimentin were all positive. The patient was then started on Imatinib postoperatively.
Conclusions: This case illustrates a rare presentation of GIST. Not only was the patient unusually young, but the GIST lesions simultaneously illicited both acute appendicitis and Meckel’s diverticulitis.