Multinodular gastro intestinal stromal tumor in small intestine with perforation and Meckel’s diverticulitis- An unusual presentation

Abstract

Gastrointestinal Stromal tumor are rare group of mesenchymal neoplasms originating from the wall of the digestive tract. Outcome strongly dependent on tumor size and mitotic activity. A 60-year male presented with abdominal pain and distention for 3 months. After initial evaluation, emergency laparotomy was done. Intraoperatively found to have multiple small nodules in peritoneum and mesenteric border of small intestine and rupture of a big nodule was observed causing peritonitis. Gross examination-Multiple nodular tumour mass in small intestine along with multiple haemorrhagic nodule of varying size seen in mesentry. Tumor arising from muscular layer arranged in interlacing fascicles, bundles, whorls and sheets. Tumor cells are elongated having spindle to elongated nucleus with vesicular to dense chromatin and inconspicuous nucleoli. Some of the nodules shows areas of haemorrhage and necrosis. Mitotic figure > 5/50 HPF seen. Histological grade-G2 High grade >5/50 HPF, TNM grade-PT4PNxPMx. Immunohistochemistry-Diffusely Positive for CD117. Focally positive for DOG1, CD34 & SMA. Small intestinal GISTs comprise approximately 30% of all GISTs. Tumor size vary from small nodules to complex masses of around 20 cm. GIST is more common in patients with age >40 years. CD117 and DOG1 positivity are used to define these tumors. Novelty: Only few cases has been reported in small bowel GIST with perforation and multiple nodules.