P4227 - GIST Found Incidentally After Further Investigation From Prior Trauma to the Chest Wall

Jacob Bulman, DO, Zachary Sherrill, DO, Gerald Mank, MD, Suneel Mohammed, MD, Matthew Mishoe, DO, Nathaniel Krogel, DO, Dustin Kilpatrick, DO
UNC Health Blue Ridge, Morganton, NC

Introduction: Gastrointestinal stromal tumors (GIST) are rare mesenchymal neoplasms of the gastrointestinal tract. We present a case of a 60 year old female with an unusual presentation of GIST. It was an incidental finding after further investigation of abdominal pain secondary to an injury from striking her chest wall on the side of a boat. GIST is rare as in only comprises approximately 1 to 2 percent of primary gastrointestinal malignancies. By providing the clinical course and presentation of this rare malignancy, we can help guide future providers in the diagnosis and treatment of GIST.

Case Description/Methods: This is a 60 year old female with a prior history of stage III breast cancer status post bilateral mastectomy who presented to the surgeon’s office after an abnormal CT finding and persistent abdominal pain. Her symptoms started 6 weeks prior when she fell over the back of a boat striking her chest. She had reported difficulty swallowing, nausea and vomiting. She also had intermittent fevers and chills. She went to an urgent care and was told she had free air in her abdomen. CT of her chest and abdomen/pelvis revealed a 11.5 x 10.3 x 13.1 cm mass like lesion within the stomach with free air in the abdomen, concerning for an ulcerative perforation. CT scan also revealed metastasis to the left adrenal gland and diffusely throughout the liver. CT scan of chest revealed a 2.2 cm nodule in the right lower lobe. Surgical intervention was deferred due to degree of metastasis. She was referred to oncology and had an ultrasound guided biopsy of the liver, which revealed metastatic GIST. She was referred to oncology for treatment with imatinib with hopeful reduction in the tumor burden to allow for possible surgical resection.

Discussion: GIST are rare mesenchymal neoplasms of the gastrointestinal tract GIST’s are rare and only account for approximately 1-2% of all primary gastrointestinal tumors. GIST primary tumors can occur anywhere from the mouth to the anus, but the most common sites are the stomach and the jejunum/ileum. Metastasis, if it occurs, usually presents in the liver, omentum, and peritoneum. This case is unique in the fact that she had metastatic disease to the adrenal gland, and lungs as well as the liver. The usual presenting symptom is GI bleeding, but in this case it was an incidental finding due to abdominal pain that did not resolve over a several weeks. Our aim is to make providers aware that GIST can present in other ways than GI bleeding.


Disclosures:


Jacob Bulman, DO, Zachary Sherrill, DO, Gerald Mank, MD, Suneel Mohammed, MD, Matthew Mishoe, DO, Nathaniel Krogel, DO, Dustin Kilpatrick, DO. P4227 - GIST Found Incidentally After Further Investigation From Prior Trauma to the Chest Wall, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.