Abstract
Background
Gastrointestinal stromal tumors (GISTs) are characterized by the expression of c-KIT (antigen CD 117) and are the most common mesenchymal tumors of the digestive tract. An important complication, although infrequently described in the literature, is the rupture of these tumors with accompanying hemoperitoneum.
Methods
We performed a retrospective evaluation of the clinical history and radiologic records of 23 patients with a diagnosis of GIST and anatomopathologic and immunohistochemical confirmation at our hospital between 1999 and 2004.
Results
In five cases there was rupture of the primary tumor (four gastric and one jejunal). In all five cases ultrasonographic and computed tomographic examinations showed a heterogenic tumor of laminated or whirled appearance, associated with echogenic or dense ascites. No relation was found between histologic criteria of malignancy and the rupture. Four patients underwent surgical intervention, three of them urgently. Two of five patients died. There was a sixth case with rupture of a hepatic metastasis, with accompanying hemoperitoneum and subcapsular hematoma. This patient died at 3 months, after recurrence of bleeding.
Conclusions
The finding of a heterogeneous tumor of laminated or whirled appearance associated with ascites with characteristics compatible with hemoperitoneum in an appropriate context must lead to a suspicion of the existence of a ruptured GIST.
Similar content being viewed by others
References
GJC Burkill M Badran O Al-Muderis et al. (2003) ArticleTitleMalignant gastrointestinal stromal tumor: distribution, imaging features, pattern of metastatic spread Radiology 226 527–532 Occurrence Handle12563150
AD Levy HE Remotti WM Thompson et al. (2003) ArticleTitleFrom the Archives of the AFIP. Gastrointestinal stromal tumors: radiologic features with pathologic correlation Radiographics 23 283–304 Occurrence Handle12640147
V Zivkovic V Katic A Nagorni et al. (2002) ArticleTitleGastrointestinal stromal tumors (GISTs): definition, clinical, histological, immunohistochemical, and molecular genetic features, and predictors of malignant potential and differential diagnosis Arch Oncol 10 267–271 Occurrence Handle10.2298/AOO0204267Z
M Miettinen M Majidi J Lasota (2002) ArticleTitlePathology and diagnostic criteria of gastrointestinal stromal tumors (GISTs): a review Eur J Cancer 38 IssueIDsuppl 5 S39–S51 Occurrence Handle10.1016/S0959-8049(02)80602-5
I Judson (2002) ArticleTitleGastrointestinal stromal tumors (GIST): biology and treatment Ann Oncol 13 IssueIDsuppl 4 287–289 Occurrence Handle12401703
S Hirota (2001) ArticleTitleGastrointestinal stromal tumors: their origin, cause Int J Clin Oncol 6 1–5 Occurrence Handle11706520
F Bagnolo U Bonsái R Scelsi PA Testoni (1998) ArticleTitleGastric stromal tumour: a rare neoplasm presenting with gastrointestinal bleeding Eur J Gastroenterol Hepatol 10 791–794 Occurrence Handle9831275
K Suzuki G Haneko K Kubota et al. (2003) ArticleTitleMalignant tumor, of the gastrointestinal stromal tumor type, in the greater omentum J Gastroenterol 38 985–988 Occurrence Handle10.1007/s00535-003-1182-z Occurrence Handle14614607
K Kitabayashi T Seki K Kishimoto et al. (2001) ArticleTitleA spontaneously ruptured gastric stromal tumor presenting as generalized peritonitis: report of a case Surg Today 31 350–354 Occurrence Handle10.1007/s005950170159 Occurrence Handle11321348
YK Cheon IS Jung YD Cho et al. (2003) ArticleTitleA spontaneously ruptured gastric stromal tumor with cystic degeneration presenting as hemoperitoneum: a case report J Korean Med Sci 18 751–755 Occurrence Handle14555833
F Bagnolo U Bonassi R Scelsi PA Testoni (1998) ArticleTitleGastric stromal tumour: a rare neoplasm presenting with gastrointestinal bleeding Eur J Gastroenterol Hepatol 10 791–794 Occurrence Handle9831275
M Pera A Sáenz L Fernández-Cruz (1999) ArticleTitleHemoperitoneum due to a ruptured gastric stromal tumor Dig Surg 16 248–249 Occurrence Handle10.1159/000018717 Occurrence Handle10436376
M Matsuda Y Watanabe N Tonosu et al. (2000) ArticleTitleHemoperitoneum secondary to exophytic leiomyoma: report of a case Surg Today 30 448–450 Occurrence Handle10.1007/s005950050622 Occurrence Handle10819484
G Karatzas G Kouraklis J Delladetsima et al. (1998) ArticleTitleMassive intraperitoneal hemorrhage caused by a giant exogastric leiomyoblastoma Surg Today 28 293–295 Occurrence Handle10.1007/s005950050124 Occurrence Handle9548312
GB Tsianos CA Argiropoulos-Rakas GG Karkanias (1995) ArticleTitleHemoperitoneum secondary to exogastric leiomyosarcoma: a case report Hepatogastroenterology 42 885–887 Occurrence Handle8847040
A Archimandritis A Pantzos A Kalos et al. (1993) ArticleTitleGiant malignant cystic leiomyoblastoma of the stomach imitating hemorrhagic ascites J Clin Gatroenterol 17 266–268
R Singer (1994) ArticleTitleMore on giant malignant leiomyoblastoma of the stomach J Clin Gastroenterol 18 89–90
SM Ramos S Mitsudo (1984) ArticleTitleHemoperitoneum secondary to exogastric leiomyosarcomas and leiomyoblastomas Am J Gastroenterol 79 637–641 Occurrence Handle6465110
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Cegarra-Navarro, M.F., de la Calle, M.A.C., Girela-Baena, E. et al. Ruptured gastrointestinal stromal tumors: radiologic findings in six cases. Abdom Imaging 30, 535–542 (2005). https://doi.org/10.1007/s00261-005-0308-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00261-005-0308-6