Gastrointestinal and Extragastrointestinal Stromal Tumors: Report of Two Cases and Review of the Literature
A 58-year-old female patient with a history of hypothyroidism, arterial hypertension and mitral regurgitation presented with left thoracic pain and fever up to 38.5°C during the last 3 days. Laboratory examination showed: WBC at the highest normal level (10,100) with elevated neutrophils count (81%), increased erythrocyte sedimentation rate of 53 and elevated cancer antigen 125 of 8,300. A lung and abdominal CT scan was performed and showed an inhomogeneous mass sized 5.8 cm located in the hepatogastric ligament, in contact with the left liver lobe (fig. ). The lesion demonstrated heterogeneity after intravenous contrast medium administration. Two small lesions of the liver compatible with hepatic metastases were also depicted. Moreover, the CT showed an extensive left pleural effusion and a myelolipoma of the left adrenal gland 3 cm in size. The patient underwent endoscopy, bronchoscopy and video-assisted thoracic surgery, which did not reveal any pathological findings. Fine needle aspiration and biopsy of the mass proved immunohistochemical features of a CD117-positive mesenchymal tumor of the hepatogastric ligament without connection to the gastrointestinal tract, compatible with an extragastrointestinal tumor. Because of the presence of hepatic metastases, conservative therapy with Gleevec was initially decided.