Delayed Diagnosis of a GIST, A Case Report from a Resource-limited Setting

Abstract

Gastrointestinal stromal tumours (GISTs) are rare but constitute the most common sub-epithelial tumours of the gastrointestinal (GI) tract. Small GISTs are mostly benign, asymptomatic, and discovered accidentally. However, larger tumours have been reported with a myriad of presentations. The diagnosis of a large malignant gastric GIST in a 35-year-old male who presented with recurrent melaena was delayed. This patient presented to various hospitals with recurrent melaena and later noticed a progressive, painless epigastric swelling. Endoscopy, unnecessarily delayed until he got to the fourth hospital, revealed a large sub-mucosal gastric mass with an overlying oozing ulcer. The patient had laparotomy and partial gastrectomy with complete resection of the tumour. Histology and immunohistochemistry confirmed a malignant GIST that was CD117 positive, S100 positive, and SMA negative. The patient did well postoperatively and was placed on Imatinib for one year. Failure to do endoscopy in unexplained recurrent melaena can delay GIST diagnosis.