TMSS Medical College Journal

Gastrointestinal stromal tumours (GISTs) are rare mesenchymal tumours of the gastrointestinal tract, first described by Mazur and Clark in 1983. At present GISTs represents 1-3% of all gastrointestinal malignancies, making it a diagnostic challenge. Lesions are frequently located in stomach and proximal small intestine but rarely elsewhere in the abdomen. They are believed to result from mutations of proto-oncogenes c-Kit or platelet-derived growth factor receptor alpha polypeptide, this increase tyrosine kinase receptor activity, leading to uncontrolled proliferation of stem cells that differentiate into cells of Cajal, autonomic nerve related gastrointestinal pacemaker cells that regulate intestinal motility. They can occur at any age but predominantly in middle-aged people and in elderly. We report the case of a 60-year-old woman presented to our hospital with upper gastrointestinal bleeding and black tarry loose stool, findings in diagnostic image studies suggested a GIST in proximal part of stomach without evidence of distant metastasis; therefore subtotal gastrectomy was performed. Cytology and immunohistochemistry analysis confirm diagnosis of GISTs.

GISTs are stromal or mesenchymal tumours that affect the gastrointestinal tract typically appear as subepithelial neoplasms and are often discovered during endoscopy done for various complaints. The most common is GIST, which arises from mesenchymal stem cells programmed to differentiate into interstitial cells of Cajal in the myenteric plexus. The cells of Cajal form a complex cell network within the gastrointestinal tract (GIT) wall where they function as a pacemaker system. The GIST can arise from anywhere into the GIT and are frequently located in stomach (66%) and small intestine (30%) particularly in duodenum, as well as in oesophagus, colon, rectum and anus (<10%).? They can even occur in extra-digestive tube, by example in omentum, mesentery or peritoneum.’