Gastrointestinal Stromal Tumor in a roux en Y limb
Keywords:
CD 117, DOG1, Gastrointestinal Stromal Tumor, Roux-en-Y anastomosisAbstract
Our patient, a 54 year old male came with abdomen distension and pain for 5 months with on and off constipation. Per abdominal examination revealed a midline scar with an ill-defined mass in the epigastrium and right hypochondrium. Endoscopy revealed a bulge in the posterior wall of the stomach. Contrast enhanced CT scan suggested a lesion arising from the posterior wall of stomach. But, laprotomy showed the mass to be arising from the blind end of the jejunum, post roux-en-Y anastomosis. We received a globular mass measuring 14x8x7.5 cm attached to one end of the intestine. External surface was grey tan to grey brown with multiple nodules of varying sizes. Cut surface was variegated with solid and cystic areas filled with blood. Our initial differential diagnoses were leiomyosarcoma, angiosarcoma, inflammatory fibroid polyp and GIST.Microscopy revealed spindle cells with mild to moderatepleomorphismadmixed with lymphocytes and plasma cells with mitotic count of four per 50 high power fields. By immunohistochemistry the spindle cells were CD117 and DOG1 positive which prompted a diagnosis of gastrointestinal stromal tumor. We present this case for the uncommon location of GIST in a roux en Y limb.
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Copyright (c) 2016 Naveen Kumar, Saishalini Chinnathambi Narayanan, Prathiba Duvvuru, Babu Elangovan
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