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Malignant gastrointestinal stromal tumor presenting with hemoperitoneum in puerperium: report of a case with review of the literature

DOI: 10.1186/1477-7819-8-95

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A 28-year old patient presented with acute abdomen due to hemoperitoneum from a large mass arising of the small intestine with distended vessels on its top and a ruptured superficial vessel bleeding into the peritoneal cavity. The patient was at the tenth postpartum day of her first pregnancy. The preoperative diagnosis was a possible ovarian or uterine mass. After an emergency exploratory laparotomy a segmental bowel resection was performed, removing the tumor with a part of 3-cm of the small intestine. Histology revealed GIST with maximum diameter of 13 cm and mitotic rates more than 5 mitoses per 50 high power fields with some atypical forms, indicating a high risk malignancy. Immunohistochemical staining of the tumor tissue demonstrated strongly positive reactivity to CD 117 (c-kit) and CD34 in almost all the tumor cells. The patient was treated with oral imatinib mesylate (Gleevec) 400 mg daily for one year. Three years after surgery, the patient was alive without evidence of metastases or local recurrence.Considering that only few patients with gastrointestinal stromal tumors have been reported in the obstetrical and gynecological literature, the awareness of such an entity by the obstetricians-gynecologists is necessary in order to facilitate coordinated approach with the general surgeons and oncologists for the optimal care of the patients.Gastrointestinal stromal tumors (GISTs) are uncommon tumors that develop in the wall of the gastrointestinal tract and usually present in the fifth to seventh decade of life [1,2]. They account for approximately 0.1% to 3% of all gastrointestinal neoplasms, with an incidence of 1-20 per million and up to 30% of these are considered malignant [1,3,4]. The term gastrointestinal sromal tumor, first used by Mazur and Clark in 1983, encompasses a heterogeneous group of nonepithelial neoplasms composed of spindle or epithelioid cells, which display a range of differentiation [5]. Given the age distribution of occurrence, a diagn


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