Giant gastrointestinal stromal tumor of the mediastinum associated with an esophageal hiatal hernia and chest discomfort: a case report

• Published in: Surgical case reports Vol. 4; no. 1; p. 144
• Main Authors: Fujisawa, Ryosuke, Akiyama, Yuji, Iwaya, Takeshi, Endo, Fumitaka, Nikai, Haruka, Baba, Shigeaki, Chiba, Takehiro, Kimura, Toshimoto, Takahara, Takeshi, Otsuka, Koki, Nitta, Hiroyuki, Mizuno, Masaru, Koeda, Keisuke, Sasaki, Akira
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 13.12.2018; SpringerOpen
• Subjects: Case Report; Gastric gastrointestinal stromal tumor; Giant gastrointestinal stromal tumor; Hiatal hernia; Mediastinal tumor; Medicine; Medicine & Public Health; Surgery; Gastric gastrointestinal stromal tumor; Hiatal hernia; Giant gastrointestinal stromal tumor; Mediastinal tumor
• ISSN: 2198-7793; 2198-7793
• DOI: 10.1186/s40792-018-0553-x

Background Gastrointestinal stromal tumors (GISTs) grow relatively slowly and without specific symptoms; therefore, they are typically incidental findings. We report a rare gastric GIST in the mediastinum associated with chest discomfort and an esophageal hiatal hernia. Case presentation An 81-year-old woman with chest discomfort was admitted to the hospital, where barium esophagography showed a sliding esophageal hiatal hernia and a tumor of the lower esophagus and gastric wall. Esophagogastroscopy confirmed the presence of a huge submucosal tumor that extended from the lower esophagus to the gastric fundus. According to computed tomography, the mediastinal mass measured 12.7 cm and had heterogeneous low-density areas. A submucosal gastric tumor, which we suspected to be a GIST, was diagnosed in association with an esophageal hiatal hernia. Using thoracolaparotomy, we performed a total gastrectomy, a lower esophagectomy, and a Roux-en-Y reconstruction with the jejunum. The presumptive diagnosis was confirmed through immunohistochemical examination; immunostaining yielded results positive for CD34 and c-kit. The patient was discharged from the hospital 13 days after surgery with no complications and remained disease-free at follow-up 24 months after surgery. Conclusions GIST should be considered in the differential diagnosis of tumors growing in the mediastinum.