Pregnancy with Gastric Stromal Tumor

Gastrointestinal stromal tumors (GIST) are rare tumors of the GI tract and account for less than 1% of gastrointestinal tumors, but they are the most common mesenchymal neoplasms of the gastrointestinal tract. They are usually found in the stomach or small intestine, but can occur anywhere along the gastrointestinal (GI) tract and may rarely have extra-GI involvement. Its early diagnosis is important for preserving the prognosis. Microscopy and immunohistochemistry allowed classifying these tumors according to their phenotypes and prognosis. The two main markers identified were CD34, and KIT protein or CD 117.

In this paper, the authors reported a case of a patient who was admitted in our university hospital for GIST discovered during the second trimester of pregnancy. She was 42 years old, in the fifth months of pregnancy. She was admitted for biliary colic pain with vomiting. On abdominal examination, they objectified a distended abdomen with uterine height of 18 cm and epigastric mass of 10 cm. Abdominal ultrasound and magnetic resonance imaging (MRI) showed a hepatic, tissue and cystic mass, developing at the expense of the left liver. Endoscopy objectified an aspect of extrinsic compression at the front of the stomach. A cesarean was scheduled at the 35^th month of pregnancy for fetal extraction and rescue. Exploration of the peritoneal cavity during surgery had objectified a hepatic highly vascularised mass reaching up to the umbilicus. This mass was unresectable. A postoperative CT scan revealed a large bilobed epigastric mass adhering to the stomach and the left liver. Histological and immunohisto- chemical study of hepatic process showed a gastrointestinal stromal tumor of high risk of malignancy. Then multidisciplinary management was carried out, which had better managed the mother and her baby.

In summary, gastrointestinal stromal tumors during pregnancy are extremely rare. It is very important to discuss their diagnosis and treatment in multidisciplinary meeting and it is also very important to know their prognostic factors and treatment options.

Article by Iliass Charif, et al, from Sidi Mohammed Ben Abdellah University, Fez, Morocco.

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