Izawa N, Sawada T, Abiko R, Kumon D, Hirakawa M, Kobayashi M, Obinata N, Nomoto M, Maehata T, Yamauchi SI, Kouro T, Tsuda T, Kitajima S, Yasuda H, Tanaka K, Tanaka I, Hoshikawa M, Takagi M, Itoh F. Gastrointestinal stromal tumor presenting with prominent calcification. World J Gastroenterol 2012; 18(39): 5645-5648 [PMID: 23112561 DOI: 10.3748/wjg.v18.i39.5645]
Corresponding Author of This Article
Takeshi Sawada, MD, PhD, Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine, 2-16-1 Sugao Miyamae-ku, Kawasaki, 216-8511, Japan. t2sawada@marianna-u.ac.jp
Article-Type of This Article
Case Report
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Naoki Izawa, Takeshi Sawada, Ryuichi Abiko, Daisuke Kumon, Mami Hirakawa, Mika Kobayashi, Nobuyuki Obinata, Masahito Nomoto, Tadateru Maehata, Shun-ichi Yamauchi, Takefumi Kouro, Takashi Tsuda, Satoshi Kitajima, Hiroshi Yasuda, Fumio Itoh, Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Kawasaki 216-8511, Japan
Keiichi Tanaka, Ichiro Tanaka, Division of Gastroenterological and General Surgery, St. Marianna University School of Medicine, Kawasaki 216-8511, Japan
Masahiro Hoshikawa, Masayuki Takagi, Department of Pathology, St. Marianna University School of Medicine, Kawasaki 216-8511, Japan
Author contributions: Izawa N and Sawada T contributed equally to this work; Izawa N and Sawada T wrote the manuscript; Abiko R, Kumon D, Hirakawa M, Kobayashi M, Obinata N, Nomoto M, Maehata T, Yamauchi S, Kouro T, Tsuda T, Kitajima S, Yasuda H, Tanaka K and Tanaka I provided medical care; Hoshikawa M and Takagi M reported pathological findings; and Itoh F gave final approval for publication.
Correspondence to: Takeshi Sawada, MD, PhD, Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine, 2-16-1 Sugao Miyamae-ku, Kawasaki, 216-8511, Japan. t2sawada@marianna-u.ac.jp
Telephone: +81-44-9778111 Fax: +81-44-9765805
Received: February 15, 2012 Revised: April 6, 2012 Accepted: April 12, 2012 Published online: October 21, 2012
Abstract
We present a rare case of a gastrointestinal stromal tumor (GIST) in the stomach with prominent calcification at presentation. A 61-year-old woman visited our hospital because of epigastric discomfort. A spherical calcified lesion with a diameter of about 30 mm was incidentally shown in the left upper quadrant on an abdominal X-ray. Computed tomography demonstrated that the tumor was growing from the upper gastric body, with calcification in the peripheral ring area. A laparoscopic partial gastrectomy was performed, and the resected specimen revealed a well-circumscribed tumor with exophytic growth from the gastric muscularis propria. Microscopic examination revealed spindle-shaped tumor cells with calcification and hemorrhage. Additionally, positive immunoreactivity of the tumor to KIT and CD34 and a low mitotic index resulted in the diagnosis of very low risk GIST. There are a few case reports of heavily calcified GIST, although solitary or punctate calcification of primary GIST has been reported in several case series. Dystrophic calcification of necrotic or degenerative tissue is the supposed cause of primary calcified GISTs. In contrast, appearance of calcification after administration of imatinib mesylate, which may be one indicator of disease response, is possibly caused by a different mechanism.
