1300 An Unusual Presentation of Gastric GIST With Double Duct Sign
L M Y Chang, A Wilkins, A Brown, D Mitton- Surgery
Abstract
Background
Gastrointestinal Stromal Tumour (GIST) most commonly arises from the stomach or small intestine, and commonly presents with mass effect or gastrointestinal bleeding. In this unusual case, imaging demonstrated a double duct sign prompting pancreatic MDT referral.
Case Presentation
A 65-year-old gentleman with a background of rheumatoid arthritis and COPD reported a 2-month history of anorexia and one stone weight loss during a rheumatology clinic follow-up. He was found to be anaemic but markers for his rheumatoid arthritis showed the disease was well controlled and imaging was performed to exclude malignancy. CT Thorax, Abdomen and Pelvis revealed a double duct sign with lung opacification, suggesting pancreatic cancer with lung metastasis. He was immediately referred to the pancreatic Multi-Disciplinary Team and underwent an Endoscopic Ultrasound which showed a 12cm cyst extending from the pelvis to the gastric body. Biopsy confirmed that this large thick-walled cyst was a Gastrointestinal Tumour (GIST). Staging PET scan was negative for metastatic disease. He underwent a laparotomy and GIST excision with a cuff of normal stomach removed. Post-operatively, his recovery was prolonged due to exacerbation of his COPD however he eventually recovered well and was discharged on day 11. There were no other post operative complications.
Conclusions
GIST are rare tumours, making up less than 1% of all gastrointestinal tumour. Patients with GISTs that are primary and localised can achieve a curative outcome through surgery alone. The prognosis of GIST tumours is favourable, with 5-year survival rates at 83%. This case demonstrates the value of pre-operative endoscopic ultrasound.