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Kim, Park, Chun, Kim, Kim, Park, Lim, and Seo: A Case of Multiple Gastrointestinal Stromal Tumor of the Jejunum Which Was Diagnosed by Capsule Endoscopy
Case Report
The Korean Journal of Gastroenterology

The Korean Journal of Gastroenterology 2012; 59(3): 250-256.

Published online: 21 March 2012

DOI: https://doi.org/10.4166/kjg.2012.59.3.250

A Case of Multiple Gastrointestinal Stromal Tumor of the Jejunum Which Was Diagnosed by Capsule Endoscopy

So Yeon Kim, Cheol Hee Park, Seung Yeon Chun, Su Jin Kim, Jong Hyeok Kim, Choong Kee Park, Man Sup Lim1, Jin Won Seo2

Department of Gastroenterology, Hallym University Sacred Heart Hospital, Anyang, Korea.

1Department of Surgery, Hallym University Sacred Heart Hospital, Anyang, Korea.

2Department of Pathology, Hallym University Sacred Heart Hospital, Anyang, Korea.

Correspondence to: Cheol Hee Park, Division of Gastroenterology, Departement of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 896 Pyeongchon-dong, Dongan-gu, Anyang 431-070, Korea. Tel: +82-31-380-3703, Fax: +82-31-386-2269, pch216@yahoo.co.kr

Received 10 August 2011       Revised 28 September 2011       Accepted 29 September 2011

Copyright © 2012 The Korean Society of Gastroenterology

(open-access):

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

More than 90% cases of chronic gastrointestinal bleeding can be diagnosed by upper endoscopy and/or colonoscopy, and therefore, obscure gastrointestinal bleeding has been defined as bleeding of unknown origin that persists after these conventional endoscopic evaluation. Gastrointestinal stromal tumors (GISTs) are rare tumors, but the most common form of mesenchymal tumors of the gastrointestinal tract. Small bowel is the second most common primary site for GISTs, and accounts for 2-10% of chronic bleeding sites. GISTs usually present as a sporadic and solitary tumor, and a minority of the cases of multiple GISTs are discovered as forms of hereditary or idiopathic tumor syndromes. Small bowel tumor has been difficult to diagnose because of absence of accurate and proper diagnostic tools. Recently developed wireless capsule endoscopy helps in the diagnostic work-up of small bowel diseases. We report a case of multiple jejunal GISTs presenting melena in a 39-year-old male, which was diagnosed with wireless capsule endoscopy.

Keywords: Gastrointestinal stromal tumors, Jejunum, Capsule endoscopy

Figures and Tables

Fig. 1
Capsule endoscopic finding. Luminal protruding masses with central ulcerative lesion were observed at the jejunum, and each lesion is noted at 14 minutes (A), 16 minutes (B), 19 minutes (C), 21 minutes (D) after passage of the pylorus.
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Fig. 2
Abdominal CT showed multiple exophytic homogeneous enhancing masses with intraluminal central ulcer at the jejunum (arrows).
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Fig. 3
PET-CT demonstrated several enhancing masses with faint to mild increased fluoro-deoxyglucose (FDG) uptake (SUVmax=2.3) in the small bowel (arrows), and there was no abnormal enlarged lymph node or other lesion with FDG uptake.
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Fig. 4
Gross findings of the surgical specimen. (A, B) About 3-4 cm sized two main masses and small multiple exophytic masses were located at the jejunum. (C) The cut surface showed a tan and multifocal hemorrhagic lesion with firm consistency, and it was well-demarcated.
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Fig. 5
Microscopic findings of the resected specimen. (A) Spindle shaped nuclei with a fascicular pattern and low cellularity were seen (H&E, ×200). (B) In immunohistochemical staining, the tumor cells were positive for c-kit (c-kit stain, ×200).
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Notes

Financial support: None.

Conflict of interest: None.

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