A Case of Large Gastrointestinal Stromal Tumor of the Stomach with Intraabdominal Hemorrhage.

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A 36-year-old woman was admitted to the department because of gradually intensifying severe abdominal pain. There were tenderness and muscle gurding in the upper abdomen. Examination of the blood disclosed anemia and leukocytosis. Ultrasonography and computed tomgraphy revealed a huge solid mass about 15cm in diameter and fluid in the upper abdomen. Tumor staining from the right and left gastric artery was demonstrated on celiac angiography, however, bleeding site was not clear. On the next day, an Emergency laparotomy was performed under a diagnosis of tumor rupture. There was about 500ml of bloody ascites in the upper abdominal cavity. The tumor was originated from the gastric lesser curvature and was growing extramurally. It was elastic firm, grayish white in color, well-demarcated, 800g in weight, and 16×10×8cm in size, but not invasive to other organs. Immunohistochemically, muscle markers (SMA, HHF35, Desmin and Myoglobin) and Vimentin were negative and CD34 and c-kit were positive. The tumor was diagnosed as gastrointestinal pacemaker cell tumor (GIPACT). Although the grade of mitosis was not high (7_??_8/50HPF), the tumor was suspected to be malignant because of its cellarity and tumor size.
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