MALIGNANT GIST OF STOMACH WITH SYNCHRONOUS GALL BLADDER ADENOCARCINOMA

The coexistence of GIST with either synchronous or metachronous gastrointestinal adenocarcinomas represents a phenomenon with increasing number of relative reports in the literature over the last 5 years. A 65 yr old female with dyspeptic symptoms for the past 6 months and a normal OGD was found to have a large heterodense exophytic lesion arising from the stomach in the CECT Abdomen which was suggestive of a GIST. On laparotomy, she was found to have a tumor arising from posterior wall of stomach infiltrating into the distal pancreas and an incidental Cholecysto duodenal fistula. A subtotal gastrectomy with a distal pancreatectomy, splenectomy and cholecystectomy was done with a Roux-en Y gastrojejunostomy. The Histopathological examination of the specimen revealed a high grade GIST of stomach, which was CD 117 Positive and an INFILTRATING ADENOCARCINOMA of the gall bladder. The Patient was started on adjuvant chemotherapy with 5-FU and subsequently she succumbed to the disease 3 months later. In any case of GIST, the surgeon should be alert to recognize a possible coexistent tumor with different histological origin and perform a thorough preoperative and intraoperative search. The correct diagnosis before and at the time of the surgical procedure is the cornerstone that secures the patients' best prognosis.