Recurrent Gastro Intestinal Stromal Tumour in Pregnancy - A Case Report

Purpose of study: Gastrointestinal stromal tumours found in pregnant women is such a rare entity that only a handful of cases have been cited in literature. Such an overlap has been less witnessed and the GIST recurrence during pregnancy has been least dealt with. Such a rarity makes our case a one in a million occurrence. Case: We present an antenatal women with Gastrointestinal stromal tumor of the pelvic region operated an year back who was on chemotherapy with a protein - tyrosine kinase inhibitor. Eventually the patient turned out to be a defaulter (imatinib) and had conceived when she was off the drugs. She presented to us in the early third trimester when she had already developed extensive metastatic deposits in the abdominal wall. We had her as an inpatient till the later half of third trimester, under close monitoring and we took her on an elective lscs, anterior wall tumour was resected intraoperattively with post - operative period being uneventful. GIST recurrence in this patient was confirmed histopathologically and with immuno - histo chemical analysis and 6 weeks post partum she was on chemotherapy. Conclusion: Our case has set us a classic example of how GIST can behave in an aggressive manner on withdrawal of chemotherapy and its extensive and rapid spread during pregnancy. The difficulty in the surgical management of pregnant patients presenting with GIST is deciding the optimal timing of surgery, the balance of good oncological response and minimising injury to the foetus.