64 year old woman with a history of dyspepsia treated by her family doctor with OCA-10 (omeprazole, clarithromycin, amoxicillin) following a "test and treat" strategy that demonstrated eradication by determining Helicobacter pylori antigens in stool samples. Five years earlier she had been evaluated at a Gastrointestinal Clinic after being sent by her doctor as in a routine analysis she showed elevated gamma glutamyltransferase (GGT) with figures ranging from 55-92 U/L and GPT between 60 and 84 U/L, and LDL-cholesterol between 230 and 272 mg/dL. The patient had no history of alcohol, drugs or other toxins. The serological study for hepatotropic viruses was negative as well as the determination of autoantibodies (ANA, ANCA, AMA, anti-SMA, anti-LKM), the levels of immunoglobulins, ferritin, plasma copper and the thyroid profile were all normal. Abdominal ultrasound showed the presence of hepatic steatosis grade I. The patient was proposed to follow a dietary treatment that normalized laboratory parameters. Her family history shows that two of his brothers suffered from gastric cancer.
The patient went to the Emergency Service presenting melena stools of about 4 days duration, accompanied in the last 48 hours by nonspecific dizziness. It must be highlighted that the patient had recently taken a compound against influenza consisting of ASA. Physical examination showed a good general condition, with normal pressure and normal heart rate. The data revealed in the examination of organs and tract did not no show any special interesting information.
Anal inspection showed no changes and in the rectal examination it could be observed a normal sphincter with no masses and remains of melena stool.
The analysis the patient underwent in the Emergency Service showed 9.5 g/L hemoglobin, 3 450 000 erythrocytes and a 30.3% hematocrit. Mean corpuscular volume and mean corpuscular hemoglobin were normal, as well as glucose, urea, creatinine, electrolytes, platelets and coagulation parameters. We decided to perform an upper endoscopy (Figures 1 and 2) which did not show significant changes in the esophagus, bulb and up to the second portion of the duodenum. The patient was admitted to complete her study after a rounded submucosal tumor of at least 4 cm in diameter was identified on retroflexion in gastric fundus on the greater curvature, with a 6-7 mm fibrinous ulcer arising from stromal tumor.
During hospitalization the patient underwent an upper endoscopy which showed a rounded submucosal lesion of about 33 by 32 mm in the front face of the subcardial fundus with two hypoechoic areas of central necrosis which moved the submucosa and mucosa and appeared to originate in the muscular layer, suggesting a possible diagnosis of leiomyoma. No surrounding adenopathies were observed. The study was completed with a thoraco-abdominopelvic computed tomography in which a rounded, polypoid, sessile intragastric mass dependent of the wall of the fundus, of smooth contours and heterogeneous (internal necrosis) without calcifications and with no apparent extraluminal growth could be observed. No adenopathies or changes at other levels were identified.
The gastric stromal tumor diagnosis was presented to the Oncology Committee which decided to remove it surgically, proceeding to perform a partial gastrectomy.