Saleem Khan, Raja G Asghar, Masoom Mirza, Tahir Naeem Khan.
Gastric Tuberculosis with concomitant Stromal Tumour of Stomach (GIST).
J Coll Physicians Surg Pak Jan ;13(1):48-50.

We present here a case of 51-year-old lady with gastric tuberculosis and concomitant stromal tumour of the stomach. Our patient presented with epigastric pain, bloating, dyspepsia, decreased appetite and loss of weight for the past 6 months. She had a history of mild pyrexia and she lost around ten pounds of weight during the past 2 months. She denied night sweats, cough, diarrhea and malaena. She had no personal and family history of tuberculosis. Her physical examination revealed visible peristalsis in the epigastric area. Her abdomen was soft with no palpable lump. She had no lymphadenopathy. Her complete blood picture revealed hemoglobin of 9 gm/dl and she had elevated ESR of 102 mmhg. Her x-ray chest showed marked calcification in the hilar region. She had a barium meal suggestive of a mass lesion at pre-pyloric area as shown in the following x-ray. Her upper GI endoscopy revealed a slightly elevated 2.5 cm ulcerated lesion with whitish slough. The histopathology was consistent with typical tuberculous chronic granulomatous inflammation. The patient had CT scan which was suggestive of dilated stomach with a 5 cm mass lesion at pre-pyloric area and malignancy was not ruled out. Owing to the obstructive symptoms with a mass lesion at pyloric area, the patient underwent laparotomy. The findings were suggestive of an ulcer at pre-pyloric area with a separate egg shaped mass at lesser curvature. The patient had partial gastrectomy and the ulcer, as well as the mass were removed and Roux-Y gastrojejunostomy performed. The microscopic examination of resected gastric specimen confirmed the histological diagnosis of tuberculous granulomas in the gastric wall. The pathology of mass displayed a concomitant stromal tumour. The final conclusive remarks based on histology and immunohistochemical profile, were supportive of malignant gastrointestinal stromal tumour with neural differentiation. Patient had a smooth postoperative recovery and later received triple regimen antituberculous medications including rifampicin, INH and pyrazinamide.

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