PMC4531185_01
(a) Coronal section: giant GIST with aerial bubbles inside. (b) Axial section: giant gastric GIST.
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The patient is a 47-year-old black male, with no medical history reported, diagnosed with a giant, cavitated, and unresectable gastric stromal tumor (GIST) (Figures 1(a) and 1(b)) with high mitotic index and c-kit gene exon 11 mutations, fistulized to the stomach lumen (Figures 2(a) and 2(b)), and liver metastases.
(a) Gastric fistula hole. (b) Necrotic intratumoral cavity.
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fig2
The patient is a 47-year-old black male, with no medical history reported, diagnosed with a giant, cavitated, and unresectable gastric stromal tumor (GIST) (Figures 1(a) and 1(b)) with high mitotic index and c-kit gene exon 11 mutations, fistulized to the stomach lumen (Figures 2(a) and 2(b)), and liver metastases.
(a) Left bronchial tree full of contrast from stomach and abscess cavity. (b) PEG tube from stomach to the skin cavity isolating bronchial fistula tract.
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A left bronchial fistula (Figure 3(a)) and a gastric fistula were confirmed. A nylon guide was introduced and a 20 Fr percutaneous gastrostomy (PEG) tube was placed from stomach to skin (Figure 3(b)).
(a) Uniform duct fistula 18 cm long from stomach to the skin. Obtained with pediatric gastroscope. (b) Gastrografin transit without any leakage. OTSC still remains near the old fistulous opening.
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In 2 months, the patient had gained 12 kg (to reach 54 kg), and a regular 18 cm long gastrocutaneous fistulous tract had been achieved (Figure 4(a)). Gastrografin transit showed no leakage (Figure 4(b)) and once the PEG tube was removed, the fistula tract closed completely in 6 days and the patient was discharged with oral intake and imatinib treatment.