PMC5301111_01
Gastrointestinal stromal tumour (GIST) with liver and bone metastases: radiological aspects. a Thoraco-abdomino-pelvic CT scan in the coronal plane showing the huge gastric GIST (star) and multiple bilateral liver metastases (arrows). b, c Magnetic resonance imaging of the spine in the sagittal plane, T2 sequence, showing the multiple bone vertebral lesions (notably in C7, T1, and T9), the sacrum, and a T1 and T9 epiduritis (arrows).
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F1
A thoraco-abdomino-pelvic CT scan (Fig. 1a) revealed a 16-cm abdominal tumour lesion above the pancreas, associated with several suspect hepatic nodules, and multiple osteolytic lesions of the spine and pelvis. Magnetic resonance imaging of the spine (Fig. 1b, c) confirmed the vertebral bone lesions, and notably identified a T1 and T9 epiduritis and a mild medullar compression in C7, T1, and T9 without intramedullary lesion.
Gastrointestinal stromal tumour (GIST) with liver and bone metastases: pathological aspects. a-c HES microphotographies showing 2 distinctive morphological patterns of GIST: epithelioid cells on gastric biopsy (a) as well as spindle cells on hepatic (b) and bone (c) metastases. d-f Immunohistochemistry staining showing expression by tumour cells (epithelioid and spindle cells) of CD117/KIT (d-f) and DOG1 (e).
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F2
Pathological analysis of endoscopic ultrasound-guided fine-needle aspiration biopsies of the gastric tumour and 1 hepatic lesion revealed an epithelioid-cell gastric tumour and a spindle-cell liver tumour (Fig. 2a, b). A CT scan-guided biopsy of a lesion of the right posterior iliac bone confirmed the diagnosis of bone metastasis by a spindle-cell GIST showing the same morphological and IHC profile (Fig. 2c) as the hepatic metastasis, and the same KIT exon 11 mutation as the primary gastric tumour.
99mTc-labelled bone scintigraphy showing multiple lesions (bone uptakes) of the cervico-dorso-lumbar spine, the pelvis, the ribs, and the clavicles.
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F3
CT scan showed an increase in size of both the abdominal tumour (19 cm) and the hepatic metastases as well as multiple osteolytic lesions involving notably the spine and the pelvis. 99mTc-labelled bone scintigraphy (Fig. 3) showed several bone uptakes located on the cervico-dorso-lumbar spine, sternum, scapula, pelvis (sacrum and left sacroiliac joint), rib cage (K5-K7), left femur, and right humerus.