[Gastrointestinal tumor (GIST) of the esophagus in a 34-year-old man: clubbed fingers and alopecia arealis as an early paraneoplastic phenomenon].
METHODS
A 34-year-old previously healthy man presented to his general practitioner with nocturnal sweating, feeling full and a weight loss of 6 kg in three months. Over a period of one year clubbing of the fingers had developed and alopecia areata had been noted six months before the diagnosis was established.


METHODS
Out-patient sonography revealed two large, partly cystic-necrotic space-occupying lesions in the liver. Sonographically guided fine-needle puncture showed cells of a mesenchymal tumor with great cell density and extensive necroses. Gastroscopy and endosonography demonstrated, as a possible primary tumor, a submucosal space-occupying lesion, ca. 3 x 5 cm, in the distal esophagus. Immunochemical tests revealed a leiomyosarcoma.


METHODS
A gastrectomy and resection of the distal esophagus were performed, together with a liver wedge resection. Histopathological examination of the surgical specimen confirmed the diagnosis of leiomyosarcoma. Further immunochemical tests provided the diagnostic criteria of a gastrointestinal stroma tumor (GIST). The patient died one year after operation from hepatic and peritoneal metastases.


CONCLUSIONS
Tumors of the gastrointestinal tract may for a long time produce no or, as in this case, only nonspecific symptoms. An early diagnosis is, however, possible if little known early paraneoplastic phenomena are noted in the clinical examination.
Axel
J
J
Abteilung für Innere Medizin, Frau Prof. Dr. med. Koop, Evangelisches Amalie-Sieveking Krankenhaus, Hamburg. Juergenaxel@aol.com
Weickert
U
U
Dancygier
H
H
D000328:Adult; D000505:Alopecia / Q000209:etiology*; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D017809:Fatal Outcome; D005743:Gastrectomy; D005770:Gastrointestinal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary; D008297:Male; D010005:Osteoarthropathy, Secondary Hypertrophic / Q000209:etiology*; D010534:Peritoneal Neoplasms / Q000556:secondary; D014463:Ultrasonography