A rare case of concomitant huge exophytic gastrointestinal stromal tumor of the stomach and Kasabach-Merritt phenomenon.
BACKGROUND
We report an extremely rare case of concomitant huge exophytic GIST of the stomach and Kasabach-Merritt phenomenon (KMP).


METHODS
The patient was a 67-year-old man experiencing abdominal distension since September 2006. A physical examination revealed a 25 x 30 cm hard mass that was palpable in the middle and lower left abdomen minimal intrinsic mobility and massive ascites. Since the admitted patient was diagnosed with DIC, surgery could not be performed. The patient received a platelet transfusion and the DIC was treated. Due to this treatment, the platelet count recovered to 7.0 x 10(4); tumor resection was performed at 16 days after admission. Laparotomy revealed a huge extraluminal tumor arising from the greater curvature of the stomach that measured 25 x 30 cm and had not ruptured into the peritoneal cavity or infiltrated other organs. Partial gastric resection was performed. The resected mass measured 25 x 25 x 20 cm. In cross section, the tumor appeared hard and homogenous with a small polycystic area. Histopathology of the resected specimen showed large spindle cell GIST with >5/50 HPF (high-power field) mitotic activity. The postoperative course was uneventful, and the coagulopathy improved rapidly.


CONCLUSIONS
Since the characteristic of tumor in this case was hypervascularity with bleeding and necrotic lesions, coagulopathy was thought to be caused by the trapping of platelets within a large vasculized tumor mass.
Watanabe
Taiji
T
Department of Gastoenterological and General Surgery, St, Marianna University School of Medicine 2-16-1, Sugao Miyamae, Kawasaki, Kanagawa, Japan. taiji_watanabe@marianna-u.ac.jp
Segami
Kohei
K
Sasaki
Takahiro
T
Kawashima
Hatsuya
H
Enomoto
Takeharu
T
Jinnouchi
Yuji
Y
Koizumi
Satoshi
S
Tobe
Naotaka
N
Sakurai
Joh
J
Shimamura
Tsukasa
T
Suda
Tadashi
T
Asakura
Takeshi
T
Nakano
Hiroshi
H
Ichiroh
Tanaka
T
Otsubo
Takehito
T
D004211:Disseminated Intravascular Coagulation / Q000150:complications* / Q000628:therapy; D046152:Gastrointestinal Stromal Tumors / Q000150:complications* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000150:complications* / Q000473:pathology