Gastrointestinal stromal tumor associated with a different malignant neoplasia.

The gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor in the digestive tract (1). It is accompanied by unspecific symptoms, and gastrointestinal bleeding is infrequent. The most common locations for the bleeding are the stomach and, secondly, the small intestine (2,3). They can be associated with malignant tumors. Case report We present a 65-year-old patient with hypercholesterolemia and alcoholic chronic pancreatitis under treatment with acetyl-salicylic acid. The patient was hospitalized for asthenia and mele-na. He presented a good general condition, with some pale skin and mucosa. Blood pressure, 110/60 mmHg; heart frequency, 82 bpm; hemoglobin, 4.6 g/dl; hematocrit, 14.2 %; serum urea, 67 mg/dl; serum creatinine, 1 mg/dl. The emergency gastroscopy revealed chronic gastritis with intestinal metaplasia, with no blood traces up to the third part of the duodenum. The colonoscopy showed abundant remains of red blood and clots from the rectum to the cecum, with normal mucosa. There was blood and clots in the cecum and on the ileocecal valve suggesting that the bleeding has its origin in the small intestine. A capsule endoscopy revealed a vegetative and ulcerative lesion in the proximal ileum that occupies the intestinal lumen, and the presence of blood that extended to the colon. The abdomino-pelvic CT scan showed a 2 x 3.5-cm heterogeneous nodular lesion that involved the ileal region. Incidentally, there was a heterogeneous lesion on the medial region of the inferior pole of the right kidney of 3 cm in diameter, with peripheral calcification. Initially, the patient underwent a 5 cm intestinal resection in which a 3 x 3 tumor was found, protruding from the serous membrane, cir-cumscribed, with a dirty white and grayish outer surface, with a marked vascular pattern and firm consistency. The final his-tological diagnosis was gastrointestinal stromal tumor of the jejunum (GIST) with a spindle-cell pattern, 1 mitosis/50; phenotype: CD117(+), CD34(+), desmin(-), actin(-), S100(-). Prog-nostic group 2 (benign). Afterwards, he underwent a kidney tumorectomy that revealed a papillary renal cell carcinoma type 1, Furhman 1-2. Stage pT1b. Discussion At least one third of all GISTs are discovered incidentally in the course of the therapeutic procedures for other conditions (4), or in the staging of primary tumors. GISTs can coexist with different types of cancer, either synchronically or metachronically. In 14-20 % of the patients, this association appears mainly with solid tumors (5). Gastric GISTs are the most common ones to be involved with other tumors, …