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BMJ Case Rep. 2017 Jul 26;2017. pii: bcr-2017-220540. doi: 10.1136/bcr-2017-220540.

Giant oesophageal gastrointestinal stromal tumour presenting with dyspnoea and clubbed fingers.

Author information

1
Department of Gastroenterology, Toho University Medical Center Omori Hospital, Ota-ku, Tokyo, Japan.
2
Department of General Medicine and Emergency Care, Toho Universtiy, School of Medicine, Ota-ku, Tokyo, Japan.
3
Department of Surgical Pathology, Toho University Medical Center Omori Hospital, Ota-ku, Tokyo, Japan.

Abstract

Gastrointestinal stromal tumours (GISTs) are mesenchymal neoplasms of the gastrointestinal tract originating from the interstitial cells of Cajal. Giant oesophageal GISTs are rare since the oesophagus is rarely the primary site of GISTs, and they are usually diagnosed early due to complaints such as dysphagia. We present the case of a giant oesophageal GIST presenting with prominent clubbing. The case underlined the diagnostic importance of clubbing and the careful consideration of chemotherapy. Although clubbed fingers associated with GISTs are rare, our experience demonstrates the importance of physicians' recognition of clubbing as a paraneoplastic phenomenon for early diagnosis of malignancies since patients seldom notice their own clubbing by themselves. Chemotherapy using imatinib, an Bcr-Abl kinase inhibitor, is the standard option for unresectable giant GISTs. However, careful consideration must be made of the risk of complications associated with rapid mass reduction due to imatinib such as bleeding, oesophageal perforation and mediastinitis.

KEYWORDS:

Contraindications And Precautions; Drug Therapy Related To Surgery; Gastrointestinal System; Medical Education; Oesophageal Cancer

PMID:
28751509
DOI:
10.1136/bcr-2017-220540

Conflict of interest statement

Competing interests: None declared.

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