ELECTRONIC IMAGE OF THE MONTH Prolapsed Gastric Gastrointestinal Stromal Tumor: A Rare Cause of Biliary Obstruction and Acute Pancreatitis Musa Yilmaz, Juan Ibarra, and Benjamin Leon Musher Baylor College of Medicine, Houston, Texas

77-year-old woman presented with abdominal pain and early satiety. Computed tomography of the abdomen (Figure A) showed a 6-cm submucosal mass (white arrow) on a stalk (black arrow) arising from the gastric fundus as well as several benignappearing liver lesions. Esophagogastroduodenoscopy (Figure B) demonstrated the same non-friable, nonobstructing gastric mass (white arrow) and its stalk (black arrow). While biopsy results were pending, the patient presented to the emergency department with acutely worsening abdominal pain, nausea, vomiting, and jaundice. Laboratory evaluation was significant for the following: alanine aminotransferase 83 U/L, aspartate aminotransferase 117 U/L, total bilirubin 4 mg/dL, and lipase 5315 U/L. Computed tomography imaging (Figure C) showed that the aforementioned mass had prolapsed into the duodenum (white arrow) and obstructed the ampulla of Vater, resulting in dilation of the common bile duct (white arrowhead), pancreatic duct (black arrow), and gallbladder. The mass was resected surgically, and microscopic evaluation (Figure D) revealed a low-grade spindle-cell neoplasm expressing CD117 (KIT), which is consistent with a gastrointestinal stromal tumor (GIST). The patient recovered well from surgery. Her serum bilirubin and lipase levels normalized, and postoperative imaging showed resolution of the pancreatobiliary ductal dilation. Because this GIST carried a low (

Prolapsed gastric gastrointestinal stromal tumor: a rare cause of biliary obstruction and acute pancreatitis.

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