Primary hepatic gastrointestinal stromal tumor presented with rupture
Images in Clinical Medicine

Primary hepatic gastrointestinal stromal tumor presented with rupture

Hon Ting Lok1, Ching Ning Chong1, Anthony Wing Hung Chan2, Kwong Wai Fong1, Yue Sun Cheung1, John Wong1, Kit Fai Lee1, Paul Bo Shan Lai1

1Department of Surgery, 2Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China

Correspondence to: Paul Bo Shan Lai. Department of Surgery, Prince of Wales Hospital, the Chinese University of Hong Kong, 4th floor, Clinical Science Building, 30-32 Ngan Shing Street, Shatin, Hong Kong, China. Email:

Submitted Sep 21, 2016. Accepted for publication Nov 02, 2016.

doi: 10.21037/hbsn.2017.01.11

A 50-year-old lady presented with sudden onset right upper quadrant abdominal pain. Physical examination found a tender hepatomegaly. Computed tomography revealed a 15 cm hypervascular heterogeneous hypodense lesion in the right hepatic lobe (Panel A). Ill-defined scattered lesions were found over left lobe of liver. Virology study was negative for both hepatitis B and C. Serum alpha-fetal protein (AFP) and carcinoembryonic antigen (CEA) were not elevated (AFP 3 µg/L, CEA 1.4 µg/L). Laparotomy demonstrated 200 mL hemoperitoneum and a 17-cm tumor at right liver lobe with rupture at the dome. Patient underwent a right lobe hepatectomy and had an uneventful recovery. Pathological examination revealed a spindle cell neoplasm with a high mitotic figure up to 70/50 high power field with clear resection margin (Panel B). The tumor showed positive stained for c-kit/CD117, CD34 and smooth muscle actin, suggestive of GIST (Panel C). Subsequent upper gastrointestinal endoscopy, positive emission tomography and computed tomography did not reveal any primary lesion. Imatinib mesylate 400 mg daily was started. The patient was found to have brain metastasis with acute cerebral hemorrhage. She finally succumbed 6 months after her initial presentation.




Conflicts of Interest: The authors have no conflicts of interest to declare.

Informed Consent: Verbal consent has been obtained from patient’s next of kin for the publication of this case report and both radiological and histological images.

Cite this article as: Lok HT, Chong CN, Chan AW, Fong KW, Cheung YS, Wong J, Lee KF, Lai PB. Primary hepatic gastrointestinal stromal tumor presented with rupture. Hepatobiliary Surg Nutr 2017;6(1):65-66. doi: 10.21037/hbsn.2017.01.11