SHM Converge Scientific Abstract ePoster Gallery-Gist With Synchronous Pheochromocytoma in Patient Without Neurofibromatosis Type 1

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This poster describes a rare case of synchronous gastrointestinal stromal tumor (GIST) and pheochromocytoma in a 72-year-old woman without neurofibromatosis type 1. GISTs account for less than 1% of gastrointestinal tumors but can coexist with other malignancies in a significant number of cases, most commonly gastrointestinal adenocarcinomas. Association with pheochromocytoma is usually seen in patients with neurofibromatosis type 1, making this case unusual.<br /><br />The patient presented to the emergency department after loss of consciousness and had several days of melena. Her history included insulin-dependent diabetes mellitus and prior papillary thyroid cancer. On evaluation she was hemodynamically stable but severely anemic, with hemoglobin of 6.4 g/dL and positive fecal occult blood testing.<br /><br />Head CT was negative for acute bleeding. Upper endoscopy revealed subepithelial gastric lesions on the lesser curvature and body of the stomach with extensive lymphadenopathy suspicious for malignancy. Fine-needle aspiration showed a spindle cell neoplasm, supporting GIST. Subsequent CT of the chest, abdomen, and pelvis identified a left adrenal mass. Biopsy of this mass demonstrated a neuroendocrine tumor, and elevated urine and serum metanephrines/normetanephrines confirmed pheochromocytoma.<br /><br />The patient was treated preoperatively with phenoxybenzamine and later underwent gastrectomy.<br /><br />The main message is that clinicians should consider and screen for associated malignancies when GIST is diagnosed, even when classic syndromic associations such as neurofibromatosis are absent.

Asset Subtitle

Muhammad Tayyeb

Meta Tag

Author List Aamir Shahzad, Farhan Khalid, Mili Kakadia, Muhammad Tayyeb, Seemab Fatima, Syed Zahid Raza Kazmi

Category Clinical Vignettes

Concept Gastrointestinal Stromal Tumor

Concept Pheochromocytoma

Concept Alpha Blockade

Concept Phenoxybenzamine

Concept Gastrointestinal Bleeding

Distinguished Non-Finalist

Presenter Organization Monmouth Medical Center

Presenting Author Muhammad Tayyeb

Track Adult

Keywords

gastrointestinal stromal tumor

GIST

pheochromocytoma

synchronous malignancy

neurofibromatosis type 1

gastric tumor

melena

spindle cell neoplasm

adrenal mass

phenoxybenzamine

Gastrointestinal Stromal Tumor

Pheochromocytoma

Alpha Blockade

Phenoxybenzamine

Gastrointestinal Bleeding