A 65-year-old patient with hypercholesterolemia and chronic ethylic pancreatitis and treated with acetylsalicylic acid was admitted for asthenia and melena.
The patient presented good general condition with skin and mucous membrane tenderness.
Arterial thrombosis, 110/60 mmHg, heart rate 82 beats/min, hemoglobin 4.6 g/dl, hematocrit 14.2 %.
Urea 67 mg/dl and creatinine 1 mg/dl. In emergency gastroscopy: chronic gastritis with intestinal metaplasia, without blood remnants up to the third duodenal portion.
Seizure: from rectum to cecum abundant red blood cells and clots with normal mucosa.
In the cecum and on the ileocecal valve there was blood and a clot, suggesting the origin in the small intestine.
A study with capsule endoscopy showed a vegetating ulcerated lesion in the proximal ileum that occupied the intestinal lumen and blood to the colon.
The abdominal-pelvic CT scan showed a nodular lesion of heterogeneous appearance, in relation to the ileum loop of 2 x 3.5 cm in diameter.
Incidentally, a heterogeneous lesion dependent on the medial region of the lower pole of the right kidney of 3 cm in diameter with peripheral calcifications was also found.
The patient was initially subjected to intestinal resection of 5 cm, obtaining a 3 x 3 cm tumor that protruded in the serosa, circumscribed, of external surface greyish whitish vascular firm consistency.
Definitive pathological diagnosis was yey ́s gastrointestinal stromal tumor (GIST), with spindle cell pattern, 1 mitosis/50, phenotype: CD117+, CD34+, S100 desmin-
Prognostic group 2 (benign).
In a second time, the patient underwent a renal tumorectomy, which was a type 1 papillary renal carcinoma, Fuman type 1-2.
Stage pT1b.
