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Gastric gastrointestinal stromal tumor presenting with an intraluminal draining abscess and left pleural effusion.

A previously healthy 77-year-old woman presented with a 2-month history of anorexia, fever, and weight loss. On physical examination, she had diminished breath sounds in the lower two-thirds of the left hemithorax; her chest radiograph revealed a left pleural effusion (●" Fig.1). Laboratory work-up showed a hemoglobin of 9.6g/dL, C-reactive protein (CRP) of 9.5mg/dL, and erythrocyte sedimentation rate (ESR) of 70mm/hour. Because of a family history of pulmonary tuberculosis, a tuberculous pleural effusion was suspected. A thoracentesis and pleural biopsy were performed, which revealed clear pleural fluid with the characteristics of an exudate, without malignant cells. A thoracic contrast-enhanced computed tomography (CT) scan incidentally showed a large gastric mass, with no fistulous tract to the pleura. Upper gastrointestinal endoscopy showed a bilobed mass of 5cm in the posterior aspect of the gastric fundus that was spontaneously discharging a large amount of purulent material from a small central orifice (●" Fig.2;●" Video1). For better characterization and staging, an abdominopelvic contrast-enhanced CT was performed, which showed a mass of 14×12×11cm, with central necrosis, originating in the posterior gastric wall and in contact with the spleen, suggestive of a gastrointestinal stromal tumor (GIST) complicated by an abscess (●" Fig.3). No nodal or distant metastases were seen. Forceps biopsies of the mass were inconclusive and no infectious agent was isolatFig.2 Images from upper gastrointestinal endoscopy showing a bilobed mass of 5cm in the posterior aspect of the gastric fundus that was spontaneously discharging a large amount of purulent material from a small central orifice. Fig.1 Chest radiograph in a 77-year-old woman with a 2-month history of anorexia, fever, and weight loss showing a left pleural effusion.