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The Old Endoscopy Quiz (and Answer) of the Month
November 2006

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Question:

Click on this image to start the slide show!

This man in his older middle age came to the hospital because of an obvious gastrointestinal bleeding. This was the finding in an acute upper endoscopy. This semimalignant - or malignant - tumour in the lower part of is gastric body is not an adenocarcinoma, nor is it a carcinoid tumour. So, what is it?

Answer:

A Gastric Gastrointestninal Stromal Tumour (GIST).
Ulcerated leiomyoma and leiomyosarcoma are of course also correct answers.

A gastric Gastrointestinal Stromal Tumour (GIST) A GIST-tumour in the distal small bowel

Gastrointestinal Stromal Tumour (GIST), a sarcoma (a tumour arising from the connective tissue) of the gastrointestinal tract. GIST is rare, only about 1-3% of all malignant tumours in the gastrointestinal canal are of this kind. About two thirds of these tumours occur in the stomach, one fifth in the small intestine and one tenth in the oesophagus. GISTs are often benign, but larger tumours can cause liver and peritoneal metastases. Bleeding causing anaemia is the main symptom. Nausea, vomiting and weight loss are other common symptoms. Diagnose is most often made by endoscopy and biopsies taken during this examination. Surgical therapy is curative if the disease is not disseminated. These tumours have recently been found to respond very favourably to treatment with Imatinib (Glivec). Tumours formerly called leiomyosarcomas are considered to be GISTs.

Correct answers and comments were emailed by

Luiz Carlos Bertges, Juiz de Fora mg, Brazil, Minas Gerais
German Lloret Salom, Alzira, Spain
Salvatore Della Ducata, Gallipoli, Italy
Gülbanu Erkan, Ankara, Turkey
Lavrentios Papalavrentios, Thessaloniki, Greece
Irina, New Haven, US/CT
Dr. Sediqi, Kabul, Afghanistan
Arber Veliu, Prishtina, Kosovo
BOIVIN, Landerneau, France
Albert J. Chang, Los Angeles, CA, USA
Zahreddine Radwan, Beirut, Lebanon
luis guillermo guerrero, Bogota, Colombia
Antonio Siqueira, Brasilia, DF - Brazil
Vimalraj Velayutham, Chennai, India/Tamilnadu
PARABOLI SILVA, Marcio Luiz , SAOJOSE DO RIO PRETO -SP-, BRAZIL
Barthe, Saint Claude, France
Saul, MAnchester, Britain
Sam Iam, age 6 (!), Durham, NC
Pavel Sillinger MD, Pardubice, Czech Republic
Rui Loureiro, Almada, Portugal
Carlos Alberto A. Ghetti, Juiz de Fora, Minas Gerais - Brazil
Recher, Rome, Italy
Christina Ecclissato, campinas, Brazil
Dr Chris Wadsworth, London, UK
Douglas Maurício Hallaruthes Santos, Belo Horizonte, Brasil/Minas Gerais
christina da cunha ecclissato, Campinas, Brasil
Sandra, Rio de Janeiro, Brasil
Marilia, Rio de Janeiro, Brazil
Balas Maria, Baia Mare, Romania
U. Cuartas, Augusta, USA
Subbaramiah Sridhar, Augusta, Georgia, USA
ivana, Osijek, Croatia
Ceci vincenzo, Roma, Italy

Colosseum, Rome, Italy Gianfranco Donatelli, Roma, Italy
Minervini Stefano, Rome, Italy
MONIER, LYON, FRANCE
Malgorzata Lazuchiewicz-Kot, Lodz, Poland
BURHAN TAM, ÝSTANBUL, TÜRKÝYE
Zlatko Bulic, Pula, Croatia
Hurler, Ulrike, Heidenheim, Germany
dr. Simeonov, Sofia, Bulgaria
Karolin Isaksson, Lund, Sweden
Amit Goyal, Denver, CO, USA
Ivan, Zagreb, Croatia
Radu Ionescu, Bucharest, Romania
Rashed Rashid Ayyash, Cangucu, RS/Brazil
Hakan, Istanbul, TURKEY
M. Narendranathan, Trivandrum, India
Sapoznikov Boris, Tel Aviv, Israel
FERNANDO PERES, Rio de Janeiro, Brazil
Dr Idris, shah alam, Malaysia
thaix, BKK, Thailand
Mohamed Gumie, Cairo, Egypt
Jose Dondis, MD, Panama, Panama
Maciej Kosieradzki, Warsaw, Poland
hew, Elgin, Scotland
Narendra Siddaiah, Jackson, Mississippi, USA
Helena Vasconcelos, Leiria, Portugal
Fmartinezj, valencia, Spain
zhuqingyun, Shanghai, CHINA
Scott Cooper, Pittsburgh, PA, USA
Claudia Iacobescu, Bucharest, Romania
Fackler, Macon, USA/GA
S.Prabhakaran, Redditch, UK
Mones Takriti, Pontiac, USA/Michigan
Cevale Karslioglu Sgouros, Istanbul, Turkey
frandah, tripoli, Libya
Bousboukea Ekaterini, Athens, Greece
rashed, fakoous, Egypt
Tsiaousi Eleni, Thessaloniki, Greece
Tamara Alempijevic, Belgrade, Serbia
Kadri Guven, Kayseri, Turkey
Ma³gorzata Ferenc, Olsztyn, Poland
Golisiri, Tehran, Iran
Luis I. Gurza Morales, Torreón, Coahuila, México
Angel Escudero, Orizaba, Ver, México
Sheikh Anwar Abdullah, Kuala Lumpur, Malaysia
Hakan, Istanbul, TURKIYE

Tropical sunset in Bonito, Brazil ©
Brazil is clearly the winner in this Quiz of November. Congratulations! There are answers from 31 countries, from Europe, Asia, Africa, North America and South America. This was thought to be quite a difficult question - so thanks to You all who have provided a correct answer!

Comments:

ULCERATED GASTRIC GIST ....CONGRATULATIONS EXCELENT CASE WONDERFUL IMAGES.....

Gist tumor but we need endoscopy ultrasound to differenciate with ectopic pancreas, carcinoid may give the same picture too.