GIST with a twist: An extra-luminal pedunculated gastric GIST presenting with tumor torsion and hemoperitoneum

Gastrointestinal stromal tumors (GIST) are rare mesenchymal tumors. Most present with nonspecific symptoms. We present a case of a 17-year-old male with sudden abdominal pain. Imaging revealed a hypodense mass inferior to the stomach. Serial blood work showed a decreasing hemoglobin level. In the operating room a pedunculated, torted, hemorrhagic mass on the anterior surface of the stomach was resected. Pathology confirmed a GIST, c-kit positive with involved margins. The patient was started on imatinib. Pediatric GISTS are different than adult GISTs; the majority are c-kit negative (wild-type) and typically indolent. Despite a high recurrence rate, aggressive resection of pediatric GIST is generally not indicated. This pediatric GISTs was c-kit and PDGFR exon 18 mutation positive and thus was treated according to the National Comprehensive Cancer Network (NCCN) guidelines (for adults).