Received: 30.11.2011 Accepted: 10.02.2012 J Gastrointestin Liver Dis March 2012 Vol. 21 No 1, 101-103 Address for correspondence: Prof. Dan L. Dumitrascu 2 nd Department of Internal Medicine Clinical County Emergency Hospital Cluj-Napoca, Romania, Email: ddumitrascu@umfcluj.ro Gastrointestinal Stromal Tumor (GIST) Associated with Synchronous Colon Adenocarcinoma – A Case Report Catalin Nemes 1 , Liliana Rogojan 2 , Teodora Surdea-Blaga 1 , Andrada Seicean 3 , Dan L. Dumitrascu 1 , Constantin Ciuce 4 1) 2 nd Department of Internal Medicine; 2) Department of Pathology, Clinical County Emergency Hospital; 3) Regional Institute of Gastroenterology and Hepatology “Prof. Dr. Octavian Fodor”, University of Medicine and Pharmacy Iuliu Hatieganu; 4) 1 st Surgical Clinic, University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napoca, Romania Abstract Gastrointestinal stromal tumors (GIST) are rare mesenchymal neoplasms of the gastrointestinal tract with a malignant potential and unpredictable behavior. In the literature a few cases of synchronous development of a GIST and another neoplasia with different incidence, etiology, evolution and prognostic have been described. We report a case of a 61 year old male with a simultaneous occurrence of a GIST and a colon adenocarcinoma. Key words Gastrointestinal stromal tumors - GIST – adenocarcinoma – synchronous tumors – metallothioneins. Introduction Gastrointestinal stromal tumors (GIST) are rare mesenchymal neoplasms of the gastrointestinal tract with an incidence of 1.5/100,000/year [1, 2] typically described in adults, with a peak incidence in the sixth and seventh decades [3]. These tumors have malignancy potential, but their behavior has been dificult to predict and the co-existence of other primary gastrointestinal malignancies and GIST has been rarely reported in the literature [4]. We present a 61 year old male with a simultaneous occurrence of a GIST and a colon adenocarcinoma. Case report A 61 year old male was admitted complaining of asthenia, weakness, chest pain, diffuse abdominal pain, latulence. He denied any associated gastrointestinal symptoms such as nausea, vomiting, weight loss, diarrhea, constipation, melena or hematemesis. A duodenal ulcer, surgery for an umbilical hernia and chronic anemia were mentioned in his medical history. The patient had as comorbidities essential hypertension, ischemic heart disease, stable angina pectoris and benign prostate hypertrophy. At physical examination, abdominal obesity with diffuse tenderness to deep palpation, leg edema, mucocutaneous pallor was detected. Laboratory tests revealed abnormal parameters (reference range in parentheses): iron deiciency anemia with hemoglobin of 7.5 g/dl (11.5–17.5 g/dl), hematocrit of 25.98% (35–52%), sideremia of 23 μg/dl (50 - 175 μg/dl), reticulocyte count of 26 ‰ (5-20‰) and a positive hemoccult test. Upper gastrointestinal (GI) endoscopy was performed, showing an ulcerated tumor, covered with normal gastric mucosa, localized on the posterior wall of the greater curvature. Upper endoscopic ultrasonography (Fig.1) evidenced a submucosal lesion, about 36/26 mm with decreased echogenicity and inhomogeneous structure, and necrotic areas. The lesion belonged to the muscular layer. The patient was scheduled for surgery. Intraoperatively a tumor at the posterior gastric wall (4/2.7/1.8 cm) and a tumor (about 4./6.55 cm) at the transverse colon had been detected which was iniltrative and stenosing. Gastric tumor Fig 1. Submucosal lesion belonging to the muscular layer by upper endoscopic ultrasonography