# Metachronous Gastrointestinal Stromal Tumors of Different Histologies: An Unusual Case

## TL;DR

A 66-year-old man developed two different types of gastrointestinal stromal tumors in separate locations over four years.

## Contribution

This is the first reported case of metachronous GISTs with distinct histologies in different gastrointestinal locations.

## Key findings

- A patient had an epithelioid GIST in the stomach followed by a spindle cell GIST in the jejunum four years later.
- Surveillance imaging three years after the second surgery showed no tumor recurrence.
- This case highlights the possibility of multiple primary GISTs with different histological subtypes.

## Abstract

Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors accounting for only a small fraction of all primary malignant tumors of the gastrointestinal tract. Histologically, GISTs are classified as epithelioid, spindle type, or mixed. We present a case of a 66-year-old male incidentally noted to have a pedunculated gastric mass along the lesser curvature of the stomach during a laparoscopic Nissen fundoplication and hiatal hernia repair. A wedge resection was performed and the pathology demonstrated a 3.7 cm GIST of epithelioid type. Four years after the initial surgery, a jejunal mass was identified via CT enterography as part of a workup for ongoing iron deficiency anemia. A laparoscopic small bowel resection was performed, and the pathology revealed a new primary 3.2 cm GIST of the spindle cell subtype. Three years after surgery, surveillance imaging is negative for any recurrence. This appears to be the first report of the occurrence of metachronous primary GISTs of different histologic subtypes, separated by location.