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논문분류	춘계학술대회 초록집
제목	A Rare Case of a 34-Year old Filipino Male with Sporadic Gastric Spindle Cell Carcinoma presented with Diabetes Insipidus
저자	Hazel Ann Gianelli Cu
출판정보	2024; 2024(1):
키워드
초록	Gastrointestinal stromal tumors (GISTs) are rare neoplasms that represent only around 1 to 2 percent of primary gastrointestinal (GI) cancers in the world. The highest incidence reported in Asia was in China wherein there are 19 to 22 cases per million population per year. GISTs are more common in the older aged 60 and up, and a younger population of 20 years or less, with equal predominance between male and females. We are presented with a 34 year old male who came in due to gastrointestinal bleeding, underwent endoscopy wherein gastritis was seen, and discharged with oral medications. A year later, with a noted recurrence of the same symptoms, unremarkable mesenteric angiogram was seen. CT scan of the abdomen was done revealing non-enhancing soft tissue mass measuring 4.0 x 3.6 x 3.5cm (AP x T x CC) seen along the jejunum. He then underwent segmental resection of the mass. Biopsy revealed gastrointestinal stromal tumor, spindle type, low grade, positive for CD117, DOG1 and CD34 stains. On the 4th postoperative day, he was referred to nephrology service due to polyuria. Electrolytes and glucose were all normal. Ultrasonography showed a normal sized kidney with no urinary retention. Work-ups done revealed a serum osmolality 275mosm/kg, serum sodium of 141mmol/L, urine osmolality 350mosm/kg and urine sodium 155mmol/L. Fluid restriction was done but there was no decrease in polyuria, initiation of low dose Desmopressin. Urine output tapered down but repeated urine and serum osmolality showed inadequate response. Vasopressin receptor defect (AVP-D) secondary to drug induced event was considered. However, due to persistence of polyuria even after withdrawal of suspected drugs, cranial MRI was done revealing a cystic focus within the pituitary gland. Patient was treated as AVP-D secondary to pituitary metastasis from GIST-spindle type. Desmopressin was started, and systemic targeted therapy was initiated.
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