P31.06: Small intestine tumor presenting as adnexal area mass

Anemia is one of the most common cause of gynecology consultation in reproductive age women, mainly caused by abnormal uterine bleeding. Gynecologycal ultrassound is the first line exam to look for gynecological disease. A 40 year old women with history of HIV and HCV infection was referred to gynecological consultation for iron deficiency anemia. On gynecological ultrassound a solid mass in the right adnexal area was found with 57x50x34mm color score 4 and low resistence flows. Uterus showed sonographic features of adenomyosis, ovaries seemed normal and a fallopian tube tumor was suspected. A CT scan was performed to clarify the origin of this finding. It revealed a solid intraperitoneale mass in the right flank with 61 × 47 × 45 mm, heterogeneous, well vascularizated, seeming to be an extraluminal lesion of small intestine or mesentery, although it couldn't be excluded a different etiology. She was submitted to exploratory laparoscopy. A multifocal tumor of small intestine was found and it was performed a 15cm resection of small intestine. Histological result revealed a gastrointestinal stromal tumor (GIST), multifocal, with low mitotic rate. GISTs constitute the most common nonepithelial “benign” neoplasm involving gastrointestinal (GI) tract but are thought to represent only 1% of primary GI cancers. Nowadays all GISTs are considered to have malignant potential although different GISTs have different tendency to recur or to metastasize. GISTs may be asymptomatic and discovered incidentally but more often they are associated with nonspecific symptoms unless they bleed or achieve large dimensions. Gynecologycal ultrasound allows a detailed study of uterus and adnexa but it allows to take an overview of the whole pelvis too. Any abnormal finding must be interpreted taking in consideration the pelvic anatomy. CT a RMI should only be used as a complement of ultrasound.