Clinical Presentation

At presentation, most patients are in their fifth and sixth decade of life, and GISTs are rarely seen in patients younger than 40 years of age.11 No gender predilection has been established,22,23 although some data showed male predominance.1,24 There is no association between race, ethnicity, occupation, or geographic location.25

The clinical manifestation of GIST is widely variable, depending on tumor location and size. The most frequent location for GIST is in the stomach (70%), followed by the small bowel (20% to 30%).10 Tumor size is extremely variable, ranging from small lesions to large masses. Small tumors are usually asymptomatic and are diagnosed incidentally during imaging, endoscopy, or surgery. GISTs may remain clinically silent because of their submucosal origin and tendency to grow exophytically. Symptomatic GISTs are usually large and may present with gastrointestinal bleeding from mucosal ulceration.26 Patients may present with hematemesis, melena, or symptoms and signs of anemia resulting from occult bleeding.27 Other symptoms include abdominal fullness and pain. A palpable mass may also be present. The submucosal location of the tumor may cause obstruction or perforation, especially those arising form the esophagus or small intestine. Tumors in the esophagus may present with dysphagia, and those arising in the duodenum may compress the adjacent pancreatic head, resulting in fever and jaundice. Rectal GISTs may present with symptoms of mass effect such as frequency, hesitancy, or poor urinary stream due to invasion of the urinary bladder.26

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