Malignant Gastric Stromal Tumor
We present the case of a woman with metastatic malignant gastric stromal tumor occurring four years following a partial gastrectomy and distal esophagectomy, which presented as atypical breast mass with synchronous occult gastrointestinal bleeding. A discussion of metastatic pattern is presented, with emphasis placed on the need for continued surveillance after resectional surgery for gastrointestinal stromal tumor (GIST).

Gastric stromal tumor is a rare entity. It accounts for a small percentage of smooth muscle tumors of the stomach. Management usually consists of excision of the tumor with a good margin of normal tissue. Wide resection of lymph node areas is not indicated because of the extreme rarity of lymph node metastasis. The most common site of metastasis of malignant stromal tumor is the liver, peritoneum and lung. These can develop as long as thirty years after the removal of the primary tumor. In this report, we describe the metastasis of a gastric stromal tumor to an intramammary lymph node and synchronous small bowel metastasis four years after primary gastric resection. A review of the literature and the pattern of metastasis are discussed.