ASPHO August 2017 Case Quiz

A 16 Year Old Male with Iron Deficiency Anemia: the essential part of the matter
Kaitlin Stanley, MD, and Erika Friehling, MD

A 16-year-old previously healthy young man presented to the emergency room with fatigue, headaches and pallor. He endorsed a history of black, tarry stool and early satiety for several months. His maternal family history was not significant, and paternal history was unknown. On physical exam, he was pale and was noted to have a systolic flow murmur. There was no organomegaly, and an abdominal mass was not palpable. 

Laboratory evaluation was significant for a hemoglobin of 6.6 g/dL with an MCV of 77 fL. The remainder of the CBC was unremarkable, as were electrolytes, hepatic function panel and coagulation studies. Stool guaiac was positive. 

Abdominal MRI was performed and revealed a large mass in the antrum of the stomach. Esophagogastroduodenoscopy was performed and revealed a large irregular, submucosal mass in the stomach antrum.  The patient underwent a biopsy of this mass.

Pathology findings are shown above, and demonstrate proliferation of short spindle cells with elongated nuclei. The tumor cells are arranged in short fascicles and demonstrate nuclear palisading. Immunohistochemistry was strongly positive for c-kit (CD117) staining.