Incidental Finding of a Gastrointestinal Stromal Tumor during an Inguinal Hernia Repair

Introduction: Gastrointestinal Stromal Tumors (GISTs) are rare tumors derived from the mesenchyme. They are usually benign and are most commonly found in the stomach. They arise from the interstitial cells of Cajal, and the majority express c-kit, a tyrosine kinase receptor. Only about a third of patients with GIST have symptoms. There have been several reports of GIST found incidentally during gastric bypass surgery. However, there is a paucity of literature regarding GISTs found incidentally during other types of operations. Case presentation: A 53-year old male was referred to the general surgery clinic for bilateral inguinal hernias. A bilateral inguinal hernia repair with plug and patch mesh was performed. At the time of his operation, a nodule was noted in the right hernia sac and was subsequently sent to pathology. The pathology report revealed a GIST with a high mitotic rate. Discussion: Most GISTs are symptomatic or found incidentally on CT (computerized tomography) scans. This is an interesting case because previous literature regarding GIST found incidentally at the time of a hernia repair is rare. Conclusions: A Computerized Tomography and Positron Emission Tomography (CT/PET)scan revealed a large mass in the left upper quadrant of the abdomen that had a necrotic center and involved several loops of small bowel. The patient was placed on Imatinib. A repeat CT/PET scans revealed decrease size in the left upper quadrant mass. This case illustrates the importance of sending tissue to pathology when there are unanticipated findings in the operating room.