Lower GI bleeding secondary to a stromal rectal tumor (rectal GIST)

We present the case of a 64-year-old woman without any known allergies to drugs, who had smoked 20 cigarettes a day for more than thirty years, and with no other relevant history, who presented to our Department of Gastroenterology complaining of rectal bleeding and secondary ferropenic anemia with a hemodynamic repercussion.A colonoscopy was made to reveal the presence of a polypoid, submucous, ulcerated lesion in its vertex (8 cm from the anal margin) (Fig. 1).An endoanal ultrasound scan showed a heterogeneous mass located in the posterior wall of the rectum, approximately 7 cm in size, with no infiltration of perirectal fat (Fig. 2).A biopsy was made with a tru-cut needle, and the pathological study showed a proliferation of fusiform cells, with no mitoses or atypias, and strongly positive for the CD-117 marker; staining by other markers (CD-34, desmine, actine, and S-100) was negative, except for one slight ki-67-related positivity, less than 10%.An abdominal CAT scan revealed no metastases at all levels.With a preoperative diagnosis of rectal stromal tumor, the mass was removed by local excision with preservation of the rectum.The patient is currently in the eighteenth month of follow-up, and has no signs or symptoms of relapse, neither locally nor distally. DISCUSSIONThe incidence of GISTs is greatest in the fifth and sixth decades of life.Histologically they are made up of fusiform, epitheloid, or mixed cells.The diagnosis is confirmed by immuno-histochemical techniques, and by the expression of a