Answer of July 2004

Clinical History:

A 40-year-old man with low-grade fever and moderate headache for a few weeks. Examination of the upper respiratory tract, chest and urine did not reveal foci of infection. 

                                            Fig.1
                Precontrast T1-weighted MR axial scan 

                                           Fig.2
              Postcontrast T1-weighted MR axial scan

                                            Fig.3
            Postcontrast T1-weighted MR coronal scan

Diagnosis:

Malignant GIST ( GI Stromal Tumour ) of stomach

Discussion:

There is a large heterogeneous oval lesion in the left upper abdomen which has close relation with the gastric fundus. It extends to the left retroperitoneum. The spleen is displaced laterally. The lateral limb of the left adrenal gland and the tail of pancreas are in contact with the lesion. No ascites or lymph node enlargement is seen. The left kidney is not involved. Malignant GISTs of stomach typically has no ascites, bowel obstruction or lymph node metastases. The differential diagnosis is malignant adrenal tumour.