WOFAPS 2025 8th World Congress of Pediatric Surgery

Armanç Güneş, Hakan Özcan, Sefer Tolga Okay, Mete Kaya

Department of Pediatric Surgery, University of Health Sciences, Bursa Yüksek İhtisas Training and Research Hospital

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Introduction

Malignant gastric tumors in children are exceedingly rare and differ considerably from adult cases in clinical presentation, histology, and management. Diagnosis is often delayed due to vague symptoms such as abdominal pain or gastrointestinal bleeding. Among these tumors, gastrointestinal stromal tumors (GISTs) typically follow a less aggressive course, whereas desmoplastic small round cell tumors (DSRCTs) are highly aggressive and require multimodal therapy. We present two adolescent cases to highlight the clinical variability and treatment considerations of pediatric gastric malignancies.

Case Reports

Case 1: A 16-year-old girl presented with abdominal pain, melena, and a palpable epigastric mass. Imaging revealed a centrally necrotic 80×100 mm lesion from the lesser curvature with increased FDG uptake on PET/CT. Histopathology confirmed DSRCT (PanCK+, WT-1+, CD99+, FLI-1+, CD117–, DOG-1–, Ki-67: 85–90%). Subtotal gastrectomy, Roux-en-Y gastrojejunostomy, and liver metastasectomy were performed. Despite initial improvement, the patient died from progressive disease during chemotherapy in the second postoperative year.

Case 2: Another 16-year-old girl with a two-year history of anemia and recent GI bleeding was found to have a 70×50 mm centrally necrotic mass at the corpus-antrum junction. Biopsy confirmed epithelioid GIST. Immunohistochemistry showed CD117(+), DOG-1(+), Desmin(–), S-100(–), Ki-67: 10–15%. Subtotal gastrectomy and Roux-en-Y reconstruction were performed. At the sixth postoperative month, she remains asymptomatic and under regular oncologic follow-up.

Conclusion

Although rare, pediatric gastric malignancies pose diagnostic and therapeutic challenges. While complete resection is often sufficient for GISTs, aggressive tumors like DSRCT require multimodal treatment. Early diagnosis supported by immunohistochemistry and molecular profiling is essential to improve outcomes.