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Yuanetal. BMC Surg (2021) 21:111
https://doi.org/10.1186/s12893-021-01088-4
CASE REPORT
A concealed inguinal presentation
ofagastrointestinal stromal tumor (GIST): acase
report andliterature review
Yujie Yuan1†, Li Ding2†, Min Tan1, An‑jia Han2* and Xinhua Zhang1*
Abstract
Background: Gastrointestinal stromal tumor (GIST) can arise anyplace along the gastrointestinal (GI) tract. The
uncommon tumor location in groin area is rarely reported.
Case presentation: We herein reported a metastasized case presented as GI hemorrhage complicated with indi‑
rect hernia, and underwent tumor cytoreduction, herniorrhaphy and chemotherapy for jejunal GIST. The case was
described consecutively based on the process of surgical management, with a good follow‑up result. A literature
review by searching similar case reports from two national medical databases was performed to summarize clinical
features of such unusual presentation of GIST, which included hernia characteristics, short‑ and long‑term outcomes
of this disease. It showed GIST presenting as groin hernia was rarely reported and all available 11 cases suggested a
primary tumor and required both tumor resection and hernia repair. The long‑term results indicated 64.3% overall
survival at 5 years after the incidental diagnosis.
Conclusions: Inguinal hernia is an extremely rare presentation of GIST, with limited case reports available in the
literature. A radical involving tumor resection plus hernia repair is an optimal surgical approach for such uncommon
condition. An adjuvant medication mounting on mutated KIT gene should be strictly followed for high risk cases.
Keywords: Gastrointestinal stromal tumor, Groin hernia, Surgery, Immunostains, Literature review
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Background
Gastrointestinal stromal tumor (GIST) is one of the most
common mesenchymal tumors, and it involves the whole
gastrointestinal (GI) tract. e recent advances in tissue
evaluation and molecular analysis have earned a deeper
understanding of GIST lesion, which was considered
as a disease arising from neurogenic or smooth mus-
cle [1]. Histologically, GIST is resulted from an anomaly
transformation in the interstitial Cajal cells, responsible
for motor function of the GI tract [2]. Around 80% of
GISTs harbor KIT gene mutations, which would result
in abnormally activation of the KIT receptor that further
leads to tumor growth. Tyrosine kinase inhibitors, such
as imatinib and sunitinib, are specifically effective to limit
its growth and fit for unresectable, metastatic or recur-
rent GIST [3, 4]. Up to the present, a radical resection of
whole tumor with at least 2mm safe margin remains the
golden standard to cure this disease. However, at least
50% of patients develop recurrence or metastasis [5].
e most common primary locations of GISTs are the
stomach (60%) and small intestine (35%). erefore, the
dominant symptoms include upper abdominal pain, GI
bleeding and passage disorders. Such non-specific fea-
tures could identify 25% of GIST patients through an
Open Access
*Correspondence: hananjia@mail.sysu.edu.cn; zhangxinhua@mail.sysu.edu.cn
†Yujie Yuan and Li Ding equally contributed to this work
1 Center of Gastrointestinal Surgery, The First Affiliated Hospital of Sun
Yat‑Sen University, 58 2nd Zhongshan Road, Guangzhou 510080,
Guangdong, People’s Republic of China
2 Department of Pathology, The First Affiliated Hospital of Sun Yat‑Sen
University, 58 2nd Zhongshan Road, Guangzhou 510080, Guangdong,
People’s Republic of China
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Page 2 of 7
Yuanetal. BMC Surg (2021) 21:111
incident diagnosis. Imaging modalities including endo-
scopic ultrasound (EUS) and computed tomography
(CT) play a critical role in its clinical diagnosis. However,
tumor biopsy prior to surgery is not recommended, as it
carries the risk of tumor rupture or seeding in the biopsy
tract [6].
ere is little literature on the GIST located in the her-
nial sac. We herein present the case of an elderly gentle-
man who referred to our institution for GI hemorrhage
due to a ruptured GIST in small intestine with an inci-
dental finding of a seeding tumor located in his right
groin. After that, a literature review of GIST-involving
inguinal hernia is performed to characterize clinical
characteristics of such rare situation.
Case presentation
A 71-year-old man presented to our emergency center
with a history of diffused abdominal pain with intermit-
tent hematochezia for 38 h. e patient denied other
GI or genitourinary complaints, had an unremarkable
medical history, and did not undergo prior abdominal
surgery. On physical examination, the abdomen appeared
tender with extensive rebound tenderness. Unfortu-
nately, his groin areas were ignored to check due to lack
of specific complaints. e blood investigation revealed
a decreased hemoglobin level (9.6 g/dL). A contrast-
enhanced CT scan indicated a lower GI bleeding result-
ing from a ruptured mass (5.2 × 4.1 × 3.0 cm3) located in
small intestine. Meanwhile, CT imaging showed a mini-
mal mass (2.0 × 1.5 × 0.5 cm3) in his right groin but failed
to mention in the emergent report (Fig.1).
e patient was immediately managed with an emer-
gent laparotomy in light of the hemodynamic instabil-
ity. During the surgery, the primary tumor was found
arising from the third jejunal segment (220 cm distant
from the duodenal-jejunal flexure), with disseminated,
multi-focal progression of tumor seeding recorded. A
palliative resection of primary tumor and seeding tumors
(> 2mm) in abdomen was achieved (R1 resection), fol-
lowed by a side-to-side bowel anastomosis. e patient
Fig. 1 The radiological finding of the current case. CT images in the venous phase indicating a huge mass in the small intestine and an isolated
inguinal mass in the right groin. Both masses were contrast‑enhanced, without distinct lymph node metastasis in the abdomen. a Coronal plane
rebuilt scan; b, c Horizontal plane scans; Arrows and triangle shapes indicating inguinal and intra‑abdominal mass, respectively
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Page 3 of 7
Yuanetal. BMC Surg (2021) 21:111
was discharged at the 11th post-operative day without
any complications. e histopathologic report of primary
tumor suggested a GIST of spindle cell nature, with high
mitotic count (25/50 HPF) and significant tumor necro-
sis (Additional file1: Fig. S1). e immunohistochemi-
cal (IHC) staining evaluation indicated severe positivity
for CD117, DOG-1 and SDHB, mild positivity for actin
and desmin, but negative for CD34 and S-100. e Ki-67
index was 20%. e molecular analysis reported a muta-
tion rate of 18.22% for the c-KIT, mainly located on
A502_T503dup exon 9. e tumor was hence categorized
as high-risk jejunal GIST.
e patient received imatinib chemotherapy (400mg/
day) postoperatively for three months until a com-
plaint of persistent pain in the right groin. On physical
examination, a painful, irreducible, non-pulsatile mass
(2.0 × 2.0 × 1.0 cm3) was felt in right groin, with negative
finding in contralateral side. He was referred to the her-
nia unit of our department. Additional CT imaging was
performed to exclude abdominal recurrence. Afterward,
a definitive herniorrhaphy with Lichtenstein’s approach
was accomplished (Fig.2), with the mass along with sac
removed before placing a self-gripping polyester mesh
(TEM1208GR, Parietex ProGrip™, US). e intraopera-
tive diagnosis was right indirect inguinal hernia, Gilbert
II classification [7]. e patient was discharged at the sec-
ond post-operative day. e final pathological report of
resected specimen in his groin indicated a metastasized
GIST in inguinal hernia. e tumor was spindle cells
morphology, with high mitotic count (> 40/50 HPF) and
strongly positive immunostains of CD117, DOG-1, Bcl-2
and CD99. e Ki-67 index was 30%, with partial positiv-
ity for SDHB (Fig.3).
e patient continued the imatinib chemotherapy as
mentioned ahead, with planed outpatient clinic visits
scheduled. At the last follow-up visit on February 14th,
2020, he was survived and capable of daily work, without
a recurrent inguinal hernia observed.
Discussion
To review this unusual presentation, we performed a lit-
erature research in two national databases (PubMed and
CNKI) with following mesh terms: “gastrointestinal stro-
mal tumor”, “GIST”, “inguinal hernia”, “groin hernia”, and
“case report”. e returned results were reviewed by two
surgeons (Y.Y. and Z.X.) independently, with included
cases summarized in Table 1. Follow up data were
requested from corresponding authors by letters or mails
when necessary.
Briefly, ten reported cases together with the current
case were finally included, with a mean age of 66 (range,
45–82) years. ere was only one female (9.1%) patient
suffering from this rare disease. Seven (63.6%) of 11 cases
had a primary tumor in the groin area, whereas the rest
(36.4%) had the metastatic tumors. ere were ten ingui-
nal hernias and only one femoral hernia, with three cases
(36.4%) developing bowel obstruction. Most of reported
cases underwent a definitive hernia repair, with only one
case (9.1%) receiving biopsy alone. Tension-free repair
with mesh was applied in six cases (54.5%), with tissue
repair in four cases (36.4%). Hernia recurrence was not
reported.
According to included reports, the estimated incidence
of GIST-involved groin hernia is less than 0.1%. Follow-
up data were received from seven case reports (Table2).
e follow-up period ranged from 18 to 60months, and
two dead cases were recorded during the period. Tumor
recurrence in groin was not observed. e Kaplan–Meier
surviving analysis suggested an approximate 64.3% over-
all survival at five years after the incidental diagnosis
(Fig.4).
GISTs, accounting for 1.0–3.0% of all GI tumors [8],
could arise in everywhere of the GI tract. Less com-
mon primary sites include the duodenum (4–5%) and
Fig. 2 The definitive operation for his right inguinal mass.
Lichtenstein approach applied to excise the mass and to repair with a
self‑gripping mesh. The mass along with hernia sac (a) was removed,
with spermatic cord reserved. The tumor (b) was homogeneous firm
as the primary GIST in the jejunum
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Page 4 of 7
Yuanetal. BMC Surg (2021) 21:111
rectum (4%). e rare sites include the esophagus
(< 5%), Meckel’s diverticulum (< 1%), appendix (< 1%),
umbilicus and pituitary (< 1%), with limited case
reports available [9–12]. To the best of our knowledge,
ten reported cases of a GIST presenting as groin hernia
were available (Table1). e first case of tumor-associ-
ated inguinal hernia was reported in 1749 [13]. Of note,
the most common inguinal tumors are of colon cancer
[14].
In clinical practice, GI hemorrhage (48.9%) and small
bowel obstruction (28.3%) were the most frequent pre-
senting symptoms of GISTs [15]. In our case, the patient
admitted with acute abdomen and GI bleeding, which
was an emergency presentation of GISTs. Unfortunately,
his concealed inguinal hernia stemming from tumor
seeding due to ruptured GIST was not diagnosed or
measured in the first place. It reminds us never to lose
sight of groin areas when performing abdominal exami-
nations. One of classical feature is the mass in the sac
would be likely diagnosed as inflamed Meckel’s diverticu-
lum [16].
GISTs possess malignant potential and are highly
invasive and tend to metastasize to remote organs [17].
Metastasis from primary GIST is frequently recorded,
and patients may present with metastatic deposit as the
first signs [18]. e most common sites of metastasis
are the liver and peritoneum; however, extra-abdom-
inal metastasis is extremely rare. ose uncommon
locations include central nervous system, lung, bone,
subcutaneous tissues and genitourinary system [18,
19]. Interestingly, lymph node metastasis was rarely
occurred.
CT scans played invaluable role in discovering GISTs.
Specifically, a modified CT by insufflating CO2 to allow
a maximum lumen distension of GI wall is strongly rec-
ommended for detecting rare site GISTs (esophagus,
appendix, rectum, etc.). Additionally, EUS could provide
a precise evaluation of submucosal esophageal and gas-
tric tumors. Its main advantage lies on the assessment
of origination and invasion of primary tumor, whether
the tumor develops from the layers of GI tract or corre-
sponds to an extrinsic compression [20].
Moreover, immunostains with CD117, DOG-1, SDHB
and other molecular markers are essential for diagno-
sis of GIST and facilitate optimization of management
of GIST [21]. e main prognostic factors of GISTs are
mitotic rate, tumor size and tumor site. ese criteria
have been incorporated into the risk classification pro-
posed by the Armed Force Institute of Pathology, which
gains great popularity in clinical practice [22]. Besides,
tumor rupture in abdomen, whether spontaneous or fol-
lowing iatrogenic injury, proved to harbor a risk of recur-
rence of nearly 100% [23]. Recently, prognostic contour
maps are developed, which incorporate the mitotic index
and tumor size as continuous non-linear variables, while
tumor rupture is considered in addition to tumor site
[24].
All irreducible hernias should be thoroughly examined,
including physical examination and imaging scans, and
then be referred for a surgical assessment. ose her-
nias may conceal an underlying case that requires urgent
investigation and treatment [25]. Suspecting the presence
of an incarcerated groin hernia, urgent exploration of
inguinal canal is required, followed by an initial evalua-
tion of herniated content. A consideration of laparotomy
conversion when the mass is failed to excise through the
inguinal incision. To achieve a negative resection margin,
at least 2cm from the gross tumor is required during sur-
gery. However, a palliative resection is not suggested due
to its high recurrence rate. As mentioned above, lymph
nodes are rarely involved, hence, lymphadenectomy is
not necessary during the surgery. As for groin area repair,
tension-free herniorrhaphy with non-absorbable mesh is
recommended.
Fig. 3 The pathological features of resected mass in the right groin.
Specific pathological staining methods (HE and IHC) were used to
confirm the diagnosis of GIST metastasized to the right groin
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Page 5 of 7
Yuanetal. BMC Surg (2021) 21:111
Table 1 Clinical characteristics ofcases ofGIST-associated groin hernia
M male, F female, G groin, Fe femoral canal, CT computed tomography, US ultrasonography, XR simple X-ray
Study Age
andgender Hernia
location Tumor size,
cm Imaging
method Primary
orSecondary Primary
location GIST
treatment Hernia repair
Yuan 2020 71 M Right (G) 5.2 CT Secondary Jejunum Palliative resec‑
tion Mesh
Ferhatoglu 2018
[12]67 M Left (G) 13.0 CT Secondary Ileum Palliative
resection and
Imatinib
Mesh
Campbell 2017
[26]53 M Right (G) 9.5 CT Secondary Jejunum Palliative resec‑
tion, Imatinib,
Sunitinib,
Regorafenib
and tumor
cytoreduction
Mesh
Massani 2017
[10]74 M Right (G) 7.0 CT Primary Ileum Radical right
hemicolec‑
tomy
Mesh
Agrawala 2017
[27]45 F Right (G) 6.0 US Primary Ileum Radical enter‑
ectomy and
partial blad‑
der resection
and Imatinib
Tissue
Tinoco‑Gonza‑
lez 2015 [28]50 M Left (G) 6.0 XR Primary Jejunum Palliative resec‑
tion Mesh
Zyluk 2015 [16] 71 M Right (Fe) 7.0 XR Primary Ileum Radical resec‑
tion Tissue
Liu 2014 [29] 82 M Right (G) 4.0 CT Secondary Jejunum Palliative
resection and
Imatinib
Tissue
Chen 2013 [30] 60 M Right (G) 28.5 CT Primary Stomach Radical resec‑
tion Imatinib Mesh
Mulla 2007 [25] 80 M Right (G) 5.0 CT Primary Ileum Biopsy and
Imatinib None
Goyal 2003 [31] 72 M Right (G) 9.5 CT Primary Ileum Radical enterec‑
tomy Tissue
Table 2 Clinical outcomes ofincluded cases
Data were retrieved or requested from included case reports. “–“ indicates not available data due to missing follow up or no response to data request
Study Follow-up period (months) Hernia recurrence Inguinal tumor recurrence Overall
survival time
(months)
Yuan 2020 18 No No 18
Ferhatoglu 2018 [12] 18 No No 12 (Died)
Campbell 2017 [26] 36 No No 35 (Died)
Agrawala 2017 [27] – – No –
Massani 2017[10] 36 No No 36
Tinoco 2015 [28] – – – –
Zyluk 2015 [16] 60 No No Survived
Liu 2014 [29] 24 No No Survived
Chen 2013 [30] 60 No No Survived
Mulla 2007 [25] – – – –
Goyal 2003 [31] – – – –
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Page 6 of 7
Yuanetal. BMC Surg (2021) 21:111
Conclusions
In summary, primary or metastatic GIST could present
with symptoms mimicking as a groin hernia. When
diagnosing those unusual cases, physicians or sur-
geons should consider whether malignancy is present,
particularly among patients with a history of GIST.
Abdominal and pelvic CT scans with enhanced con-
trast are effective tools for differential diagnoses and
subsequent treatments. Never forget to check both
groin areas when doing physical examination. Radi-
cal tumor resection plus tissue-free hernia repair is an
optimal operation for an emergency case. An adjuvant
medication targeted to the mutated KIT gene should be
strictly followed for high-risk cases.
Supplementary Information
The online version contains supplementary material available at https ://doi.
org/10.1186/s1289 3‑021‑01088 ‑4.
Additional le1: Fig. S1 The primary jejunal GIST and its pathological
presentation. (A) primary tumor and intra‑abdominal tumor seeding were
found; (B) The primary tumor was excised with a safe margin; (C) The
tumor‑attached intestinal lumen was uninvolved; (D) The gross appear‑
ance from middle‑incision cut surface showed hemorrhagic necrosis and
firm spindle mass with a pseudo‑capsule; (E) The hematoxylin–eosin (HE)
staining recorded its spindle cell nature.
Abbreviations
GIST: Gastrointestinal stromal tumor; GI: Gastrointestinal; EUS: Endoscopic
ultrasound; CT: Computed tomography; HPF: High power field; IHC:
Immunohistochemical.
Acknowledgements
None.
Authors’ contributions
AH and XZ planned and designed the case report and literature review. YY,
MT and LD collected and reviewed the literature on the subject and drafted
the paper. YY and LD performed the draft revision and collected clinical and
pathological data. LD provided the images and XZ performed the analysis and
interpretation of data. All authors read and approved the final manuscript.
Funding
None.
Availability of data and materials
The datasets used during the current study are available from the correspond‑
ing author on reasonable request.
Ethics approval and consent to participate
The consent for the case report was obtained from the patient. The need for
ethics approval was waived due to its retrospective review.
Consent for publication
The written consent to publish was obtained from the patient.
Competing interests
The authors declare that they have no competing interests.
Received: 31 July 2020 Accepted: 1 February 2021
References
1. Mansoor E. Multifocal small bowel stromal tumours presenting with
peritonitis in an HIV positive patient. Int J Surg Case Rep. 2014;5:243–5.
2. Cybulka B, Golanski M, Rapela J, Wach A. Elective surgery of umbilical
hernia as a first clinical manifestation of a gastrointestinal stromal tumor
(Gist)—case report. Pol Przegl Chir. 2016;88:221–5.
3. Machishi H, Okada Y, Nagai M, Noda N, Hori T, Shimono T, et al. A rare case
of huge gastrointestinal stromal tumor (GIST) of the stomach extending
into the posterior mediastinum. Dig Dis Sci. 2002;47:1492–7.
4. Al‑Thani H, El‑Menyar A, Rasul KI, Al‑Sulaiti M, El‑Mabrok J, Hajaji K, et al.
Clinical presentation, management and outcomes of gastrointestinal
stromal tumors. Int J Surg. 2014;12:1127–33.
5. Romic I, Pavlek G, Romic M, Moric T, Bajt M, Puz P, et al. Urgent surgical
treatment of GIST of esophago‑gastric junction in a patient with giant
hiatal hernia. Klin Onkol. 2019;32:306–9.
6. Connolly EM, Gaffney E, Reynolds JV. Gastrointestinal stromal tumours. Br
J Surg. 2003;90:1178–86.
7. Zollinger RM Jr. Classification systems for groin hernias. Surg Clin North
Am. 2003;83:1053–63.
8. van der Zwan SM, DeMatteo RP. Gastrointestinal stromal tumor: 5 years
later. Cancer. 2005;104:1781–8.
9. Mainprize KS, Dehn TC. Laparoscopic management of pseudoachalasia,
esophageal diverticulum, and benign esophageal stromal tumor. Dis
Esophagus. 2001;14:73–5.
10. Massani M, Capovilla G, Ruffolo C, Bassi N. Gastrointestinal stromal
tumour (GIST) presenting as a strangulated inguinal hernia with small
bowel obstruction. BMJ Case Rep. 2017. https ://doi.org/10.1136/bcr‑
2016‑21727 3.
11. O’Halloran PJ, Hannon AM, Bartels C, McCawley N, Agha A, Brett F, et al.
Gastrointestinal stromal tumor metastases to the pituitary: a rare entity.
Br J Neurosurg. 2017;31:603–4.
12. Ferhatoglu MF, Kartal A, Kivilcim T. Gastrointestinal stromal tumor mimick‑
ing such as incarcerated inguinal hernia. Med Sci Discov. 2018;5:166–8.
13. Arnaud G. Traité des hernies ou descentes. Vol. 2. Paris: Le Mercier; 1749.
14. Miyake Y, Kato T, Katayama K, Doi T, Oshima K, Handa R, et al. A case of
ascending colon carcinoma metastasized to an inguinal hernia sac. Gan
To Kagaku Ryoho. 2007;34:2016–8.
15. Sorour MA, Kassem MI, Ghazal Ael H, El‑Riwini MT, Abu NA. Gas‑
trointestinal stromal tumors (GIST) related emergencies. Int J Surg.
2014;12:269–80.
16. Zyluk A, Majewski W. Parietal strangulation of small intestine in femoral
hernia site with symptoms of intestinal obstruction in patient with
Fig. 4 The long‑term oncological outcomes of patients with
GIST‑associated groin hernia. Kaplan–Meier surviving analysis with
available follow‑up data showed that estimated 5‑year overall survival
rate was 64.3%
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
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incidentally found small intestine tumor—a case report. Pol Przegl Chir.
2015;87:413–6.
17. Colovic R, Micev M, Matic S, Colovic N, Grubor N, Atkinson HD. Malignant
stromal tumor of the stomach with giant cystic liver metastases prior to
treatment with imatinib mesylate. Vojnosanit Pregl. 2013;70:225–8.
18. Thomas R, Swamy S. Rare case of gastrointestinal stromal tumor present‑
ing with scrotal metastasis. Indian J Surg. 2015;77:188–9.
19. Burkill GJ, Badran M, Al‑Muderis O, Meirion Thomas J, Judson IR, Fisher
C, et al. Malignant gastrointestinal stromal tumor: distribution, imaging
features, and pattern of metastatic spread. Radiology. 2003;226:527–32.
20. Fuente I, Cavadas D, Francisco C, Oria I, Beskow A, Wright F. Slipped liver
segment mimicking an esophageal stromal tumor. J Gastrointest Surg.
2019;23:1069–70.
21. Wang L, Liu L, Liu Z, Tian Y, Lin Z. Giant gastrointestinal stromal tumor
with predominantly cystic changes: a case report and literature review.
World J Surg Oncol. 2017;15:220.
22. Miettinen M, Lasota J. Gastrointestinal stromal tumors: pathology and
prognosis at different sites. Semin Diagn Pathol. 2006;23:70–83.
23. Hohenberger P, Ronellenfitsch U, Oladeji O, Pink D, Strobel P, Wardelmann
E, et al. Pattern of recurrence in patients with ruptured primary gastroin‑
testinal stromal tumour. Br J Surg. 2010;97:1854–9.
24. Joensuu H, Vehtari A, Riihimaki J, Nishida T, Steigen SE, Brabec P, et al. Risk
of recurrence of gastrointestinal stromal tumour after surgery: an analysis
of pooled population‑based cohorts. Lancet Oncol. 2012;13:265–74.
25. Mulla MG, Yeung J, Reynolds JR. Gastrointestinal stromal tumour (GIST)
mimicking an indirect inguinal hernia, a rare presentation. Eur Surg‑Acta
Chirurgica Austriaca. 2007;39:270–2.
26. Campbell R, Hashmi A, Hunsinger M. Incidental finding of a gastrointes‑
tinal stromal tumor during an inguinal hernia repair. JSM Gen Surg Cases
Images. 2017;2:1024–7.
27. Agrawala SK, Panda PC, Samal D, Hansa J, Mohanty DP, Sahoo MK, Kannan
R. Gastrointestinal stromal tumour (GIST) presenting as inguinal mass‑an
unusual presentation and literature review. Int J Pharm Sci Rev Res.
2017;44(2):112–4.
28. Tinoco‑Gonzalez J. Gastrointestinal stromal tumor (GIST) presenting as
a groin mass mimicking and incarcerated hernia. Int J Surg Case Rep.
2015;6C:166–8.
29. Liu P‑H, Kung W‑C, Wu Y‑C, Chien S‑T, Chang W‑Y, Hsu C‑W. Metastatic
malignant gastrointestinal stromal tumor mimicking a right incarcerated
inguinal hernia. Forms J Surg. 2014;47:189–92.
30. Chen X, Lü H, Xiaoyong Y, Zhang W, Zhang F, Zhang S. Diagnosis and
treatment of huge gastrointestinal stromal tumor combined with large
inguinal hernia. Chin J Digest Surg. 2013;6:475–6.
31. Goyal A, Mansel RE, Goyal S. Gastrointestinal stromal tumour in an ingui‑
nal hernial sac: an unusual presentation. Postgrad Med J. 2003;79:707–8.
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