1Department of Radiodiagnosis, Sree Balaji Medical College and Hospital, Chromepet, Chennai - 600044, Tamil Nadu, India.
Corresponding author email: 11shiyam96@gmail.com
Email: rithani21@gmail.com
Background: Jejunal gastrointestinal stromal tumors (GISTs) are uncommon mesenchymal neoplasms of the small intestine and may demonstrate aggressive biological behavior compared with gastric counterparts. Large exophytic tumors can extend into the pelvis and radiologically mimic adnexal masses, particularly in young female patients.
Case Presentation: A 26-year-old female presented with right lower abdominal pain and severe iron deficiency anemia (hemoglobin 6.8 g/dL; serum ferritin 8 ng/mL). Contrast-enhanced computed tomography revealed a well-defined, lobulated, heterogeneously enhancing pelvic mass measuring 12.3 × 10.1 × 9.4 cm with central low-attenuation areas suggestive of necrosis. The lesion displaced the uterus medially and small bowel loops superiorly without ascites or lymphadenopathy. MRI demonstrated heterogeneous T2 hyperintensity with internal cystic degeneration, diffusion restriction on DWI indicating high cellularity, and blooming on gradient echo (GRE) sequence consistent with intratumoral hemorrhage. Despite detailed imaging, bowel wall attachment was not confidently identified preoperatively, and an adnexal neoplasm was considered. Exploratory laparotomy revealed a 13 cm exophytic tumor arising from the jejunum approximately 45 cm distal to the ligament of Treitz. Segmental jejunal resection with primary anastomosis was performed. Histopathology showed spindle cell morphology with a mitotic count of 6 per 50 high-power fields. Immunohistochemistry demonstrated diffuse CD117 and DOG1 positivity, confirming high-risk jejunal GIST.
Conclusion: Large exophytic jejunal GISTs may present as pelvic masses and simulate adnexal pathology on cross-sectional imaging. Severe iron deficiency anemia in the absence of overt gastrointestinal bleeding should raise suspicion for occult small intestinal tumors. Careful radiologic assessment and multidisciplinary management are essential for accurate diagnosis and appropriate oncologic treatment.
Keywords: Jejunal GIST; Pelvic mass; Adnexal mimic; Iron deficiency anemia; Diffusion restriction; Intratumoral hemorrhage.
How to cite this article: Rithani KR, Sundaran S, Kumar AA, Murugan G, Jeyasoorian S. Jejunal gastrointestinal stromal tumor presenting as a right adnexal mass with severe iron deficiency anemia in a young female: A diagnostic challenge. Int J Drug Deliv Technol. 2026;16(6s): 500-505; DOI: 10.25258/ijddt.16.6s.53
Source of support: Nil
Conflict of interest: None