Discussion

Current published literature includes only a limited number of reports describing the coexistence of GISTs and Dieulafoy’s lesions or Dieulafoy-like vascular abnormalities. Several cases have described GISTs presenting with severe GI hemorrhage associated with prominent tumor-related vessels or overlying vascular lesions, suggesting that local vascular alterations may contribute to the bleeding phenotype of some GISTs [2,6-8]. The present case of a 71-year-old male with two episodes of upper GI bleeding separated by seven years adds a distinct temporal dimension to these previously reported associations.

In one reported case, an 86-year-old male presented with melena and was found to have a gastric GIST with an overlying Dieulafoy’s lesion. Endoscopic hemostasis was successfully achieved, followed by surgical resection for definitive treatment [2]. Similarly, a 64-year-old female presented with hemorrhagic shock secondary to a gastric GIST associated with a Dieulafoy-like vascular lesion. Surgical resection confirmed the diagnosis, with bleeding attributed to dilated peritumoral vessels [6]. Another report described a 69-year-old male with severe upper GI bleeding caused by a duodenal GIST associated with a Dieulafoy’s lesion. Endoscopic clipping achieved initial hemostasis before definitive surgical resection was performed [7].

Compared with these previously reported cases, our patient’s clinical course was distinguished by a seven-year interval between the initial diagnosis of a Dieulafoy’s lesion and the subsequent diagnosis of a gastric GIST in the same anatomical region. To our knowledge, this prolonged temporal sequence has not been previously described. Although this observation raises the possibility of an association between localized vascular abnormalities and subsequent tumor development, it does not establish a causal relationship. Unlike previous cases [2,6,7], the prolonged timeline allowed multidisciplinary management, with endoscopic, radiologic, and histopathologic tools guiding diagnosis and treatment.

A possible explanation for this unusual association is that a microscopic or subclinical GIST may have been present during the patient’s initial presentation in 2017 but remained undetectable on endoscopic evaluation. However, this hypothesis remains speculative and cannot be confirmed retrospectively. Alternatively, the Dieulafoy’s lesion and the subsequently diagnosed gastric GIST may represent two independent pathological entities that occurred coincidentally in the same anatomical region. GISTs are well recognized to present with GI hemorrhage secondary to mucosal ulceration, tumor necrosis, or erosion into adjacent vessels, which may complicate differentiation from other vascular causes of upper GI bleeding [4,9]. The relatively indolent clinical course observed in our patient is consistent with the tumor’s gastric location, low histologic grade (G1), and low mitotic rate (3 mitoses/5 mm²), all of which are associated with less aggressive tumor biology [9-11]. Although the resected tumor measured 6.5 cm, these pathological features may explain why it remained clinically silent for several years before presenting as a significant source of bleeding.

The shared need for prompt endoscopic hemostasis and definitive surgical intervention underscores the importance of recognizing this rare association. Similar to previously reported cases, definitive management ultimately required a combination of endoscopic hemostasis and surgical resection, highlighting the importance of a multidisciplinary approach when rare bleeding etiologies coexist [2,6-8]. However, our case highlights the added complexity of recurrent bleeding over time and emphasizes the value of comprehensive follow-up and multidisciplinary collaboration in managing such atypical presentations.