[Gastrointestinal tumor (GIST) of the esophagus in a 34-year-old man: clubbed fingers and alopecia arealis as an early paraneoplastic phenomenon].

HISTORY: A 34-year-old previously healthy man presented to his general practitioner with nocturnal sweating, feeling full and a weight loss of 6 kg in three months. Over a period of one year clubbing of the fingers had developed and alopecia areata had been noted six months before the diagnosis was established.

INVESTIGATIONS AND DIAGNOSIS: Out-patient sonography revealed two large, partly cystic-necrotic space-occupying lesions in the liver. Sonographically guided fine-needle puncture showed cells of a mesenchymal tumor with great cell density and extensive necroses. Gastroscopy and endosonography demonstrated, as a possible primary tumor, a submucosal space-occupying lesion, ca. 3 x 5 cm, in the distal esophagus. Immunochemical tests revealed a leiomyosarcoma.

TREATMENT AND COURSE: A gastrectomy and resection of the distal esophagus were performed, together with a liver wedge resection. Histopathological examination of the surgical specimen confirmed the diagnosis of leiomyosarcoma. Further immunochemical tests provided the diagnostic criteria of a gastrointestinal stroma tumor (GIST). The patient died one year after operation from hepatic and peritoneal metastases.

CONCLUSION

Tumors of the gastrointestinal tract may for a long time produce no or, as in this case, only nonspecific symptoms. An early diagnosis is, however, possible if little known early paraneoplastic phenomena are noted in the clinical examination.