Laparoscopic resection of pedunculated extraluminal gastrointestinal stromal tumor (GIST) from gastric greater curvature: a case report and review of literature.

INTRODUCTION AND IMPORTANCE: Gastric gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract, and exophytic lesions from the greater curvature may initially mimic hepatic or pancreatic masses. Extraluminal pedunculated gastric GISTs are exceptionally rare, and laparoscopic resection of large pedunculated tumors of the greater curvature with oncologic margins is exceptionally rare and rarely described in the literature. CASE PRESENTATION: A 64‑year‑old Middle Eastern woman presented with a 2‑month history of dull, non‑radiating epigastric pain without bleeding, weight loss, or obstructive symptoms. Endoscopic ultrasonography (EUS) and contrast‑enhanced computed tomography revealed a 14 × 8 cm, well‑circumscribed, completely extraluminal mass arising from the gastric greater curvature and attached by a pedunculated stalk, with no evidence of metastasis. She underwent laparoscopic wedge resection with an approximately 1 cm gross margin around the stalk and two‑layer closure, had an uncomplicated postoperative course, and histopathology confirmed a gastric GIST. CLINICAL DISCUSSION: This case adds to the limited literature on pedunculated extraluminal gastric GISTs and demonstrates that, in anatomically favorable locations on the greater curvature, laparoscopic wedge resection can achieve R0 margins while minimizing morbidity. EUS-guided biopsy was deferred to avoid seeding, given unambiguous imaging of gastric origin, and neoadjuvant imatinib was not initiated as the tumor was upfront resectable with anticipated clear margins. As a tumor exceeding 10 cm, it is classified as high-risk by the Joensuu criteria, and adjuvant imatinib was offered accordingly. CONCLUSION: A large pedunculated extraluminal GIST of the gastric greater curvature can be safely managed by stomach-preserving laparoscopic wedge resection with R0 excision, supporting minimally invasive surgery as a viable option for carefully selected exophytic or pedunculated gastric GISTs and highlighting the importance of meticulous preoperative imaging and strict adherence to oncologic principles.