The Successful Treatment of Primary and Recurrent Ruptured Gastric Gastrointestinal Stromal Tumor (GIST) Through Coordinated Surgical Intervention and c-Kit Inhibitor Therapy

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract, with the stomach as the most frequent site of occurrence. Spontaneous rupture of gastric GISTs is rare but represents a life-threatening complication requiring emergency intervention. We report a case of a 29-year-old male who presented with the sudden onset of severe abdominal pain following the spontaneous rupture of a giant gastric GIST. Emergency laparotomy and tumor resection were performed, with histopathological examination confirming a high-risk GIST with positive c-Kit (CD117) and CD34 immunostaining. The patient subsequently received imatinib mesylate as adjuvant therapy but temporarily discontinued treatment due to family planning concerns. Three years after discontinuation of imatinib, he developed tumor recurrence, which responded favorably to reintroduction of the c-Kit inhibitor. This report highlights the importance of timely surgical management of ruptured GISTs, the efficacy of imatinib in both adjuvant and recurrence settings, and the need to consider treatment interruption for reproductive planning. We also review the literature on c-Kit inhibitor therapy in GIST management and discuss emerging evidence on imatinib's effects on fertility, as well as potential strategies for balancing oncological and reproductive goals in young patients with high-risk GIST.