A rare case of sudden death due to hemorrhage in a gastrointestinal stromal tumor

Sudden and unexpected natural death presents a diagnostic challenge in forensic practice, as the underlying cause often remains unclear before death. Acute gastrointestinal hemorrhage due to gastric tumors, such as gastrointestinal stromal tumors (GISTs), is an uncommon cause of sudden death. GISTs are primary mesenchymal tumors of the gastrointestinal tract and most frequently arise in the stomach. To the best of our knowledge, this is the first reported case of sudden and unexpected death due to acute hemorrhage from a GIST. This case report describes a medico-legal autopsy of a 62-year-old Indian male who presented with hematemesis, became unconscious, and died shortly after hospital admission. Internal examination revealed a well-circumscribed nodular tumor along the greater curvature of the stomach, associated with massive intragastric and intestinal hemorrhage. Histopathological examination showed a spindle-cell tumor composed of cells arranged in fascicles and whorls, with low mitotic activity and no evidence of necrosis. Immunohistochemical analysis demonstrated strong positivity for DOG-1 and H-Caldesmon, confirming the diagnosis of a gastric GIST. This case report highlights the importance and seriousness of GIST even when it falls in the low-risk category. In this case, GISTs presented with fatal upper gastrointestinal hemorrhage encountered during medico-legal autopsy in a case of sudden death.