A Case Report of an Advanced Stage Gastrointestinal Stromal Tumor Successfully Treated by Surgery and Imatinib
Asian Journal of Medicine and Health,
Background: The most prevalent gastrointestinal sarcoma is a gastrointestinal stromal tumor.It is frequently misdiagnosed due to its indolent symptoms, which only manifest at an advanced and potentially incurable stage.
Case Report: This case report is that ofa recent case of a GIST of gastric origin. Itdiscusses the case of a 56-year-old, non-smoking male with no comorbiditieswho presented to the emergency department with severe colicky intermittent adnominal pain that had occurred over the past three days, approximately three years ago. On September3, 2019, the patient underwent laparotomy in which a mass and related small bowel segment (the part of the omentum) was removed. Later, the pathology profile revealed a neoplasm of the small bowel-Ileum, Gastrointestinal stromal tumor (GIST) with a high-risk tumor of stage 4 with no recorded nodular involvement and no recorded metastasis pT4 pNxpMx but with clear margins. Moreover, the tumor markers KIT (CD117), CD34, and DOG1 (ANO1) were found to be positive. Ki67 was noted up to 35%. However, S-100 and SMA were found to be negative. On gross examination, the lesion's greatest dimension was 11 cm, and other dimensions were 9x6 cm. The tumor had a spindle-shaped morphology. On the basis of these laboratory findings and pathology profile, the patient's diagnosis was a Gastrointestinal Stromal tumor thatwas managed viasurgery. At that time, the patient was also prescribed Imatinib 400 mg. It has been three years since then, our patient is still alive, and no cancer recurrence has been reported yet.
Conclusion: This case report revealed that interventional radiology's early engagement with the surgical procedure was the cornerstone of our patient's effective treatment and should be investigated at different stages of the gastrointestinal tumor.
- Gastrointestinal stromal tumor
- small intestine
How to Cite
DOI: 10.7759/cureus.4120, PMID 31037234.
Oliveros R, Pinilla R, Sánchez R, Contreras H. Gastrointestinal stromal tumors (GIST). Case series. Rev Colomb Gastroenterología. 2021;36(2):172-9.
Foong D, Zhou J, Zarrouk A, Ho V, O’Connor MD. Understanding the biology of human interstitial cells of Cajal in gastrointestinal motility. Int J Mol Sci. 2020;21(12):4540.
DOI: 10.3390/ijms21124540, PMID 32630607.
Huizinga JD, Hussain A, Chen JH. Interstitial cells of Cajal and human colon motility in health and disease. Am J Physiol Gastrointest Liver Physiol. 2021; 321(5):G552-75.
DOI: 10.1152/ajpgi.00264.2021, PMID 34612070.
Kwaghe B, Richard S, Abobarin F, Akpa P, Innocent E, Ochigbo A, et al. The prevalence of gastrointestinal stromal tumour as seen in the Jos University Teaching Hospital (Juth), Jos, North Central, Nigeria. Jos J Med. 2019; 13(2):55-60.
Wu CE, Tzen CY, Wang SY, Yeh CN. Clinical diagnosis of gastrointestinal stromal tumor (GIST): From the molecular genetic point of view. Cancers. 2019; 11(5):679.
DOI: 10.3390/cancers11050679, PMID 31100836.
Yao X, Ghert M, Dickson BC, Popovic S, Purgina BM, Verma S, et al. An evidence-based guideline on the application of molecular testing in the diagnosis, prediction of prognosis, and selection of therapy in non-GIST soft tissue sarcomas. Cancer Treat Rev. 2020;85:101987.
DOI: 10.1016/j.ctrv.2020.101987, PMID 32092619.
Kandel RA, Yao X, Dickson BC, Ghert M, Popovic S, Purgina BM, et al. Molecular analyses in the diagnosis and prediction of prognosis in non-GIST soft tissue sarcomas: a systematic review and meta-analysis. Cancer Treat Rev. 2018;66: 74-81.
DOI: 10.1016/j.ctrv.2018.04.005, PMID 29709714.
Mazzei MA, Cioffi Squitieri N, Vindigni C, Guerrini S, Gentili F, Sadotti G, et al. Gastrointestinal stromal tumors (GIST): a proposal of a ”CT-based predictive model of Miettinen index” in predicting the risk of malignancy. Abdom Radiol (NY). 2020; 45(10):2989-96.
DOI: 10.1007/s00261-019-02209-7, PMID 31506758.
Rajappan Y, Thangavelu M, Kumar MA, Mari RA, Kumaraswamy S. A case series on gastro intestinal stromal tumors at various sites. Int Arch Integr Med. 2019; 6:355-9.
Ceausu M, Socea B, Ciobotaru VP, Constantin VD, Enache S, Enache V, et al. A multidisciplinary approach in the diagnostic challenge of GIST. Exp Ther Med. 2021;22(4):1063.
DOI: 10.3892/etm.2021.10497, PMID 34434277.
Morgan J, Raut CP, Duensing A, Keedy VL, Maki R, Pappo AS. Clinical presentation, diagnosis, and prognosis of gastrointestinal stromal tumors.
Güller U, Tarantino I, Cerny T, Schmied BM, Warschkow R. Population-based SEER trend analysis of overall and cancer-specific survival in 5138 patients with gastrointestinal stromal tumor. BMC Cancer. 2015;15(1):557.
DOI: 10.1186/s12885-015-1554-9, PMID 26223313.
Sugarbaker PH. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the management of gastrointestinal cancers with peritoneal metastases: Progress toward a new standard of care. Cancer Treat Rev. 2016;48:42-9.
DOI: 10.1016/j.ctrv.2016.06.007, PMID 27347669.
Schouwenburg MG, Busweiler LAD, Beck N, Henneman D, Amodio S, van Berge Henegouwen MI, et al. Hospital variation and the impact of postoperative complications on the use of perioperative chemo (radio) therapy in resectable gastric cancer. Results from the Dutch Upper GI Cancer Audit. Eur J Surg Oncol. 2018; 44(4):532-8.
DOI: 10.1016/j.ejso.2018.01.008, PMID 29439836.
Liu J, Ahmed S. Long term survival of patients with gastric cancer treated with adjuvant radio-chemotherapy: proposal of a prognostic index with implication for treatment modification. Oncol Res Rev. 2018;1(2):1-5.
Serrano C, Mariño-Enríquez A, Tao DL, Ketzer J, Eilers G, Zhu M, et al. Complementary activity of tyrosine kinase inhibitors against secondary kit mutations in imatinib-resistant gastrointestinal stromal tumours. Br J Cancer. 2019; 120(6):612-20.
DOI: 10.1038/s41416-019-0389-6, PMID 30792533.
Adwan AK, Alakkad A, Almahameed FB, Hejazee MF. Gastrointestinal stromal tumor (GIST): case study. IRJGH. 2022; 5(1):45-51.
Serrano C, George S. Gastrointestinal stromal tumor: Challenges and opportunities for a new DecadeReview. Clin Cancer Res. 2020;26(19):5078-85.
DOI: 10.1158/1078-0432.CCR-20-1706, PMID 32601076.
Sanai FM, Al-Karawi MA. Biliary ascariasis: Report of a complicated case and literature review. Saudi J Gastroenterol. 2007;13(1):25-32.
DOI: 10.4103/1319-3767.30462, PMID 19858609.
Yu Z, Tu H, Liang C, Qiu S, Dong X, Zhang Y, et al. Therapeutic effects of 4 surgical approaches for small gastrointestinal stromal tumors: A network meta-analysis. Surg Laparosc Endosc Percutan Tech. 2022;32(5):606-15.
DOI: 10.1097/SLE.0000000000001076, PMID 35960698.
Blay JY, Kang YK, Nishida T, von Mehren M. Gastrointestinal stromal tumours. Nat Rev Dis Primers. 2021;7(1):22.
DOI: 10.1038/s41572-021-00254-5, PMID 33737510.
Nishida T, Blay JY, Hirota S, Kitagawa Y, Kang YK. The standard diagnosis, treatment, and follow-up of gastrointestinal stromal tumors based on guidelines. Gastric Cancer. 2016;19(1):3-14.
DOI: 10.1007/s10120-015-0526-8, PMID 26276366.
Akahoshi K, Oya M, Koga T, Shiratsuchi Y. Current clinical management of gastrointestinal stromal tumor. World J Gastroenterol. 2018;24(26):2806-17.
DOI: 10.3748/wjg.v24.i26.2806, PMID 30018476.
Liu X, Chu KM. Molecular biomarkers for prognosis of gastrointestinal stromal tumor. Clin Transl Oncol. 2019;21(2):145-51.
DOI: 10.1007/s12094-018-1914-4, PMID 30003531.
Zhang H, Liu Q. Prognostic indicators for gastrointestinal stromal tumors: A review. Transl Oncol. 2020;13(10):100812.
DOI: 10.1016/j.tranon.2020.100812, PMID 32619820.
Wan W, Xiong Z, Zeng X, Yang W, Li C, Tang Y, et al. The prognostic value of gastrointestinal bleeding in gastrointestinal stromal tumor: A propensity score matching analysis. Cancer Med. 2019; 8(9):4149-58.
DOI: 10.1002/cam4.2328, PMID 31197969.
Cavnar MJ, Seier K, Curtin C, Balachandran VP, Coit DG, Yoon SS, et al. Outcome of 1,000 patients with gastrointestinal stromal tumor (GIST) treated by surgery in the pre- and post-imatinib eras. Ann Surg. 2021;273(1): 128-38.
DOI: 10.1097/SLA.0000000000003277, PMID 30946076.
Tan CB, Zhi W, Shahzad G, Mustacchia P. Gastrointestinal stromal tumors: A review of case reports, diagnosis, treatment, and future directions. ISRN Gastroenterol. 2012;2012:595968.
DOI: 10.5402/2012/595968, PMID 22577569.
Kaneko M, Emoto S, Murono K, Sonoda H, Hiyoshi M, Sasaki K, et al. Neoadjuvant imatinib therapy in rectal gastrointestinal stromal tumors. Surg Today. 2019; 49(6):460-6.
DOI: 10.1007/s00595-018-1737-5, PMID 30443673.
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