Abstract
A 49-year-old man was admitted to our hospital with a 1-month history of dysphagia. An upper endoscopy revealed a lower esophageal submucosal tumor. Immunohistochemical staining of the biopsy specimen revealed KIT positivity. Thus, the tumor was diagnosed as a gastrointestinal stromal tumor (GIST). After 6 months of imatinib treatment, the tumor decreased from 92 mm × 55 mm × 80 mm to 65 mm × 35 mm × 55 mm in diameter, and surgery was performed. The tumor was completely resected without rupture, by partial esophagogastric resection through a thoracotomy incision, using an abdominal laparoscopic approach. Immunohistochemical staining revealed that the tumor was negative for c-kit but positive for CD34. Genetic examination showed that the tumor had a mutation in exon 11. The patient experienced minor leakage but recovered conservatively. Adjuvant imatinib was initiated 64 days after surgery. We report this rare case to show the potential of preoperative imatinib treatment in patients with large esophageal GISTs, to achieve complete resection without rupture.
Highlights
Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors of the gastrointestinal tract, commonly found in the stomach (60% to 70%) and small intestine (20% to 30%) [1,2]
There is no evidence of an effective neoadjuvant therapy for GISTs, especially for very large primary GISTs, which have an increased risk of a positive resection margin [6]
Complete surgical resection is the standard treatment for localized GISTs; 40% to 90% of curative resection patients experience recurrence [10]
Summary
Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors of the gastrointestinal tract, commonly found in the stomach (60% to 70%) and small intestine (20% to 30%) [1,2]. Standard laboratory test results on serum and urine showed no significant findings Tumor markers such as carcinoembryonic antigen, carbohydrate antigenic determinant 19-9 and squamous cell carcinoma antigen were within the reference limits. The patient received neoadjuvant imatinib (400 mg/day) treatment and was followed-up for 2 months with CT scans to assess the therapeutic effect. He was treated for 6 months with chemotherapy and the tumor shrank by 25% (Figure 2C). The patient experienced aspiration pneumonia and minor leakage after the operation, but recovered conservatively from both conditions He was discharged 52 days after the surgery, and adjuvant chemotherapy (imatinib, 400 mg/day) was initiated at 64 days after the surgery. There has been no recurrence for 12 months post-surgery
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