Abstract
Gastrointestinal stromal tumors (GISTs) are potentially malignant mesenchymal tumors that can give rise to distant metastases, mainly in the liver. The co-occurrence of synchronous primary liver tumors (e.g., hepatocellular carcinoma (HCC)) in patients with GIST is extremely rare. This report describes a 77-year-old male patient with liver metastasis of GIST originating in the small intestine and synchronous HCC. The patient had undergone resection of the small intestine for the primary GIST 3 years earlier and partial hepatectomy and radiofrequency ablation for liver metastases of GIST 1 year earlier. Despite the continuation of adjuvant therapy with imatinib, two new lesions in the liver were detected by follow-up computed tomography scanning, which showed the gradual enlargement of one tumor. A second hepatectomy was performed. Pathological examination revealed that one tumor was a liver metastasis of GIST and the other was a primary HCC. To our knowledge, this is the first report of the synchronous co-occurrence of a liver metastasis of GIST and a primary HCC.
Highlights
Gastrointestinal stromal tumors (GISTs) are rare mesenchymal tumors of the gastrointestinal tract, arising mainly in the stomach and small intestine
GISTs have been reported to occur together with other malignancies, including chronic lymphocytic leukemia, lymphoma, renal cell carcinoma, and gastric cancer [5], few reports have described the synchronous occurrence of primary GISTs and hepatocellular carcinoma (HCC)
Imaging findings of the two liver tumors were consistent with metastases of GIST, and he was diagnosed with GIST originating in the small intestine and liver metastases of GIST
Summary
Gastrointestinal stromal tumors (GISTs) are rare mesenchymal tumors of the gastrointestinal tract, arising mainly in the stomach and small intestine. Imaging findings of the two liver tumors were consistent with metastases of GIST, and he was diagnosed with GIST originating in the small intestine and liver metastases of GIST Because he had abdominal symptoms, he first underwent resection of the small intestine for the primary lesion. KIT mutation analysis of the resected tumor specimen showed an in-frame deletion of a portion of the juxtamembrane domain (exon 11) He was subsequently started on treatment with imatinib for the Yamashita et al Surgical Case Reports (2016) 2:86 metastatic lesions. A follow-up CT scan 5 months later showed tumor recurrence in segment 4 of the liver He was again started on treatment with low-dose imatinib, during which the metastatic lesion became gradually enlarged, the internal CT image showed a cystic change. Follow-up for 12 months after the latest surgery has shown no signs of recurrent disease
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