Abstract
BackgroundRectal gastrointestinal stromal tumor (GIST) is a very rare tumor of gastrointestinal tract. Surgical management of rectal GIST requires special attention for preserving of anal and urinary functions. Transanal minimal invasive surgery (TAMIS) is a well-developed minimally invasive technique for local excision of benign and early malignant rectal tumors; however, the application of TAMIS for rectal GIST is rarely and inadequately reported. We report the novel application of TAMIS for rectal GIST with considerations for anal and urinary functions.Case presentationA 67 years old female, who presented with history of per rectal bleeding, was diagnosed with submucosal GIST of 4.5 cm in diameter at right posterior wall of 7 cm from anal verge. Histology of biopsy showed abundant spindle-shaped cells arranged in bundles that were positive for CD34 and negative for C-Kit, desmin, smooth muscle actin (SMA), and S-100. The tumor was excised by TAMIS successfully. Final histopathology showed pT2 tumor with C-Kit positive and mitosis count 10 per 50 HPF. Postoperative period was uneventful, and she was discharged on adjuvant imatinib mesylate for 3 years.ConclusionTAMIS can be used safely in the management of rectal GIST after appropriate evaluation of tumor size, extent, location, and experience of operating surgeon.
Highlights
Rectal gastrointestinal stromal tumor (GIST) is a very rare tumor of gastrointestinal tract
Various surgical techniques have been described for the treatment of rectal GIST, including traditional transanal resection, trans-sacral approach, transanal endoscopic microsurgery (TEM), transanal minimal invasive
A biopsy showed spindle-shaped cells arranged in bundles, positive for CD34 and negative for C-Kit, Desmin, smooth muscle actin, and S-100 (Fig. 3). These findings suggested a rectal GIST, and Transanal minimal invasive surgery (TAMIS) was scheduled
Summary
Gastrointestinal stromal tumor (GIST) is a rare tumor of the gastrointestinal (GI) tract that constitutes less than 1% of all GI tumors. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a tumor 4.5 cm in diameter in right posterior wall of the middle rectum with no adjacent infiltration or lymph node metastasis (Fig. 1a, b). A biopsy showed spindle-shaped cells arranged in bundles, positive for CD34 and negative for C-Kit, Desmin, smooth muscle actin, and S-100 (Fig. 3). These findings suggested a rectal GIST, and TAMIS was scheduled. The tumor was located at the right posterior wall in the middle rectum; the incision site 1 cm away from the tumor margin was tattooed circumferentially. The patient was discharged on IM (Gleevec), 400 mg once daily for 3 years under regular follow-up
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