Abstract
BackgroundTo date, only a few cases of multiple GISTs with different clones in different organs have been published. However, a case of multiple GISTs with different clones occurring in a single organ has never been reported.Case presentationA 41-year-old patient underwent laparoscopic partial gastrectomy for gastric gastrointestinal stromal tumor (GIST) in 2012. The pathological findings showed high-risk characteristics for recurrence, so he received adjuvant therapy with imatinib for 3 years. In 2018, 3 years after completing the adjuvant therapy, tumor lesions at residual gastric cardia were incidentally identified by follow-up computed tomography (CT). The pathological findings of the tumor biopsy revealed gastric GIST. He underwent secondary laparoscopic partial gastrectomy and was diagnosed with high-risk GIST. Adjuvant therapy with imatinib was restarted immediately. The two gastric GISTs had the same exon 11 mutations in the c-kit gene, but they had different missense mutations. This molecular heterogeneity suggested that they were derived from different origins.ConclusionWe reported a multiple heterochronic GIST in the stomach detected 6 years after resection. There may be a possibility that another heterochronic GIST will occur in the remnant stomach in the future, so close follow-up will be needed.
Highlights
To date, only a few cases of multiple gastrointestinal stromal tumor (GIST) with different clones in different organs have been published
There may be a possibility that another heterochronic GIST will occur in the remnant stomach in the future, so close follow-up will be needed
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumor of the gastrointestinal tract originating from cells of Cajal [1], and the estimated annual incidence is 10 to 20 per million
Summary
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumor of the gastrointestinal tract originating from cells of Cajal [1], and the estimated annual incidence is 10 to 20 per million. Case presentation A 41-year-old man underwent laparoscopic partial gastrectomy for gastric GIST in 2012. He has no familial history of GIST-rerated heredity disorder. The pathological findings suggested that the tumor had highrisk characteristics of recurrence according to the modified Fletcher classification (Fig. 1a, b). He received adjuvant therapy with imatinib for 3 years and follow-up computed tomography (CT) every 6 months. Positron emission tomography (PET) CT showed abnormal high uptake at gastric cardia (Fig. 2c). Adjuvant therapy with imatinib was restarted for the second time
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