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Abstract
BackgroundPlanning the surgical strategy for a gastrointestinal stromal tumor (GIST) at the posterior wall of the lower rectum is difficult, as the procedures for the lower rectum are hampered by poor visualization and may cause anal dysfunction or discomfort. We report a novel procedure to resect a submucosal tumor of the rectum.Case presentationA 75-year-old woman presented with metrorrhagia. Endovaginal ultrasonography showed a low echoic tumor. Computed tomography showed an enhanced tumor, measuring 5.3 × 4.2 cm, behind the rectum. Magnetic resonance imaging revealed a submucosal tumor of the rectum, measuring 5.3 cm at its greatest dimension. Colonoscopy showed that the distal tumor margin was 1 cm above the dentate line. Core needle biopsy of the tumor revealed the rectal GIST. After receiving neoadjuvant imatinib treatment, the tumor size decreased to 3.5 cm. During the operation, we approached the rectum and resected the posterior rectal wall, including the 3.5 × 3.5 cm tumor with a safety margin, making an arched incision at the buttocks to form a skin flap with the patient in a jackknife position. The histopathological diagnosis was GIST of the rectum. Her anorectal sphincter function was well preserved. No recurrence was seen during the 2-year follow-up.ConclusionsThis novel approach improves the operative field visibility in resecting a tumor with a safety margin and preserves a patient’s anorectal sphincter function.
Highlights
Planning the surgical strategy for a gastrointestinal stromal tumor (GIST) at the posterior wall of the lower rectum is difficult, as the procedures for the lower rectum are hampered by poor visualization and may cause anal dysfunction or discomfort
We describe our experience with a patient who underwent a novel approach, which improves the operative field visibility in resecting a tumor with a safety margin and preserves a patient’s anorectal sphincter function
Colonoscopic examination revealed that a submucosal tumor at the posterior rectal wall, and that the distal tumor margin was 1 cm above the dentate line (Fig. 2c)
Summary
Gastrointestinal stromal tumors (GISTs) occur most often in the stomach (60%) and the small intestine (35%) [1]. She was referred to our hospital for a detailed examination. Colonoscopic examination revealed that a submucosal tumor at the posterior rectal wall, and that the distal tumor margin was 1 cm above the dentate line (Fig. 2c). The tumor, lifted via digital rectal examination, was extracted with a safety margin (Fig. 3b, d, and e). Histopathological examination revealed that the tumor was located in the muscularis of the rectum, with a negative margin (Fig. 4a), and had widespread central necrosis via effective response from imatinib (Fig. 4b). Microscopic examination showed the tumor was consisted of bundle-like proliferations of spindle-shaped cells (Fig. 4c). The immunohistological findings showed that the tumor cells stained negatively with S100 and SMA and positively with c-kit and CD34; the tumor was diagnosed to be a KIT-positive GIST (Fig. 4d).
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