J Korean Surg Soc.  2012 Feb;82(2):120-124. 10.4174/jkss.2012.82.2.120.

Clinicopathologic change of gastrointestinal stromal tumor after neoadjuvant imatinib followed by surgical resection

• Kang GH
• Son MW
• Han SW
• Bae SH
• Kim SY
• Kim YJ
• Chung GA
• Cho GS
• Lee MS
• Park NK

• KMID: 2212211
• DOI: http://doi.org/10.4174/jkss.2012.82.2.120

Abstract

A 53-year-old woman was diagnosed with gastrointestinal stromal tumor (GIST) of the stomach. Computed tomography (CT) revealed a huge mass (12 cm in diameter), likely to invade pancreas and spleen. In the operation field, the tumor was in an unresectable state. The patient was then started on imatinib therapy for 4 months. On follow-up imaging studies, the tumor almost disappeared. We performed total gastrectomy and splenectomy upon which two small-sized residual tumors were found on microscopy. In this paper, we describe a case of clinicopathologic change in unresectable GIST after neoadjuvant imatinib mesylate.

Keyword

Gastrointestinal stromal tumors; Imatinib; Neoadjuvant

MeSH Terms

Benzamides
Female
Follow-Up Studies
Gastrectomy
Gastrointestinal Stromal Tumors
Humans
Imatinib Mesylate
Mesylates
Microscopy
Middle Aged
Neoplasm, Residual
Pancreas
Piperazines
Pyrimidines
Spleen
Splenectomy
Stomach
Benzamides
Mesylates
Piperazines
Pyrimidines

Figure

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  Fig. 1 Computed tomography and fluorodeoxyglucose-positron emission tomography (FDG-PET) computed tomography (CT) scans. Images showed a huge heterogeneous mass that is originated from stomach (A) and the tumor seemed to invade pancreas and spleen (B). A FDG-PET CT scan showed FDG uptake in the lesion (C).

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  Fig. 2 Endoscopic finding of a huge subepithelial lesion with central ulceration was noticed on fundus.

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  Fig. 3 Histological study showing spindle cell tumor (H&E, ×100).

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  Fig. 4 Immunohistochemistry finding revealing positive staining for CD34 (×10).

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  Fig. 5 Neoadjuvant therapy with imatinib for 4 months: there was no evidence of mass lesion in stomach on computed tomography.

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  Fig. 6 On the endoscopy, the mass lesion was invisible and just ulcerative lesion was observed.

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  Fig. 7 Fluorodeoxyglucose-positron emission tomography showed a hypermetabolic lesion around medial side of spleen.

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  Fig. 8 Histological study showing a residual tumor in fibrotic tissue (H&E, ×20).

Reference

1. Kang DY, Park CK, Choi JS, Jin SY, Kim HJ, Joo M, et al. Multiple gastrointestinal stromal tumors: clinicopathologic and genetic analysis of 12 patients. Am J Surg Pathol. 2007. 31:224–232.

2. DeMatteo RP, Lewis JJ, Leung D, Mudan SS, Woodruff JM, Brennan MF. Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival. Ann Surg. 2000. 231:51–58.

3. Wu PC, Langerman A, Ryan CW, Hart J, Swiger S, Posner MC. Surgical treatment of gastrointestinal stromal tumors in the imatinib (STI-571) era. Surgery. 2003. 134:656–665.

4. Eisenberg BL, Smith KD. Adjuvant and neoadjuvant therapy for primary GIST. Cancer Chemother Pharmacol. 2011. 67:Suppl 1. S3–S8.

5. Sym SJ, Ryu MH, Lee JL, Chang HM, Kim TW, Kim HC, et al. Surgical intervention following imatinib treatment in patients with advanced gastrointestinal stromal tumors (GISTs). J Surg Oncol. 2008. 98:27–33.

6. Blay JY, Bonvalot S, Casali P, Choi H, Debiec-Richter M, Dei Tos AP, et al. Consensus meeting for the management of gastrointestinal stromal tumors. Report of the GIST Consensus Conference of 20-21 March 2004, under the auspices of ESMO. Ann Oncol. 2005. 16:566–578.

7. Kang YK, Kim KM, Sohn T, Choi D, Kang HJ, Ryu MH, et al. Clinical practice guideline for accurate diagnosis and effective treatment of gastrointestinal stromal tumor in Korea. J Korean Med Sci. 2010. 25:1543–1552.

8. Eisenberg BL, Judson I. Surgery and imatinib in the management of GIST: emerging approaches to adjuvant and neoadjuvant therapy. Ann Surg Oncol. 2004. 11:465–475.

9. Blanke CD, Rankin C, Demetri GD, Ryan CW, von Mehren M, Benjamin RS, et al. Phase III randomized, intergroup trial assessing imatinib mesylate at two dose levels in patients with unresectable or metastatic gastrointestinal stromal tumors expressing the kit receptor tyrosine kinase: S0033. J Clin Oncol. 2008. 26:626–632.

10. Andtbacka RH, Ng CS, Scaife CL, Cormier JN, Hunt KK, Pisters PW, et al. Surgical resection of gastrointestinal stromal tumors after treatment with imatinib. Ann Surg Oncol. 2007. 14:14–24.