J Korean Neurosurg Soc.  2017 Jan;60(1):94-97. 10.3340/jkns.2014.0506.007.

Skull Metastasis of Gastric Gastrointestinal Stromal Tumor Successfully Managed by Surgery

• Park I
• Chung DH
• Yoo CJ
• Shin DB

• KMID: 2365593
• DOI: http://doi.org/10.3340/jkns.2014.0506.007

Abstract

Gastrointestinal stromal tumors (GISTs) are rare, but are the most common mesenchymal neoplasm of the gastrointestinal tract. The most common sites of metastasis are liver and peritoneum, while bone metastasis is rare. We report on a patient with skull metastasis after seven years of treatment with imatinib for metastatic GIST. She underwent metastasectomy consisting of craniectomy with excision of the mass, and cranioplasty and continued treatment with imatinib and sunitinib, without evidence of cranial recurrence. She died of pneumonia sepsis one year after metastasectomy. Skull metastasis of GIST is a very rare presentation, and an aggressive multidisciplinary approach should be considered whenever possible.

Keyword

Gastrointestinal stromal tumor; Skull metastasis; Metastasectomy; Target therapy; Multidisciplinary treatment

MeSH Terms

Gastrointestinal Stromal Tumors*
Gastrointestinal Tract
Humans
Imatinib Mesylate
Liver
Metastasectomy
Neoplasm Metastasis*
Peritoneum
Pneumonia
Recurrence
Sepsis
Skull*
Imatinib Mesylate

Figure

• 

  Fig. 1 Imaging findings of skull metastasis and hepatic metastasis in a patient with malignant gastrointestinal stromal tumor. A: Post-contrast brain CT image reveals a 7.7 cm sized, well-defined mass (arrows) centered on the diploic space of the calvaria. B: Abdomen CT image reveals a hypodense single metastasis (arrow) in left medial segment of the liver. C and D: Axial T1- (C) and T2-weighted (D) MR images show heterogeneous signal intensity of the skull metastasis. The dura (arrows) is intact and the underlying cortex appears compressed. Note the multiple signal voids on T2-weighted image. E: After gadolinium enhancement, the mass demonstrates heterogeneous enhancement.

• 

  Fig. 2 Pathology of a resected skull tumor. A: Metastatic gastrointestinal stromal tumor in the skull. The tumor consists of atypical spindle cells with high cellularity and infiltrative growth pattern with destruction of normal bone tissue (H&E, ×100). B: High power view of the tumor. Mitotic figures (arrows) are frequently noted (H&E, ×400). C: Tumor cells are positive for c-kit (c-kit immunostain, ×400).

Reference

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