Korean J Gastroenterol.  2020 Oct;76(4):206-210. 10.4166/kjg.2020.76.4.206.

Gastric Gastrointestinal Stromal Tumor with Repeated Recurrence at the Anastomosis Site in a Very Elderly Patient

• Kim HJ
• Park JY
• Kim BJ
• Kim JG
• Kim HS
• Park JM

• KMID: 2507768
• DOI: http://doi.org/10.4166/kjg.2020.76.4.206

Abstract

Although high-risk gastrointestinal stromal tumors (GISTs) frequently recur, even after a complete resection and imatinib therapy, local recurrence at the suture line after complete resection is rare. The present case was an 88-year-old woman who was initially diagnosed with high-risk GIST without a distant metastasis. She underwent a complete surgical resection of the lesion and received adjuvant imatinib therapy for 18 months, which was discontinued due to severe drug-induced anemia. During the follow-up, an endoscopic examination performed 40 months after the initial surgery revealed local recurrence at the anastomosis site. Although a complete surgical resection was performed, repeated local recurrence was detected 18 months later, which progressed rapidly to metastatic disease. This paper reports a case of a completely resected gastric GIST with repeated local recurrence, despite the complete surgical resections and adjuvant imatinib therapy.

Keyword

Gastrointestinal stromal tumors; Surgery; Imatinib mesylate; Recurrence

Figure

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  Fig. 1 Endoscopic images of the gastric lesion and abdominal computed tomography findings at the initial presentation. (A) A 2-cm sized, irregular shaped ulcerofungating mass on the greater curvature of the high body of the stomach. (B) An exophytic, heterogeneous enhancing mass with necrosis and central calcification, located adjacent to the gastric high body, closely abutting the splenic hilum (arrow).

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  Fig. 2 Histologic features of the gastric gastrointestinal stromal tumor at the first surgery. (A) Histopathological evaluation reveals blandly spindle cells with faintly eosinophilic cytoplasm in a syncytial pattern. Elongated nuclei with inconspicuous nucleoli are noted (H&E, ×400).(B) Diffuse positive cytoplasmic staining for CD117 (Immunohistochemical staining, ×20). (C) Diffuse positive staining for CD34 (Immunohistochemical staining, ×20). (D) Focal positive cytoplasmic staining for DOG-1 (Immunohistochemical staining, ×20). (E) Ki-67 proliferation index is less than 5% (Immunohistochemical staining, ×20).

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  Fig. 3 Endoscopic images of the recurred gastric lesion and abdominal computed tomography findings at the first recurrence. (A) A 2-cm sized spherical shaped subepithelial mass lying on the anastomosis site. (B) An exophytic, heterogeneously enhancing mass at the anastomosis site of the stomach, measuring 2.6 cm, without signs of extragastric metastasis (arrow).

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  Fig. 4 Histologic features of a gastric gastrointestinal stromal tumor at the second surgery. (A) Histopathological evaluation revealed spindle cell proliferation with frequent mitoses up to 159/50 high-power fields (H&E, ×40) (B) Ki-67 proliferation index is 30% (Immunohistochemical staining, ×20).

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  Fig. 5 Follow-up abdominal computed tomography findings after the second surgery. (A) A newly appeared 2.6-cm sized mass was found at the gastric anastomosis site (arrow), 1.5 years after the second surgery. (B) After 6 months of observation, the recurrent gastric lesion increased in size (2.6→9.4 cm, arrow) with invasion to the adjacent liver, pancreas, diaphragm, and pericardial fat (arrowheads).

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