Korean J Gastroenterol.  2021 Oct;78(4):235-239. 10.4166/kjg.2021.097.

Successful Endoscopic Resection of a Rectal Gastrointestinal Stromal Tumor Larger Than 5 cm

• Kim SJ
• Jung Y
• Hong R
• Lee J

• KMID: 2521498
• DOI: http://doi.org/10.4166/kjg.2021.097

Abstract

Preoperative imatinib treatment for rectal gastrointestinal stromal tumors (GISTs) has been reported to reduce the tumor size and help preserve the anal sphincter function. On the other hand, preoperative imatinib may prevent an accurate assessment of the recurrent risk. The endoscopic resection of rectal GIST is rarely reported because of challenges that include securing the visual field and avoiding perforation. This paper reports a case in which a 5.5×4.0 cm sized rectal GIST was treated effectively by an endoscopic submucosal dissection (ESD) without preoperative imatinib. To date, the patient had no tumor recurrence or complications and is receiving adjuvant imatinib treatment. This case shows that ESD may be a good treatment option to preserve the anus in rectal GIST treatment.

Keyword

Gastrointestinal stromal tumors; Endoscopy; Imatinib mesylate

Figure

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  Fig. 1 Initial colonoscopy and endoscopic ultrasonography. (A) Rectal retroflection during colonoscopy shows an approximately 5 cm-sized submucosal tumor-like lesion between the first Houston plate of rectum and anus. (B) The distal margin of the lesion was extremely close to the anus in the forward endoscopic view. (C) Endoscopic ultrasonography showed that 5.5×4.0 cm sized heterogeneous hypoechoic mass originated from muscularis propria. (D) Computed tomography showed a 5.5×4.0 cm sized round mass of soft tissue density in the distal rectum.

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  Fig. 2 Endoscopic resection. (A) After submucosal injection, the mucosal incision starts on the anal side of the lesion using a Dual knife. (B) The proper muscle layer dissection was performed using Dual knife and IT knife nano. (C) The rectal mass lesion was removed completely without complications. (D) The 5.5×4.0 cm sized specimen with the mass lesion after its en bloc resection.

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  Fig. 3 Pathological findings of the tumor and immunohistochemical staining. The tumor is located from the mucosa to the circular layer of proper muscle. (A) Proliferating round to oval-shaped cells dissecting the muscularis mucosa (Hematoxylin and Eosin [H&E] staining, ×100) and (B) show frequent mitosis (arrow, H&E staining, ×200). (C) The deepest resection margin of the specimen was free of the lesion (arrowhead, H&E staining, ×40). Immunohistochemically, the tumor cells were reactive for (D) c-Kit, (E) CD34 , and (F) DOG1 (respectively, ×200).

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  Fig. 4 Follow-up endoscopy after 3 months. The rectal retroflection during colonoscopy reveals an oval-shaped ulcer with a diffuse fibrotic scar.

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