Kosin Med J.  2023 Mar;38(1):60-65. 10.7180/kmj.22.138.

A case report of successfully treated metachronous gastrointestinal stromal tumor and colon cancer

• Heo YJ
• Lee JY

• KMID: 2540764
• DOI: http://doi.org/10.7180/kmj.22.138

Abstract

The diagnosis of gastrointestinal stromal tumor (GIST) has become relatively common in recent years, but little is known about its association with other malignancies. We present a rare case of successfully treated metachronous GIST and colon cancer with concurrent FOLFOX (5-fluorouracil, leucovorin, and oxaliplatin) chemotherapy and imatinib. A 63-year-old man presented with abdominal pain that had started 2 weeks ago, and endoscopic ultrasonography showed masses that were compatible with GIST on the duodenum. He underwent Whipple surgery. One year after the GIST diagnosis, two liver masses were found on abdominal computed tomography images taken for surveillance. A liver biopsy showed metastatic adenocarcinoma, not GIST. Colonoscopy was then performed to identify the primary site of the metastatic adenocarcinoma in the liver, and sigmoid colon cancer was found. He received 12 cycles of adjuvant FOLFOX concurrently with adjuvant imatinib. There were no serious adverse events of grade 3 or higher from either imatinib or chemotherapy. He has completed adjuvant imatinib and FOLFOX chemotherapy and there is no evidence of disease recurrence. When a synchronous or metachronous tumor is found in a GIST patient, the clinician should keep in mind the possibility of another primary tumor of different histopathology, as well as GIST recurrence.

Keyword

Adenocarcinoma; Case reports; Colonic neoplasms; Gastrointestinal stromal tumors

Figure

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  Fig. 1. Endoscopic and endoscopic ultrasonographic findings of gastrointestinal stromal tumor. (A) Bulging at the duodenal second portion and (B) an inhomogeneous hypoechoic oval mass with regular margins and a largest diameter of 42 mm.

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  Fig. 2. Computed tomographic findings of gastrointestinal stromal tumor. There was circumferential wall thickening with aneurysmal dilatation of the second and third portions of the duodenum (arrow). There was no bowel obstruction or organ invasion by the mass.

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  Fig. 3. Gross and microscopic findings of the surgically resected gastrointestinal stromal tumor specimen. (A) Three exophytic oval masses (arrows). (B) A well-defined submucosal tumor (hematoxylin and eosin staining, ×40). The immunohistochemical staining results were positive for CD117 (C) and positive for CD34 (D) (×100). CD, cluster of differentiation.

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  Fig. 4. Computed tomographic findings of two liver metastases (arrow). (A) A 2.4-cm metastatic mass at liver segment 8. (B) An 0.6-cm metastatic nodule at liver segment 5.

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  Fig. 5. Colonoscopic findings of colon cancer. (A) A large fungating mass at the sigmoid colon. (B) Microscopic findings of moderately differentiated colon adenocarcinoma (hematoxylin and eosin staining, ×40).

Reference

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