Gastrointestinal Stromal Tumor in Periproctic Area-Report of three cases-
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Abstract:
Gastrointestinal stromal tumor(GIST)は問葉系腫瘍として近年注目されている.今回,直腸肛門部GISTの3症例を経験したので報告する.第1例は,平成12年に平滑筋腫の診断で切除され,平成14年に再発をきたしたたΨ再切除しGISTと診断された.初回切除標本を免疫染色したところ,smooth muscle typeのGISTであり,,再発時にはuncommitted typeと脱分化していた.第2例目は平成11年に平滑筋腫として経肛門的腫瘍切除を施行した例を免疫染色を行い,GISTと診断した例である.第3例目は,平成15年に手術を行い初回手術時にGISTと診断された例である.GISTの概念は近年確立されたもので,過去に平滑筋腫と診断されたものの中に,少なからずGISTの症例が含まれていると考えられる.したがって過去に切除された平滑筋腫はGISTを念頭に置き経過観察する必要がある.Keywords:
Stromal tumor
Stromal tumor
Adjuvant Therapy
Targeted Therapy
Imatinib Mesylate
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Gastrointestinal stromal tumor [GIST] is commonest mesenchymal tumor, mainly affects adults. But, 1.5% to 2% GISTs were reported in pediatrics and adolescents. The treatment of GIST is managed as in adult because of lack of information about pediatric GIST.
Stromal tumor
Mesenchymal Tumor
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Background: Gastrointestinal stromal tumor (GIST) is a rare gastrointestinal tumor but the most common mesenchymal tumor. It originates in the interstitial cells of Cajal, which on their own membranes have a specific antigen designated as CD117 or KIT receptor, a reliable indicator of tumor detection and therapy. Case: We reported a case of a 63-year-old male patient, who presented with symptoms of severe abdominal pain, discomfort, and secondary anemia. After a physical examination and a CT scan of the abdomen with angiography, the presence of a large tumor in the right hypochondrium was detected. Blood tests showed a high C-reactive protein and low hemoglobin. The patient had an exploratory laparotomy on his abdomen with complete removal of the tumor growth, which was then histologically analyzed. The obtained result from the histological analysis showed a high-degree of GIST. Conclusion: Early diagnosis of GISTs is of paramount importance to reduce mortality rate. This requires good background in pathobiology and knowledge of the physical manifestations of this malignant tumor. When this is combined with various imaging techniques, it becomes the gold standard method for GIST diagnosis.
CD117
Exploratory laparotomy
Stromal tumor
Acute abdomen
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Stromal tumor
Imatinib Mesylate
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A 21 year old male presented with a swelling in the right testicular region for the past 2 months. Serum tumor markers were within normal limits. Fine needle aspiration from right testis (8x6cms) revealed plasmacytoid to epithelioid cells with necrosis. The patient had a distal gastrectomy 5 years back, which was diagnosed as gastrointestinal stromal tumor (GIST) with high malignant potential and was on continuous imatinib therapy from the time of diagnosis till two years, however, at present was off and on therapy. Varied differential diagnosis were kept considering morphology, however, in view of the past history, cytological diagnosis was given as metastatic GIST. Orchidectomy specimen showed features of epithelioid GIST (CD117 and CD34 positive expression). A final diagnosis of metastatic epithelioid GIST to the testis was thus rendered. This case is being discussed due to rarity of metastatic GIST in testis with an emphasis on the differential diagnosis.
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Stromal tumor
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The gastrointestnal stromal tumor (GIST) is a gastrointestnal tract tumor, previously known as the group of smooth muscle tumors. By using medical technology improvement, GIST is shown as nonepitelial tumor that can arise along gastrointestnal tract. A patent with gastric disorder had been hospitalized multple tmes is reported. Defnitve diagnosis was delayed due to inappropriate applicaton of imaging diagnostic modalites, and the best treatment for the patent could not be done earlier.
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症例は51歳の男性. タール便を主訴に来院し, 精査の結果, 十二指腸水平脚に潰瘍を伴う隆起性病変を認め, 当科に紹介となった. 術前の上部消化管内視鏡検査の生検結果から, 十二指腸原発のgastrointestinal stromal tumor (GIST) と診断され, 十二指腸部分切除術を施行した. 摘出標本は38×37×30mmの境界明瞭な粘膜下腫瘍で, 中心部が粘膜面に露出し潰瘍を形成していた. 組織学的には, 紡錘形の腫瘍細胞が束状に増殖し, 核分裂像を2～4個/10HPF認めた. 免疫組織学的にはvimentin, CD34のみが陽性を示し, desmin, α-smooth muscle actin, HHF-35, S-100蛋白は陰性で, gastrointestinal stromal tumor, uncommitted type, malignantと診断した. 十二指腸原発のGISTはまれであるが, ほかの部位の消化管原発のGISTと比較して悪性度は高いといわれ, 厳重な経過観察が必要と考えられた.
Stromal tumor
Desmin
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Objective:To explore the clinical character of gastrointestinal stromal tumor(GIST)examined by prostate needlebiopsy.Methods:A case of GIST on prostate needle biopsy was reported and some questions about this disease was discussed with reviewing related literatures.Results:The biopsy specimen was proved to be GIST through immuno-enzymohistochemistry,the tumor was too huge to be resected.Imatinib was used to treat with this tumor and in 12 months the patient was still alive.Conclusion:GIST proved by prostate needle biopsy may be in prostate or rectum,which can only be determined through resection sample.GIST should be differentiated from other stromal tumor of prostate,immuno-enzymohistochemistry is very useful.Complete resection of the tumor and imatinib are effective in treating GIST.
Stromal tumor
Prostate biopsy
Needle biopsy
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Imatinib is a standard treatment for unresectable gastrointestinal stromal tumor (GIST). We described the case of a 66- year-old woman with bulky GIST of which a diameter was 25 cm. Therefore, we decided the tumor was unresectable. After 2-year administration of imatinib, the diameter of tumor was reduced to 6 cm. After 3-year administration of imatinib, the diameter of tumor was increased to 8 cm. The patient did not have any distant metastasis. He underwent a resection of the tumor. The historical examination showed that c-kit and CD34 were positive. The number of mitosis was 12/50 HPF. Conversion chemotherapy for bulky GIST may contribute to a curative resection.
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Imatinib Mesylate
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Objective To analyze the CT manifestation features of gastrointestinal stromal tumor(GIST) and explore the CT diagnosis value for the tumor.Methods 25 cases with GIST confirmed by surgical pathology were retrospectively analyzed.The patients were done preoperative CT scan and/or enhanced checks.Results There were 16 cases that the tumor exited in the stomach,4 cases exited in jejunum,1 case exited in esophagus,3 cases exited in ileum,1 case exited in rectum,and the lesion showed rounded or quasi-circular.There were 18 cases with uniform density by the scan and 7 cases with uneven density by the scan.There were 4 cases with uniform strengthening by the enhanced checks and 17 cases with uneven strengthening by the enhanced checks.In 25 patients with GIST,11 cases were benign,and had the tumor diameter less than 5 cm,the clear border,and were uniform strengthening;15 cases were malignant,and had the tumor diameter more than 5 cm,the unclear border,and were uneven strengthening,of all 2 cases happened metastases.Conclusion CT examination for GIST has accuracy position and the value for the determinations on benign and malignant tumor.
Stromal tumor
Jejunum
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