Department of Surgery, School of Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara Kanagawa, 252-0374, Japan.
Surg Today. 2012 Nov;42(11):1096-9. doi: 10.1007/s00595-012-0134-8.
This report describes the laparoscopic resection of a rectal GIST after treatment with imatinib mesylate. A 56-year-old male presented with a submucosal tumor (longest diameter, 8 cm) arising in the lower rectum. A core needle biopsy revealed that the tumor contained bundles of spindle-like cells. Immunostaining revealed that the tumor was positive for c-kit and CD34. Analysis of the c-kit gene revealed a substitution of ACA (threonine) by GCA (alanine) at codon 574 of exon 11. Imatinib mesylate (400 mg/day) was given as preoperative adjuvant therapy for 3 months, and the tumor shrank to 5 cm in diameter. Proctectomy with transanal anastomosis could be performed laparoscopically, while preserving the anus. There was no evidence of recurrence 2 years 6 months after surgery. Preoperative adjuvant chemotherapy with imatinib mesylate may permit the use of less invasive treatment procedures, allowing anal preservation.
这篇报告描述了一例直肠 GIST 在接受甲磺酸伊马替尼治疗后的腹腔镜切除。一位 56 岁男性因直肠下段黏膜下肿瘤（最长径 8cm）就诊。核心针活检显示肿瘤内有束状梭形细胞。免疫组化显示肿瘤 c-kit 和 CD34 阳性。c-kit 基因分析显示外显子 11 第 574 密码子由 ACA（苏氨酸）突变为 GCA（丙氨酸）。甲磺酸伊马替尼（400mg/天）作为术前辅助治疗应用 3 个月，肿瘤直径缩小至 5cm。经肛门吻合直肠切除术可通过腹腔镜完成，同时保留肛门。术后 2 年 6 个月无复发证据。术前伊马替尼甲磺酸盐辅助化疗可能使患者接受侵袭性更小的治疗方法，从而保留肛门。
