Ebisui Chikara, Okada Kazuyuki, Wada Yuma, Kato Ryo, Makino Shunichiro, Nishigaki Takahiko, Owada Yoshiyuki, Yanagisawa Tetsu, Okamura Shu, Fukuchi Nariaki, Murata Kohei, Yokouchi Hideoki, Tamai Masamitsu, Kinuta Masakatsu
Dept. of Surgery, Suita Municipal Hospital.
Gan To Kagaku Ryoho. 2013 Nov;40(12):1708-10.
A 73-year-old man was found to have an intestinal tumor, approximately 10 cm in diameter, on computed tomography (CT). In September 2001, he underwent partial resection of the jejunum with partial colectomy and left nephrectomy. Pathological examination showed 2 mitoses per 50 high-power fields, and immunohistochemical analysis showed positive staining for c-kit. Based on the above findings, the tumor was diagnosed as a high-risk malignant gastrointestinal stromal tumor( GIST) of the small intestine; the patient was followed up and no adjuvant therapy was administered. In October 2005, an abdominal CT scan revealed 2 tumors with diameters of 21 and 28 mm in the S8 and S7 region of the liver, respectively, and the patient was diagnosed with liver metastases from GIST. After obtaining adequate informed consent, chemotherapy with imatinib (400 mg/day) was initiated. Although the patient experienced partial response (PR) 2 months after the treatment, grade 3 neutropenia and general fatigue were observed. Therefore, the treatment schedule was changed to 1 week of therapy, followed by 1 week of rest. At present, at 91 months after the diagnosis of liver metastases, the patient shows no signs of recurrence. Therefore, it is important that adjuvant chemotherapy should be considered for the treatment of patients with high-risk malignant GIST.
一名73岁男性经计算机断层扫描(CT)发现患有直径约10厘米的肠道肿瘤。2001年9月,他接受了空肠部分切除术、部分结肠切除术和左肾切除术。病理检查显示每50个高倍视野中有2个有丝分裂,免疫组化分析显示c-kit染色呈阳性。基于上述发现,该肿瘤被诊断为小肠高危恶性胃肠道间质瘤(GIST);对患者进行随访,未给予辅助治疗。2005年10月,腹部CT扫描显示肝脏S8和S7区域分别有两个直径为21毫米和28毫米的肿瘤,患者被诊断为GIST肝转移。在获得充分的知情同意后,开始使用伊马替尼(400毫克/天)进行化疗。尽管患者在治疗2个月后出现部分缓解(PR),但观察到3级中性粒细胞减少和全身乏力。因此,治疗方案改为治疗1周,然后休息1周。目前,在诊断为肝转移91个月后,患者未出现复发迹象。因此,对于高危恶性GIST患者的治疗,考虑辅助化疗很重要。