Yanagawa Senichiro, Tanabe Kazuaki, Suzuki Takahisa, Tokumoto Noriaki, Arihiro Koji, Ohdan Hideki
Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hirohima 734-8551, Japan.
World J Surg Oncol. 2014 Feb 27;12:47. doi: 10.1186/1477-7819-12-47.
A 49-year-old man was admitted to our hospital with a 1-month history of dysphagia. An upper endoscopy revealed a lower esophageal submucosal tumor. Immunohistochemical staining of the biopsy specimen revealed KIT positivity. Thus, the tumor was diagnosed as a gastrointestinal stromal tumor (GIST). After 6 months of imatinib treatment, the tumor decreased from 92 mm × 55 mm × 80 mm to 65 mm × 35 mm × 55 mm in diameter, and surgery was performed. The tumor was completely resected without rupture, by partial esophagogastric resection through a thoracotomy incision, using an abdominal laparoscopic approach. Immunohistochemical staining revealed that the tumor was negative for c-kit but positive for CD34. Genetic examination showed that the tumor had a mutation in exon 11. The patient experienced minor leakage but recovered conservatively. Adjuvant imatinib was initiated 64 days after surgery. We report this rare case to show the potential of preoperative imatinib treatment in patients with large esophageal GISTs, to achieve complete resection without rupture.
一名49岁男性因吞咽困难1个月入院。上消化道内镜检查发现食管下段黏膜下肿瘤。活检标本免疫组化染色显示KIT阳性。因此，该肿瘤被诊断为胃肠道间质瘤（GIST）。伊马替尼治疗6个月后，肿瘤直径从92 mm×55 mm×80 mm缩小至65 mm×35 mm×55 mm，随后进行了手术。通过开胸切口行部分食管胃切除术，采用腹部腹腔镜入路，肿瘤被完整切除且未破裂。免疫组化染色显示肿瘤c-kit阴性但CD34阳性。基因检测显示肿瘤外显子11存在突变。患者出现轻微渗漏，但经保守治疗后康复。术后64天开始辅助伊马替尼治疗。我们报告这一罕见病例，以展示术前伊马替尼治疗对大型食管GIST患者的潜力，可实现完整切除且不破裂。
