Fargose Preeti, Basu Sandip
Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Hospital Annexe, Mumbai, Maharashtra, India.
Homi Bhabha National Institute, Mumbai, Maharashtra, India.
Indian J Nucl Med. 2018 Apr-Jun;33(2):140-142. doi: 10.4103/ijnm.IJNM_142_17.
Discordant primary resistance and response of the metastatic lesions in the same individual coupled with splenic involvement in gastrointestinal stromal tumors (GISTs) are relatively uncommon. We herein report such a case of recurring GIST of the stomach that presented with the involvement of spleen with F-fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET-CT) imaging documentation. Ultrasonography-guided fine needle aspiration cytology from the splenic and paravesical lesions demonstrated metastatic spindle cell tumor consistent with diagnosis of metastasis from GIST of the stomach. The splenic and the paravesical lesions appeared resistant to the conventional 400 mg of imatinib mesylate, while most other abdominopelvic metastatic lesions demonstrated good metabolic response on FDG-PET/CT, with the noteworthy findings of interlesional heterogeneity of the metastatic lesions in terms of differential primary response in the same individual.
同一患者体内转移性病变出现原发性耐药和反应不一致，且脾脏受累于胃肠道间质瘤（GIST）的情况相对少见。我们在此报告一例复发性胃GIST病例，其脾脏受累有氟脱氧葡萄糖正电子发射断层扫描-计算机断层扫描（FDG PET-CT）影像记录。超声引导下对脾脏和膀胱旁病变进行细针穿刺细胞学检查，显示转移性梭形细胞瘤，符合胃GIST转移的诊断。脾脏和膀胱旁病变对常规400 mg甲磺酸伊马替尼似乎耐药，而大多数其他腹盆腔转移性病变在FDG-PET/CT上显示出良好的代谢反应，同一患者体内转移性病变在原发性反应差异方面存在病灶间异质性，这一发现值得注意。
