Ishigame Teruhide, Kimura Takashi, Kase Koji, Muto Makoto, Watanabe Junichiro, Sato Naoya, Kofunato Yasuhide, Okada Ryo, Kenjo Akira, Shimura Tatsuo, Marubashi Shigeru
Dept. of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University.
Gan To Kagaku Ryoho. 2018 Mar;45(3):527-529.
We hereby report a case of long-term survival of metastatic and recurrent duodenal gastrointestinal stromal tumor(GIST) treated with multimodality managements. A 59-year-old man was diagnosed with duodenal GIST and underwent surgical resection of a primary lesion of the duodenum. Since the pathological findings on mitotic rate indicated its high risk of recurrence, the systemic treatment by imatinib mesylate was given shortly after the surgery. Six months later, metastatic lesions being considered to be imatinib-resistant were observed in the remnant liver. Since there were no other drugs available for GISTs in clinic at that time, surgery of central bisegmentectomy with partial resection of the liver was performed to eliminate all metastatic lesions. However, recurrences had been repeatedly diagnosed afterward. In response to them, four more surgery for recurrent liver or peritoneal tumors, two transcatheter arterial chemoembolizations(TACE)and one radiofrequency ablation(RFA)were performed on the basis of its resectability. Sunitinib malate had been given since it was approved for imatinib-resistant GISTs in clinic. Eventually, as long as 99 months had passed since we observed the first evidence of the resistance to imatinib mesylate when he died from the GIST.
我们在此报告一例经多模式治疗的转移性复发性十二指肠胃肠道间质瘤（GIST）长期存活的病例。一名59岁男性被诊断为十二指肠GIST，并接受了十二指肠原发性病变的手术切除。由于有丝分裂率的病理结果表明其复发风险高，术后不久即给予甲磺酸伊马替尼全身治疗。6个月后，在残余肝脏中观察到被认为对伊马替尼耐药的转移病灶。由于当时临床上没有其他可用于GIST的药物，因此进行了肝中叶双段切除术及部分肝切除术以清除所有转移病灶。然而，此后反复诊断出复发。针对复发情况，根据其可切除性，又进行了4次复发性肝或腹膜肿瘤手术、2次经动脉化疗栓塞术（TACE）和1次射频消融术（RFA）。自苹果酸舒尼替尼在临床上被批准用于治疗伊马替尼耐药的GIST以来，该患者一直服用此药。最终，从我们首次观察到对甲磺酸伊马替尼耐药的证据起，直至他死于GIST，时间长达99个月。
