Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medicine, Kagoshima University, Sakuragaoka 8-35-1, Kagoshima, 890-8520, Japan.
World J Surg Oncol. 2018 Aug 11;16(1):165. doi: 10.1186/s12957-018-1463-x.
Rectal gastrointestinal stromal tumor (GIST) is a very rare tumor of gastrointestinal tract. Surgical management of rectal GIST requires special attention for preserving of anal and urinary functions. Transanal minimal invasive surgery (TAMIS) is a well-developed minimally invasive technique for local excision of benign and early malignant rectal tumors; however, the application of TAMIS for rectal GIST is rarely and inadequately reported. We report the novel application of TAMIS for rectal GIST with considerations for anal and urinary functions.
A 67 years old female, who presented with history of per rectal bleeding, was diagnosed with submucosal GIST of 4.5 cm in diameter at right posterior wall of 7 cm from anal verge. Histology of biopsy showed abundant spindle-shaped cells arranged in bundles that were positive for CD34 and negative for C-Kit, desmin, smooth muscle actin (SMA), and S-100. The tumor was excised by TAMIS successfully. Final histopathology showed pT2 tumor with C-Kit positive and mitosis count 10 per 50 HPF. Postoperative period was uneventful, and she was discharged on adjuvant imatinib mesylate for 3 years.
TAMIS can be used safely in the management of rectal GIST after appropriate evaluation of tumor size, extent, location, and experience of operating surgeon.
直肠胃肠道间质瘤（GIST）是一种非常罕见的胃肠道肿瘤。直肠 GIST 的外科治疗需要特别注意保留肛门和泌尿功能。经肛门微创外科（TAMIS）是一种用于局部切除良性和早期恶性直肠肿瘤的成熟微创技术；然而，TAMIS 应用于直肠 GIST 的报道很少且不充分。我们报告了 TAMIS 在考虑肛门和泌尿功能的情况下，应用于直肠 GIST 的新方法。
一名 67 岁女性，因直肠出血就诊，在距肛门 7cm 的直肠右后壁被诊断为直径 4.5cm 的黏膜下 GIST。活检组织学显示大量成束排列的梭形细胞，CD34 阳性，C-Kit 阴性，结蛋白、平滑肌肌动蛋白（SMA）和 S-100 阴性。肿瘤通过 TAMIS 成功切除。最终组织病理学显示 pT2 肿瘤，C-Kit 阳性，每 50HPF 有 10 个有丝分裂。术后恢复顺利，她接受了 3 年的辅助甲磺酸伊马替尼治疗。
在适当评估肿瘤大小、范围、位置和手术医生的经验后，TAMIS 可安全用于直肠 GIST 的治疗。
