Department of Surgery, Onomichi General Hospital, Onomichi, Japan.
Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Sapporo, Japan.
Asian J Endosc Surg. 2020 Oct;13(4):574-577. doi: 10.1111/ases.12782. Epub 2020 Feb 3.
This report describes the combination of a transanal total mesorectal excision (TaTME) and neoadjuvant therapy with Imatinib mesylate (IM) for a gastrointestinal stromal tumor (GIST) of the lower rectum. A 49-year-old man presented with a submucosal tumor with ulcer located 3 cm above the anal verge. Histopathologically, a biopsy showed spindle-shape cells, positive for C-kit and CD34, negative for smooth muscle actin, desmin and S-100 protein. Genetically, this GIST had the mutation in KIT exon 11. IM (400 mg/d) was administered as neoadjuvant therapy for 80 days. The GIST shrank from 4.7 to 3.3 cm in diameter. Abdominal and transanal approach were started at the same time. The tumor was resected by TaTME successfully. The manometric pressure data and anal function were preserved before and after surgery. TaTME and neoadjuvant therapy with IM provide a treatment option which can preserve anal function for the lower rectal GIST.
本报告描述了经肛门全直肠系膜切除术（TaTME）联合伊马替尼（IM）新辅助治疗低位直肠胃肠道间质瘤（GIST）的病例。一名 49 岁男性因距肛门 3cm 处黏膜下有一溃疡型肿物就诊。病理活检显示梭形细胞，免疫组化 C-kit 和 CD34 阳性，平滑肌肌动蛋白、结蛋白和 S-100 蛋白阴性。基因检测显示 KIT 外显子 11 突变。该患者接受 IM（400mg/d）新辅助治疗 80 天，肿瘤从 4.7cm 缩小至 3.3cm。同期行经腹和经肛门入路，成功行 TaTME 切除肿瘤。手术前后肛管测压和肛门功能保留良好。TaTME 联合 IM 新辅助治疗为低位直肠 GIST 保留肛门功能提供了一种治疗选择。
