Yasuda Tadahito, Eto Kojiro, Yoshida Naoya, Iwagami Shiro, Hiyoshi Yukiharu, Nagai Youhei, Iwatsuki Masaaki, Ishimoto Takatsugu, Baba Yoshifumi, Miyamoto Yuji, Shiota Takuya, Mikami Yoshiki, Baba Hideo
Department of Gastroenterology, Graduate School of Medical Science, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
Department of Diagnostic Pathology, Kumamoto University Hospital, Kumamoto, Japan, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
Surg Case Rep. 2020 Mar 7;6(1):48. doi: 10.1186/s40792-020-00812-1.
BACKGROUND: To date, only a few cases of multiple GISTs with different clones in different organs have been published. However, a case of multiple GISTs with different clones occurring in a single organ has never been reported. CASE PRESENTATION: A 41-year-old patient underwent laparoscopic partial gastrectomy for gastric gastrointestinal stromal tumor (GIST) in 2012. The pathological findings showed high-risk characteristics for recurrence, so he received adjuvant therapy with imatinib for 3 years. In 2018, 3 years after completing the adjuvant therapy, tumor lesions at residual gastric cardia were incidentally identified by follow-up computed tomography (CT). The pathological findings of the tumor biopsy revealed gastric GIST. He underwent secondary laparoscopic partial gastrectomy and was diagnosed with high-risk GIST. Adjuvant therapy with imatinib was restarted immediately. The two gastric GISTs had the same exon 11 mutations in the c-kit gene, but they had different missense mutations. This molecular heterogeneity suggested that they were derived from different origins. CONCLUSION: We reported a multiple heterochronic GIST in the stomach detected 6 years after resection. There may be a possibility that another heterochronic GIST will occur in the remnant stomach in the future, so close follow-up will be needed.
背景:迄今为止,仅有少数不同器官中存在不同克隆的多发胃肠道间质瘤(GIST)病例被报道。然而,单个器官中出现不同克隆的多发GIST病例从未被报道过。 病例介绍:一名41岁患者于2012年因胃GIST接受了腹腔镜下胃部分切除术。病理检查结果显示具有复发的高危特征,因此他接受了3年的伊马替尼辅助治疗。2018年,在完成辅助治疗3年后,通过随访计算机断层扫描(CT)偶然发现残胃贲门处有肿瘤病变。肿瘤活检的病理结果显示为胃GIST。他接受了二次腹腔镜下胃部分切除术,并被诊断为高危GIST。立即重新开始伊马替尼辅助治疗。这两个胃GIST在c-kit基因中具有相同的第11外显子突变,但它们具有不同的错义突变。这种分子异质性表明它们起源不同。 结论:我们报告了一例切除6年后在胃中检测到的多发异时性GIST。未来残胃中可能会出现另一个异时性GIST,因此需要密切随访。
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