Kawabata Kota, Takahashi Tsuyoshi, Nakajima Kiyokazu, Tanaka Koji, Miyazaki Yasuhiro, Makino Tomoki, Kurokawa Yukinori, Yamasaki Makoto, Mori Masaki, Doki Yuichiro
Dept. of Gastroenterological Surgery, Osaka University Graduate School of Medicine.
Gan To Kagaku Ryoho. 2020 Apr;47(4):670-672.
An 83-year-old woman was hospitalized with abdominal discomfort. Abdominal computed tomography(CT)revealed a hugetumor (size, 15 cm)in thegastric body. Based on thefindings of endoscopic ultrasonography-guided fine-needle aspiration, she was diagnosed with gastrointestinal stromal tumor(GIST). Invasion of thesurrounding viscera and distant metastasis were not observed; however, owing to the tumor size(>10 cm), we initiated neoadjuvant chemotherapy with imatinib. CT performed a month after chemotherapy revealed tumor shrinkage, and CT repeated 6 months after the second CT revealed tumor shrinkage to 8 cm. The patient showed a partial response to chemotherapy. She was deemed suitable to undergo laparoscopic radical resection and subsequently underwent laparoscopic partial gastric resection. Histopathological examination of the resected specimen(measuring 10 cm)revealed hyaline degeneration in most tumor cells and positive ckit expression in only some proportion of tumor cells. Based on histopathological evaluation, the tumor was diagnosed as Grade 2b. The patient showed an uneventful postoperative course. After discharge, she received imatinib as adjuvant chemotherapy and is progressing well without recurrence. Taken together, we reported the case of a huge gastric GIST in a patient who showed significant tumor shrinkage following preoperative neoadjuvant chemotherapy and successfully underwent laparoscopic radical resection.
一名83岁女性因腹部不适入院。腹部计算机断层扫描（CT）显示胃体部有一个巨大肿瘤（大小为15厘米）。根据内镜超声引导下细针穿刺活检结果，她被诊断为胃肠道间质瘤（GIST）。未观察到周围脏器侵犯及远处转移；然而，由于肿瘤大小（>10厘米），我们开始用伊马替尼进行新辅助化疗。化疗1个月后进行的CT显示肿瘤缩小，在第二次CT检查6个月后复查CT显示肿瘤缩小至8厘米。患者对化疗显示出部分缓解。她被认为适合接受腹腔镜根治性切除术，随后接受了腹腔镜部分胃切除术。对切除标本（大小为10厘米）进行的组织病理学检查显示，大多数肿瘤细胞出现透明变性，仅部分肿瘤细胞ckit表达呈阳性。根据组织病理学评估，该肿瘤被诊断为2b级。患者术后恢复顺利。出院后，她接受伊马替尼作为辅助化疗，目前进展良好，无复发。综上所述，我们报告了一例巨大胃GIST患者的病例，该患者术前新辅助化疗后肿瘤显著缩小，并成功接受了腹腔镜根治性切除术。
