Sugiyama Yoichi, Shimbara Kensuke, Sasaki Masaru, Kouyama Mohei, Tazaki Tatsuya, Takahashi Shinya, Nakamitsu Atsushi
Department of Gastrointestinal Surgery, JA Hiroshima General Hospital, Hatsukaichi 738-8503, Japan.
Department of Surgery, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan.
World J Gastroenterol. 2020 Sep 28;26(36):5527-5533. doi: 10.3748/wjg.v26.i36.5527.
A gastrointestinal stromal tumor (GIST) is a mesenchymal tumor of the gastrointestinal tract that is most commonly found in the stomach. Recurrence of GISTs mostly occurs in the liver or peritoneum, and in most cases, multiple metastases occur. As a solitary peritoneal metastasis is rare, an appropriate treatment strategy has not been established. Here, we report a case of solitary peritoneal metastasis after complete resection of gastric GIST.
A 76-year-old woman was diagnosed with stomach GIST and underwent laparoscopic local resection using the CLEAN-NET method. As the recurrence risk was intermediate, adjuvant imatinib therapy was not administered. Two years after surgery, routine computed tomography revealed an abdominal mass between the dorsal side of the right hepatic lobe and right kidney. Other imaging tests did not reveal any abnormalities. Laparoscopic observation showed that the tumor was located at the retroperitoneum, and intraperitoneal dissemination was not found. Therefore, we performed laparoscopic tumor resection. Immunohistochemically, the tumor was positive for c-kit and CD34 and had a relatively high mitotic index and MIB-1 Labeling index. We administered adjuvant imatinib therapy. There was no evidence of recurrence 3 years after the operation.
This is the first reported case of a solitary recurrence of GIST in the peritoneum treated with complete laparoscopic resection.
胃肠道间质瘤（GIST）是一种胃肠道间叶组织肿瘤，最常见于胃。GIST复发多发生于肝脏或腹膜，且多数情况下会出现多发转移。由于孤立性腹膜转移罕见，尚未确立合适的治疗策略。在此，我们报告1例胃GIST完整切除术后发生孤立性腹膜转移的病例。
一名76岁女性被诊断为胃GIST，采用CLEAN-NET法行腹腔镜局部切除术。由于复发风险为中度，未给予辅助伊马替尼治疗。术后两年，常规计算机断层扫描显示右肝叶背侧与右肾之间有一腹部肿块。其他影像学检查未发现任何异常。腹腔镜观察显示肿瘤位于腹膜后，未发现腹腔播散。因此，我们进行了腹腔镜肿瘤切除术。免疫组织化学检查显示，肿瘤c-kit和CD34呈阳性，有丝分裂指数和MIB-1标记指数相对较高。我们给予了辅助伊马替尼治疗。术后3年无复发迹象。
这是首例报道的经腹腔镜完整切除治疗的GIST腹膜孤立性复发病例。
