Carvalho José, Teixeira Margarida, Silva Francisco Teixeira, Esteves Alexandra, Ribeiro Carlos, Guerra Diana
Serviço de Medicina Interna, ULSAM-Hospital de Santa Luzia, Viana Do Castelo, Portugal.
Serviço de Anatomia Patológica, Hospital de Braga, Braga, Portugal.
Case Rep Gastrointest Med. 2020 Oct 11;2020:8842006. doi: 10.1155/2020/8842006. eCollection 2020.
. Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors and constitute the largest group of nonepithelial digestive neoplasms. However, they do not represent more than 1% of primary digestive tumors. They commonly metastasize to the liver and peritoneum, but brain metastases are extremely rare. . A 76-year-old woman with a diagnosis of esophageal GIST with liver and lung metastases for 13 years, medicated with imatinib, is presented. She was brought to the emergency department after falling and due to changes in behavior and vertigo with 24 hours of evolution. On physical examination, she presented changes in behavior, dysarthria, dysmetria on the right, gait imbalance, and no motor or sensory deficits. On brain computed tomography and posteriorly on magnetic resonance, 2 lesions were observed, left frontal and right cerebellar, compatible with metastatic lesions. After contribution of neurosurgery, histology was obtained that confirmed the lesions were GIST metastases. Imatinib was maintained, and whole brain radiotherapy was performed. After 6 months, she died. . The rarity of GIST brain metastases is noteworthy, and because of that, there is not enough experience to be certain of the best treatment. Our patient lived for 13 years with excellent disease control with imatinib, but the fact that it does not cross the blood-brain barrier makes it not useful in preventing or treating brain lesions. New tyrosine kinase inhibitors that may cross the blood-brain barrier could be the answer to these cases.
胃肠道间质瘤（GISTs）是间叶组织肿瘤，是最大的非上皮性消化系肿瘤组群。然而，它们在原发性消化系肿瘤中所占比例不超过1%。它们通常转移至肝脏和腹膜，但脑转移极为罕见。本文介绍了一名76岁女性，诊断为食管GIST伴肝肺转移13年，一直服用伊马替尼。她因跌倒、行为改变和眩晕24小时后被送往急诊科。体格检查发现，她存在行为改变、构音障碍、右侧辨距不良、步态不稳，无运动或感觉缺陷。脑部计算机断层扫描及随后的磁共振成像检查发现2个病灶，位于左额叶和右小脑，符合转移瘤表现。经神经外科会诊后，组织学检查证实病灶为GIST转移瘤。继续使用伊马替尼，并进行了全脑放疗。6个月后，患者死亡。GIST脑转移罕见，因此目前尚无足够经验确定最佳治疗方案。我们的患者使用伊马替尼病情得到了13年的良好控制，但由于该药不能通过血脑屏障，故对预防或治疗脑转移无效。可能通过血脑屏障的新型酪氨酸激酶抑制剂或许是解决这类病例的答案。
