Kong Yan, Ma Xiao-Wei, Zhang Qian-Qian, Zhao Yi, Feng He-Lin
Department of Medical Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China.
Department of Orthopedics, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China.
World J Clin Cases. 2021 Feb 26;9(6):1490-1498. doi: 10.12998/wjcc.v9.i6.1490.
Gastrointestinal stromal tumor (GIST) usually originates in the stomach, followed by the small intestine, rectum, and other parts of the gastrointestinal tract. The most common sites of metastasis are the liver and peritoneum, whereas spinal metastases from GIST are extremely rare.
We found a case of GIST with the first presentation of multilevel spinal metastases involving the thoracic and lumbar vertebrae. A 61-year-old Chinese man presented to our clinic because of pain in his lower back and hip for 10 d without cause. Subsequently, computed tomography (CT) and magnetic resonance imaging (MRI) revealed abnormal signals in the vertebral appendages of T12 and L4 accompanied by spinal canal stenosis, which was considered as tumor metastasis. As there were no metastases to vital organs, posterior thoracic and lumbar spinal decompression + adnexal mass resection + pedicle internal fixation was adopted to achieve local cure and prevent nerve compression. The results of histopathological studies were consistent with the metastasis of GIST. No local recurrence or new metastases were found at the 6-mo follow-up at the surgical site. The patient has no neurological symptoms at present. It is worth mentioning that a rectal mass was found and surgically removed 1 mo after the patient was discharged from hospital, and the pathological diagnosis of the mass was GIST.
By reviewing 26 previously reported cases of spinal metastasis in GIST, it was found that spinal metastasis of GIST has become more common in recent years, so the possibility of early spinal metastasis should be recognized. CT and MRI are of great value in the diagnosis of spinal metastatic tumors, and pathological biopsy is the gold standard for the diagnosis of metastatic tumors. It is safe and feasible to treat isolated spinal metastasis in GIST by excising metastatic masses, decompressing the spinal canal, and stabilizing the spine.
胃肠道间质瘤(GIST)通常起源于胃,其次是小肠、直肠和胃肠道的其他部位。最常见的转移部位是肝脏和腹膜,而GIST发生脊柱转移极为罕见。
我们发现1例以胸腰椎多发脊柱转移为首发表现的GIST病例。一名61岁的中国男性因无诱因下背部和臀部疼痛10天前来我院就诊。随后,计算机断层扫描(CT)和磁共振成像(MRI)显示T12和L4椎附件有异常信号,伴有椎管狭窄,考虑为肿瘤转移。由于重要器官无转移,遂采用胸腰椎后路减压+附件肿物切除+椎弓根内固定术以实现局部治愈并防止神经受压。组织病理学研究结果与GIST转移相符。手术部位6个月随访时未发现局部复发或新的转移。患者目前无神经症状。值得一提的是,患者出院1个月后发现直肠肿物并手术切除,肿物病理诊断为GIST。
通过回顾既往报道的26例GIST脊柱转移病例,发现近年来GIST脊柱转移变得更为常见,因此应认识到早期脊柱转移的可能性。CT和MRI在脊柱转移瘤的诊断中具有重要价值,病理活检是转移瘤诊断的金标准。通过切除转移瘤、减压椎管和稳定脊柱来治疗GIST孤立性脊柱转移是安全可行的。