Surgical management of rectal GIST. A case report and a review of literature.

AIM

Rectal GIST is a rare tumor of the gastrointestinal tract. The few literature cases didn't show significant evidence about diagnostic and therapeutic management. We present a rare case of rectal GIST treated with laparoscopic anterior rectal resection (RARLs) preceded by neoadjuvant therapy with Imatinib Mesylate (IM).

CASE REPORT

A 68-year-old woman with abdominal pain, rectal bleeding and palpable mass on rectal exam has been subjected to computerized tomography (CT) of the abdomen and pelvis and magnetic resonance imaging (MRI) that revealed a rectal GIST of 5x4x2 cm at 3 cm from anal verge. The diagnosis was confirmed with colonoscopy. After 3- mounts neoadjuvant therapy with IM, which allowed to down-stage the neoformation, the patient underwent RARLs without intraoperative or postoperative complications. Immunohistochemistry revealed cluster of differentiation CD 117 positive, HPF 5/50, Ki 67overexpressed. PDGF mutation was detected. The patient was therefore taken in charge by the oncologist.

DISCUSSION AND CONCLUSION

Resection appear curative for rectal GIST. Extensive resections aren't necessary because of downstaging after IM therapy. However, the appropriate surgical technique is still debated. Further studies are necessary for a correct surgical standardization.

KEY WORDS

Rectal GIST, Cajal cell, Laparoscopic rectal resection, Imatinib.