Mikuni Masanori, Wakuta Makiko, Masaki Tatsuya, Hirose Yoshinobu, Takasu Hiroyuki, Kawano Hiroo, Aoki Ren, Ota Manami, Kimura Kazuhiro
Department of Ophthalmology, Yamaguchi University Graduate School of Medicine, Japan.
Department of Otorhinolaryngology, Yamaguchi University Graduate School of Medicine, Japan.
Am J Ophthalmol Case Rep. 2022 Jan 25;25:101353. doi: 10.1016/j.ajoc.2022.101353. eCollection 2022 Mar.
We present a case of a gastrointestinal stromal tumor (GIST) metastasis of the rectal primary resisting chemotherapy to the right orbit 15 years after excision of the primary lesion.
A 79-year-old man was diagnosed with rectal GIST at the age of 65 years and underwent rectal amputation. He underwent hepatectomy for GIST liver metastases at the age of 69 years and pericardiectomy for GIST pericardial metastases at 72 years of age. At the age of 79 years, positron emission tomography-computed tomography revealed the possibility of liver metastasis and metastasis to the right orbit of 10 mm in size. Magnetic resonance imaging revealed a well-circumscribed mass of 10 mm × 12 mm in the deep medial rectus muscle of the right orbit, which was referred to our department for ophthalmic examination. The latter revealed only mild abduction disorder in the right eye. Although chemotherapy was initiated, the tumor gradually increased, causing exophthalmos in the right eye, visual field impairment due to optic nerve exclusion, and decreased visual acuity. Due to repeated multiple metastases, the patient underwent right orbital exenteration and free flap reconstruction at the age of 83 years for radical cure. Pathological examination revealed c-Kit positive, CD34 positive, S100 protein minority positive, MIB-1 positive rate of 10% or more, and α-SMA negative, and the diagnosis was intraorbital metastasis of GIST.
Orbital metastases in GISTs are extremely rare, and there is no established standard treatment. Therefore, a comprehensive decision must be made based on the final treatment goal and the patient's background when selecting treatment.
我们报告一例直肠原发性胃肠道间质瘤（GIST）在原发灶切除15年后转移至右眼眶且对化疗耐药的病例。
一名79岁男性在65岁时被诊断为直肠GIST，并接受了直肠切除术。他在69岁时因GIST肝转移接受了肝切除术，在72岁时因GIST心包转移接受了心包切除术。79岁时，正电子发射断层扫描-计算机断层扫描显示有肝转移的可能性以及大小为10 mm的右眼眶转移。磁共振成像显示右眼眶内侧直肌深部有一个边界清晰的10 mm×12 mm肿块，该患者被转诊至我科进行眼科检查。眼科检查仅发现右眼轻度外展障碍。尽管开始了化疗，但肿瘤逐渐增大，导致右眼眼球突出、视神经受压引起视野缺损以及视力下降。由于反复多次转移，患者在83岁时接受了右眼眶内容剜除术及游离皮瓣重建术以达到根治目的。病理检查显示c-Kit阳性、CD34阳性、S100蛋白少数阳性、MIB-1阳性率达10%或更高，α-SMA阴性，诊断为GIST眶内转移。
GIST眶内转移极为罕见，且尚无既定的标准治疗方法。因此，在选择治疗方案时，必须根据最终治疗目标和患者背景做出综合决策。
