Mishima Keisuke, Matsutani Takeshi, Yamagiwa Ryo, Hanawa Hidetsugu, Kurihara Yuji, Motoda Norio, Taniai Nobuhiko, Yoshida Hiroshi
Department of Digestive Surgery, Nippon Medical School Musashikosugi Hospital, 1-383, Kosugimachi Nakahara-ku, Kawasaki-shi, Kanagawa, 211-8533, Japan.
Department of Diagnostic Pathology, Nippon Medical School Musashikosugi Hospital, Kanagawa, Japan.
Surg Case Rep. 2022 Jun 6;8(1):109. doi: 10.1186/s40792-022-01464-z.
Esophageal gastrointestinal stromal tumors (E-GISTs) are often diagnosed early due to complaints such as dysphagia and are rarely found to be huge in size. Here, we report the treatment of a case of huge E-GIST successfully resected by minimally invasive surgery after neoadjuvant imatinib therapy.
An 86-year-old male patient with a 3-month history of dysphagia was referred to our hospital because of a suspected mediastinal tumor on chest X-ray. The chest computed tomography scan revealed a huge solid tumor, of about 100 mm in diameter, protruding into the left thoracic cavity. Histopathological examination results of fine-needle aspiration biopsy under endoscopic ultrasonography revealed a c-kit and CD34-positive esophageal gastrointestinal stromal tumor. The patient received neoadjuvant therapy with imatinib (400 mg/day) to reduce the size of the tumor and prevent rupture during resection. After 28 days of oral administration of imatinib, the tumor size decreased. However, the patient refused to continue treatment with imatinib and therefore underwent mediastino-laparoscopic transhiatal esophagectomy. We successfully resected the tumor completely with mediastino-laparoscopic surgical techniques. Esophageal reconstruction was performed using a gastric tube in the posterior sternal route. After an uneventful postoperative course, the patient was discharged postoperative day 14. Immunohistochemical findings of the resected specimen showed that the tumor cells were positive for c-kit, DOG-1 and CD34 and negative for smooth muscle actin and S100.
Hybrid surgical procedure utilizing mediastino-laparoscopy might be useful for high-risk patient with esophageal tumors.
食管胃肠道间质瘤（E-GISTs）常因吞咽困难等症状而早期确诊，很少发现体积巨大。在此，我们报告1例巨大E-GIST患者，在新辅助伊马替尼治疗后通过微创手术成功切除。
一名86岁男性患者，有3个月吞咽困难病史，因胸部X线检查怀疑纵隔肿瘤转诊至我院。胸部计算机断层扫描显示一个巨大的实性肿瘤，直径约100毫米，突入左胸腔。内镜超声引导下细针穿刺活检的组织病理学检查结果显示为c-kit和CD34阳性的食管胃肠道间质瘤。患者接受伊马替尼（400毫克/天）新辅助治疗以缩小肿瘤大小并防止切除过程中破裂。口服伊马替尼28天后，肿瘤大小减小。然而，患者拒绝继续使用伊马替尼治疗，因此接受了纵隔-腹腔镜经裂孔食管切除术。我们使用纵隔-腹腔镜手术技术成功完整切除肿瘤。采用胸骨后途径用胃管进行食管重建。术后过程顺利，患者于术后第14天出院。切除标本的免疫组织化学结果显示肿瘤细胞c-kit、DOG-1和CD34阳性，平滑肌肌动蛋白和S100阴性。
纵隔-腹腔镜联合手术方法可能对食管肿瘤高危患者有用。
