Alsaud Jolan S, Alruqayi Saja, Alomair Abdulaziz
College of Medicine, Qassim University, Buraidah, SAU.
Clinical Pharmacy, Qassim University, Buraidah, SAU.
Cureus. 2024 Mar 6;16(3):e55655. doi: 10.7759/cureus.55655. eCollection 2024 Mar.
Gastric gastrointestinal stromal tumour (GIST) is a rare disease with an annual incidence of 10 cases per million. Herein, we present the case of a 45-year-old man who visited our clinic with complaints of weight loss and anorexia, without changes in bowel habits or vomiting, for four months. On physical examination, all vital signs were normal. The abdomen was distended without tenderness and had a giant upper abdominal mass. Tumour marker investigation revealed high levels of cancer antigen 125 with normal levels of alpha-1-fetoprotein, carcinoembryonic antigen, and carbohydrate antigen. A computed tomography (CT) scan showed a mass measuring 35 × 25 × 20 cm, likely originating from the fundus of the stomach. Upper gastrointestinal endoscopy indicated external compression of the stomach and a fundal submucosal mass. Ultrasound-guided biopsy demonstrated the presence of a GIST. There was a severe danger of both the tumour rupturing during surgery and the combined excision of adjacent organs if the surgery was performed with the massive tumour. Therefore, daily neoadjuvant therapy with imatinib 400 mg was administered for three months. Post-therapeutic CT indicated a significant reduction in the size of the mass, which now measured 17 × 14 × 21 cm. The patient underwent surgical resection a month after the completion of neoadjuvant therapy, and the post-operative period was uneventful. He was followed up regularly at the general surgery department for 24 months without recurrence. This case asserts the benefit of neoadjuvant therapy in reducing the tumour size pre-operatively, which enhances the complete resection rate, prevents the need for multi-organ resection, and lowers the risk of surgery.
胃胃肠道间质瘤（GIST）是一种罕见疾病，年发病率为百万分之十。在此，我们报告一例45岁男性患者，因体重减轻和厌食前来我院就诊，持续4个月，无排便习惯改变或呕吐症状。体格检查时，所有生命体征均正常。腹部膨隆，无压痛，上腹部有一巨大肿块。肿瘤标志物检查显示癌抗原125水平升高，而甲胎蛋白、癌胚抗原和糖类抗原水平正常。计算机断层扫描（CT）显示一个大小为35×25×20 cm的肿块，可能起源于胃底。上消化道内镜检查显示胃受外压，胃底有一黏膜下肿块。超声引导下活检证实为GIST。如果对巨大肿瘤进行手术，术中肿瘤破裂以及联合切除相邻器官的风险都很高。因此，给予每日400 mg伊马替尼新辅助治疗3个月。治疗后的CT显示肿块大小显著缩小，现为17×14×21 cm。新辅助治疗完成1个月后，患者接受了手术切除，术后恢复顺利。他在普通外科定期随访24个月，无复发。该病例证实了新辅助治疗在术前缩小肿瘤大小方面的益处，这提高了完整切除率，避免了多器官切除的需要，并降低了手术风险。
