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Case Reports
. 2014 Feb 27:12:47.
doi: 10.1186/1477-7819-12-47.

A large esophageal gastrointestinal stromal tumor that was successfully resected after neoadjuvant imatinib treatment: case report

Senichiro Yanagawa, Kazuaki Tanabe  1 , Takahisa Suzuki, Noriaki Tokumoto, Koji Arihiro, Hideki Ohdan
Affiliations
Case Reports

A large esophageal gastrointestinal stromal tumor that was successfully resected after neoadjuvant imatinib treatment: case report

Senichiro Yanagawa et al. World J Surg Oncol. .

Abstract

A 49-year-old man was admitted to our hospital with a 1-month history of dysphagia. An upper endoscopy revealed a lower esophageal submucosal tumor. Immunohistochemical staining of the biopsy specimen revealed KIT positivity. Thus, the tumor was diagnosed as a gastrointestinal stromal tumor (GIST). After 6 months of imatinib treatment, the tumor decreased from 92 mm × 55 mm × 80 mm to 65 mm × 35 mm × 55 mm in diameter, and surgery was performed. The tumor was completely resected without rupture, by partial esophagogastric resection through a thoracotomy incision, using an abdominal laparoscopic approach. Immunohistochemical staining revealed that the tumor was negative for c-kit but positive for CD34. Genetic examination showed that the tumor had a mutation in exon 11. The patient experienced minor leakage but recovered conservatively. Adjuvant imatinib was initiated 64 days after surgery. We report this rare case to show the potential of preoperative imatinib treatment in patients with large esophageal GISTs, to achieve complete resection without rupture.

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Figures

Figure 1
Figure 1
Preoperative image and tumor biopsy images. (A) Endoscopic image taken before chemotherapy showing the tumor with a smooth surface in the lower esophagus. Histopathologically, H & E staining showed that the spindle tumor cells had no mitotic activity, as shown at × 200 (B). The tumor cells were positive for c-kit, as shown at × 200, (C) and CD34, as shown at × 200, (D) using immunohistochemistry.
Figure 2
Figure 2
CT and PET-CT images. (A) CT scan before chemotherapy. The tumor was 92 × 55 mm × 80 mm in diameter. (B) PET-CT scan before chemotherapy. SUV max was 4.9. (C) CT scan after chemotherapy. The tumor was 70 mm × 37 mm × 60 mm in diameter. (D) PET-CT scan after chemotherapy. SUV max was 1.2.
Figure 3
Figure 3
Resected surgical specimen. (A) The resected tumor was approximately 65 mm × 35 × 55 mm in diameter. (B) Histopathologically, H & E staining showed that the tumor cells had no necrosis and mitotic activity, as shown at × 200. The tumor cells were negative for c-kit, as shown at × 200, (C) and positive for CD34, as shown at × 200, (D) using immunohistochemistry.
See this image and copyright information in PMC

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