A vanished gastric gastrointestinal stromal tumor

Abstract

Background: Local resection is the standard treatment for gastrointestinal stromal tumors (GISTs). Laparoscopic and endoscopic cooperative surgery (LECS) is a minimally invasive surgery used to resect GISTs. Herein, we report an extremely rare case of a gastric GIST that grossly vanished during LECS.

Case presentation: A 50-year-old Japanese female was referred to our hospital after an abnormality was detected during an esophagogastroduodenoscopy (EGD) at her annual health checkup. Based on EGD, endoscopic ultrasound (EUS), and computer tomography (CT) findings, the patient was diagnosed with a 50-mm submucosal tumor (SMT) with intraluminal growth on the anterior wall of the lesser curvature of the upper body of the stomach. We routinely use LECS to treat the intraluminal growth type of GISTs. During the intraoperative endoscopy, the intraluminal submucosal tumor, which was detected preoperatively, had vanished. A red-white scar was observed in the regressed tumor region. LECS was performed by resecting at a distance away from the scar tissue and closing the gastric wall with intracavitary sutures. In the evaluation from the tumor section view of the original resected specimen, a 22 × 14 × 8 mm lobular neoplasm was observed that was predominantly located in the gastric submucosa to the muscularis propia. Pathological findings confirmed the diagnosis of GIST with intermediate risk indicated by the Fletcher classification. The patient continued postoperative adjuvant chemotherapy with imatinib and no recurrence was detected over 12 months after surgery.

Conclusion: LECS was performed on the vanished gastric GIST, providing the best surgical treatment and leading to an accurate diagnosis and optimal postoperative care.

Keywords: Gastrointestinal stroma tumor (GIST); Laparoscopy and endoscopy cooperative surgery (LECS); Spontaneous regression; Vanished.

Fig. 1

Esophagogastroduodenoscopy revealed a submucosal tumor of over 50 mm with central ulceration on the anterior wall of the lesser curvature of the upper body of the stomach

Fig. 2

Endoscopic ultrasound revealed a 50-mm oval heteroechoic tumor arising from the muscularis propria (fourth layer) with a slight blood flow signal

Fig. 3

Computer tomography showed a 50 mm × 36 mm ovoid, well-marginated, intraluminal, heterogeneous mass at the upper body of the stomach, without invasion of adjacent organs or tissues (white arrow)

Fig. 4

The previously detected intraluminal growth submucosal tumor was no longer visible. A red and white scar was observed in the regressed tumor region

Fig. 5

Laparoscopic and endoscopic cooperative surgery was performed by resecting at a distance away from scar tissue and closing the gastric wall with intracavitary sutures

Fig. 6

a A 22 × 14 × 8 mm lobular neoplasm was observed that was predominantly located in the gastric submucosa to the muscularis propia (white arrow). b Microscopic examination showed bundle-like proliferation of spindle-shaped cells in the tumor. c The tumor was positive for c-kit. d The tumor was positive for DOG-1. e The tumor was positive for CD34. f MIB-I index was 8%