A CASE OF RECTAL GASTROINTESTINAL STROMAL TUMOR (GIST) WITH LYMPH NODE METASTASIS TREATED BY IMATINIB MESYLATE

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  • 直腸ＧＩＳＴのリンパ節再発に対しメシル酸イマチニブが奏効した１例

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Abstract

This paper deals with a case of gastrointestinal stromal tumor (GIST) of the rectum metastasized to the obturator lymph nodes 19 months after surgery for the primary lesion which was treated by imatinib mesylate. A 62-year-old man complaining of anal pain was found having a tumor 7cm in diameter in the lower rectum and anal canal compressing the lumen on abdominal CT and magnetic resonance imaging (MRI) scans. A biopsy through the anus showed proliferation of spindle shaped cells with sporadic findings of karyomitosis. Rectal GIST was suspected and abdomino-perineal resection of rectum was performed in February 2001. Immunostaining of the resected material gave positive reaction to c-kit, so that GIST of the rectum was diagnosed. One year 7 months later, the patient developed obturator neurothlipsis radiating from the right gluteal region to interior aspect of the thigh. Metastasis of GIST to the right obturator lymph nodes was diagnosed by MRI scan. In April 2003 administration of imatinib mesylate at a dose of 400mg/day was started, and 6 months after the initiation the tumor decreased in size and symptomatic remission was attained. Although obturator lymph node metastasis of GIST of the rectum rarely occurs, imatinib mesylate is considered effective if it occurs.

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