A Case of Gastrointestinal Stromal Tumor（GIST）of the Stomach Causing Threatened Ruptur with Tumor Necrosis and Penetration during Neoadjuvant Chemotherapy

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  • 術前化学療法中に腫瘍壊死穿通に伴う切迫破裂をきたした胃GISTの1例
  • 症例 術前化学療法中に腫瘍壊死穿通に伴う切迫破裂をきたした胃GISTの1例
  • ショウレイ ジュツゼン カガク リョウホウ チュウ ニ シュヨウ エシセンツウ ニ トモナウ セッパク ハレツ オ キタシタ イ GIST ノ 1レイ

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Abstract

<p>A 64-year-old man presenting with continuous distention of the upper abdomen was referred to our hospital because an abdominal tumor was detected by an abdominal ultrasonography at another hospital. Esophagogastroduodenoscopy showed a submucosal tumor with multiple ulcers at the anterior wall under the cardia of the remnant stomach. A biopsy revealed the diagnosis of gastrointestinal stromal tumor (GIST) of the stomach. An abdominal CT scan showed a tumor with the longer diameter of 20 cm at the left upper quadrant of abdomen, where infiltration of the tumor into the surrounding organs was suspected. We planned to conduct neoadjuvant chemotherapy and imatinib regimen at a dose of 400 mg/day was started. The following CT scan on the 19th day after the initiation of the regimen revealed necrosis of the tumor and its penetration into the gastric lumen. This situation appeared to entail a greater risk of causing threatened rupture of the tumor, and we performed an emergency operation. Intraoperative findings did not confirm the tumor rupture, but it so firmly adhered with left lobe of the liver, diaphragm, spleen and pancreatic tail that combined resection of them was needed. His postoperative course was uneventful and he was discharged from our hospital on the 11th postoperative day.</p><p>Neoadjuvant chemotherapy for GISTs appears to be beneficial for its contribution to a complete resection, however, careful observation is needed because it can also cause serious complications.</p>

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