Gastrointestinal stromal tumor of the stomach with lymph node metastasis
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Open Access
Case report
Gastrointestinal stromal tumor of the stomach with lymph node metastasis Aras Emre Canda*1, Yucel Ozsoy1, Olcay Ak Nalbant2 and Ozgul Sagol3 Address: 1Department of Surgery, Manisa State Hospital, Manisa, Turkey, 2Department of Pathology, Manisa State Hospital, Manisa, Turkey and 3Department of Pathology, Dokuz Eylul University School of Medicine, Izmir, Turkey Email: Aras Emre Canda* - [email protected]; Yucel Ozsoy - [email protected]; Olcay Ak Nalbant - [email protected]; Ozgul Sagol - [email protected] * Corresponding author
Published: 5 September 2008 World Journal of Surgical Oncology 2008, 6:97
doi:10.1186/1477-7819-6-97
Received: 26 April 2008 Accepted: 5 September 2008
This article is available from: http://www.wjso.com/content/6/1/97 © 2008 Canda et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract Background: Lymph node (LN) metastasis of gastrointestinal stromal tumors (GIST) is unusual. Unlike gastric adenocarcinomas, routine lymphadenectomy is not recommended unless there is no suspicion for LN metastasis. Herein, we report a case of GIST of the stomach with LN metastasis treated with distal gastrectomy with perigastric LN dissection followed by adjuvant imatinib therapy. Case presentation: A 32-year-old female presented with anemia. Diagnostic investigations including thoracoabdominopelvic computed tomography (CT) scan and gastroscopy revealed a 8 cm gastric antral submucosal tumor without any metastasis. Enlarged periantral LNs were detected during laparotomy and patient underwent distal gastrectomy with en bloc perigastric LN dissection. Pathologic investigation revealed antral stromal tumor with high mitotic and Ki-67 index. Lymph node metastasis was observed in 7 of 12 resected perigastirc nodes. Immunohistochemically, tumor cells were positive for CD117. She was diagnosed as high grade gastric GIST due to the presence of LN metastasis, large tumor size and unfavorable histopathologic features thus underwent adjuvant imatinib treatment (400 mg, daily). No recurrence or metastasis has been detected during a 12-month of postoperative follow-up. Conclusion: Surgery remains the mainstay of treatment in patients with localized, resectable GISTs. Although lymphatic metastasis rarely occurs in patients with GIST, LN dissection should be considered for patients with any suspicion of nodal metastasis. Adjuvant imatinib treatment is recommended according to the well defined prognostic factors.
Background Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of the gastrointestinal tract. They most commonly arise from the stomach; which account for ~1% of gastric malignancies [1]. Their origin has been proposed to be the intestinal cells of Cajal [2]. The mainstay of primary
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