A large esophageal gastrointestinal stromal tumor that was successfully resected after neoadjuvant imatinib treatment: c
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WORLD JOURNAL OF SURGICAL ONCOLOGY
CASE REPORT
Open Access
A large esophageal gastrointestinal stromal tumor that was successfully resected after neoadjuvant imatinib treatment: case report Senichiro Yanagawa1, Kazuaki Tanabe1*, Takahisa Suzuki1, Noriaki Tokumoto1, Koji Arihiro2 and Hideki Ohdan1
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. Keywords: Esophageal GIST, Neoadjuvant chemotherapy, Imatinib
Background Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors of the gastrointestinal tract, commonly found in the stomach (60% to 70%) and small intestine (20% to 30%) [1,2]. Surgery is the first treatment for resectable GISTs, which cures approximately 60% of patients [3]. However, the prognosis of patients who relapse is poor. Imatinib mesylate is now the standard drug for patients with unresectable or metastatic GISTs and was recently approved for use as an adjuvant treatment [4,5]. Currently, there is no evidence of an effective neoadjuvant therapy for GISTs, especially for very large primary GISTs, which have an increased risk of a positive resection margin [6]. As esophageal GISTs are very rare, accounting for
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