DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20192927

Fifty five years old male with gastrointestinal stromal tumor: a case report

Sylvia Frisca Laura, Warsinggih Warsinggih, M. Ihwan Kusuma, Muhammad Faruk

Abstract


Esophageal Gastrointestinal Stromal Tumors (GISTs) were extremely rare, with an incidence of 0,2% of GIST cases. Majority of esophageal GISTs were classified as high-risk category (70.83%), thus, it was required more aggressive approaches, e.g. radical surgery, chemotherapy and radiotherapy. This was a case of a 55-year-old male patient who was referred to surgery department complained of atypical chest pain and swallowing difficulty. Based on thorax X-Ray, it was suspected mediastinal mass. In addition, based on chest CT scan, it was suspected a mass at distal esophagus with multiple nodular lesions in liver dd/fatty liver. X-ray Oesophagus Maag Duodenum (OMD): Esophageal mass at 1/3 middle-distal part. Upper endoscopy diagnosis showed a fragile circularly spreading tumor mass which it was easily bleeds. Biopsy also showed a mild esophageal dysplasia with non-specific inflammation and necrotic tissue which was difficult to assess. This patient underwent McKeown esophagectomy. Moreover, pathology report showed diagnosis of a malignant tumor which fitted with criteria of malignant GIST, with both ends tumor-free. Finally, the patient was administered for imatinib as adjuvant therapy 1x400mg daily. This report illustrated complexity in diagnosing and treating esophageal GIST. The tumor size and mitotic rate of tumor were associated with poor survival.


Keywords


Gastrointestinal stromal tumors, Esophagus, McKeown procedure

Full Text:

PDF

References


Akahoshi K, Oya M. Gastrointestinal stromal tumor of the stomach: how to manage. World J Gastrointest Endosc. 2010;2(8):271-7.

ESMO. Gastrointestinal stromal tumors: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2012;23(7):49-55.

Nishida T, Blay JY, Hirota S, Kitagawa Y, Kang YK. The standard diagnosis, treatment, and follow-up of gastrointestinal stromal tumors based on guidelines. Gastric Cancer. 2016;19(1):3-14.

El-Menyar A, Mekkodathil A, Al-Thani H. Diagnosis and management of gastrointestinal stromal tumors: an up-to-date literature review. J Cancer Res Ther. 2017;13(6):889-900.

Lott S, Schmieder M, Mayer B, Bruns HD, Knippschild U, Agaimy A, et al. Gastrointestinal stromal tumors of the esophagus: evaluation of a pooled case series regarding clinicopathological features and clinical outcome. Am J Cancer Res. 2014;5(1):333-43.

Wardelmann E. Gastrointestinal stromal tumor pathophysiology & drug targets. tyrosine kinase inhibitors for gastrointestinal stromal tumor. United Kingdom: Future Medicine Ltd; 2012: 7-14.

Søreide K, Sandvik OM, Søreide JA, Giljaca V, Jureckova A, Bulusu VR. Global epidemiology of gastrointestinal stromal tumours (GIST): a systematic review of population-based cohort studies. Cancer Epidemiol. 2016;40:39-46.

Judson I, Bulusu R, Sedon B, Dangoor A, Wong N, Mudan S. UK clinical practice guidelines for the management of gastrointestinal stromal tumours (GIST). Clin Sarcoma Res. 2017;7:6.

Workum F, Berkelmans GH, Klarenbeek BR, Nieuwenhuijzen GA, Luyer MD, Rosman C. McKeown or Ivor Lewis totally minimally invasive esophagectomy for cancer of the esophagus and gastroesophageal junction: systematic review and meta-analysis. J Thoracic Dis. 2017;9(8):S826-333.

Kulendran M, Siddiqui M, Du D, Khan A. Oesophageal cancer: diagnosis and management. Trends Urol Men’s Heal. 2016;7(6):23-6.

Arnal MJD, Arenas ÁF, Arbeloa ÁL. Esophageal cancer: risk factors, screening and endoscopic treatment in western and eastern countries. World J Gastroenterol. 2015;21(26):7933-43.

D’Amico TA. McKeown Esophagogastrectomy. J Thoracic Dis. 2014;6(3):S322-4.

Koo DH, Ryu MH, Kim KM, Yang HK, Sawaki A, Hirota S, et al. Asian consensus guidelines for the diagnosis and management of gastrointestinal stromal tumor. cancer res treat. Off J Korean Cancer Asso. 2016;48(4):1155-66.

Flanagan JC, Batz R, Saboo SS, Nordeck SM, Abbara S, Kernstine K, et al. Esophagectomy and gastric pull-through procedures: Surgical techniques, imaging features, and potential complications. Radiographics. 2016;36(1):107-21.

Zhai C, Liu Y, Li W, Xu T, Yang G, Lu H, at el. A comparison of short-term outcomes between ivor-lewis and mckeown minimally invasive esophagectomy. J Thoracic Dis. 2015;7(12):2352-8.

Shirinzadeh A, Talebi Y. Pulmonary complications due to esophagectomy. J Cardiovas Thorac Res. 2011;3(3):93-6.