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A 78-year-old woman had undergone surgical resection of a gastrointestinal stromal tumor (GIST) of the jejunum. A second intestinal resection proceeded one year later and therapy with imatinib mesylate was started due to recurrence in the superior mesenterium. However, the tumor recurred in the superior mesenterium at four years after the first operation. At that time, the patient elected to continue with internal imatinib mesylate rather than endure further surgery. The local tumor obviously increased in size and hepatic metastasis appeared at seven years after the initial surgery. The disease had progressed locally and the metastasis seemed completely resectable. We applied a curative operation comprising partial resections of the jejunum, duodenum, and hepatic segment 7. Genetic analysis of resected specimens showed that the imatinib mesylate had been effective. Considering that the patient had a history of poor compliance with medication, internal administration of imatinib mesylate was resumed. However, metastases were discovered in the thoracic vertebra at three months after the last operation. Thus, bisphosphonate was also administered internally, and MRI findings one month later showed that this combination therapy had stabilized the metastases. Appropriate therapeutic intervention should be considered even for rare bone metastasis, especially in longterm survivors of highly malignant, recurrent GIST.

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