Brain Metastasis from Gastrointestinal Stromal Tumor: A Case Report and Review of the Literature

Abstract

Metastasis of gastrointestinal stromal tumor (GIST) into the central nervous system is extremely rare. We report a patient with synchronous GIST and brain metastasis. At disease onset, there was left hemiplegia and ptosis of the right eyelids. Resection cytology of the brain tumor was reported as metastasis of GIST. After positron emission tomography examination, another tumor in the small bowel was discovered, which suggested a small bowel GIST associated with intracranial metastasis. Immunohistochemical analysis of the intestinal tumor specimen obtained by double balloon endoscopy showed a pattern similar to the brain tumor, with the tumors subsequently identified as intracranial metastases of jejunal GIST. After surgical resection of one brain tumor, the patient underwent whole brain radiation therapy followed by treatment with imatinib mesylate (Gleevec; Novartis Pharma, Basel, Switzerland). Mutational analysis of the original intestinal tumor revealed there were no gene alterations in KIT or PDGFRα. Since the results indicated the treatment had no apparent effect on either of the tumors, and because ileus developed due to an intestinal primary tumor, the patient underwent surgical resection of the intestinal lesion. However, the patient’s condition gradually worsen and she subsequently died 4 months after the initial treatment.

Sunitinib Treatment for Multiple Brain Metastases from Jejunal Gastrointestinal Stromal Tumor: Case Report

“…Of note, in 2 cases among the 11 cases (18%), brain metastases were found prior to detection of primary lesion. 11,12) There seems no tendency about the duration from the first operation of GIST to detection of brain metastasis (from 3 weeks to 5 years).…”

“…19) In most of the reported cases of brain metastases from GISTs, imatinib did not exert anti-tumor effect. 4–7,9,11,12) Table 1 displays all English-language published cases of brain metastasis from GISTs (including this case report) found during a thorough literature review. Of note, in 2 cases among the 11 cases (18%), brain metastases were found prior to detection of primary lesion.…”

Metastatic Cerebellar Gastrointestinal Stromal Tumor with Obstructive Hydrocephalus Arising from the Small Intestine: A Case Report and Review of the Literature

“…Although the genetic status of the primary lesion and CNS metastases is of interest, whether identical mutations were present in the primary and intracranial metastatic lesions remains unknown. Only five reports have described molecular features of metastatic intracranial GIST [ 10 , 11 , 16 , 18 , 19 ], with only two patients showing KIT mutation (exon 9 and exon 11) [ 10 , 16 ]. Molecular findings of the primary and intracranial metastases were identical in both cases.…”

“…GISTs are considered “radioresistant” tumors due to their histological relationship to soft tissue sarcomas, which show relatively poor responsiveness to radiotherapy. Some case reports have indicated that radiotherapy can reduce the tumor burden and produce durable local control for locally advanced and metastatic tumors [ 9 – 11 ]. Radiotherapy can provide both objective responses and symptomatic relief without detracting dramatically from quality of life and should be considered in the multidisciplinary care of patients with locally advanced or metastatic GIST.…”

Safety of Regular-Dose Imatinib Therapy in Patients with Gastrointestinal Stromal Tumors Undergoing Dialysis

“…Imatinib is an effective and safe therapy for KIT-positive gastrointestinal stromal tumors (GIST) [ 2 , 3 , 4 , 5 ]. However, the efficacy and safety of imatinib treatment in dialysis patients remain unclear because clinical trials have not been conducted in this population.…”