Gastrointestinal stromal tumor with intracranial metastasis: case presentation and systematic review of literature

Abstract

BackgroundIntracranial metastasis of Gastrointestinal Stromal Tumors (GISTs) is rare but presents unique treatment challenges. We present a case of intracranial metastasis of GIST with a systematic review of the literature. A literature search using key terms “‘gastrointestinal stromal tumor’ AND brain AND metastasis”” was conducted through May 2019 via Embase and Pubmed according to PRISMA guidelines. Only cases describing intradural metastases rather than calvarial or intraorbital metastases were included.Case presentationA 57-year-old woman with history of GIST metastatic to the liver presented with a six-week history of left facial weakness, left hearing loss, and left facial numbness, and a one-week history of headaches, gait disturbance, and dizziness. MRI revealed a contrast-enhancing dural-based left middle cranial fossa mass measuring 2.9 cm × 3.1 cm × 3.4 cm with extension into the internal auditory canal and cerebral edema. A left temporal craniotomy was performed to excise the lesion, and the patient was discharged to a rehabilitation facility at her preoperative baseline. Intraoperative pathology revealed a spindle cell neoplasm, postoperative MRI demonstrated gross total resection of the lesion, and microscopic analysis demonstrated sheets of spindled tumor cells with short ovoid, irregular, hyperchromatic nuclei and scattered large atypical nuclei without extensive necrosis. Immunohistochemical staining was positive for KIT proto-oncogene (CD117, c-KIT), and the patient was put on imatinib (400 mg/day).ConclusionsOf the 18 cases analyzed and our present case, metastasis typically involved the cerebrum with only one in infratentorial elements. The tumors in seven of the cases involved the dura, and one case metastasized to the pituitary. Eight patients died following treatment. Surgery remains the mainstay of intracranial metastatic GIST, however there are many reports of good responses to radiation or chemotherapy alone. More investigation is required to determine the best treatment course for these patients.

The Application of Prussian Blue Nanoparticles in Tumor Diagnosis and Treatment

“…In general, the limitation of early tumor diagnosis makes it less likely that tumors can be detected in the optimal treatment window. Once the most treatable stage passes, the tumor is likely to spread uncontrolled through the body by damaging the majority of healthy tissue, and this often leads to death [2,3]. In view of these issues, developing diagnostic techniques can be helpful for the early detection of tumor metastasis and their timely treatment using therapeutic agents that provide new possibilities for the efficient treatment of tumors.…”

Esophageal Gastrointestinal Stromal Tumor with Rare Intracranial Metastasis

“…The rarity of GIST brain metastases is noteworthy [ 2 , 5 , 6 ]. Only few cases are described in the literature, and because of that, there is lack of experience and evidence to be certain of the best treatment [ 2 ]. Our patient lived for 13 years with excellent disease control with imatinib, but the fact that it does not cross the blood-brain barrier makes it not useful in preventing or treating brain lesions.…”

“…Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors and constitute the largest group of nonepithelial digestive neoplasms; however, they do not represent more than 1% of primary digestive tumors [ 1 ]. They are more commonly found in the stomach, jejunum, and ileum and rarely arise from the esophagus [ 2 ].…”

“…When there are metastases, they commonly are found in the liver and peritoneum. Brain metastases are extremely rare [ 2 ].…”

Review of Management of Gastrointestinal Stromal Tumor in Low-Resource Centers

“…The risk of GIST increases with an increase in mutations, which can be inherited and found in several members of one family [7]. Since 95% of GIST are positive for CD117, diagnosis is based on a positive stain of KIT (CD117) on immunohistochemical (IHC) staining [15], [16]. Surgical resection with clear margins for resectable GIST and for GIST with resectable oligometastasis can be liver or peritoneal metastasis [12], [17].…”