Small Gastrointestinal Stromal Tumor of the Stomach Showing Rapid Growth and Early Metastasis to the Liver

Abstract

A 65-year-old man received upper gastrointestinal endoscopy. At that time, no abnormalities were identified in the stomach except for a submucosal tumor approximately 1 cm in maximal diameter at the gastric cardia. Two months later, he developed tarry stools and anemia. Colonoscopy revealed no abnormal findings in the colon or terminal ileum. Upper gastrointestinal endoscopy was re-evaluated in our hospital. Macroscopically, the previously detected submucosal tumor had grown to 3.0 cm in maximal diameter and the tumor was exposed by extensive ulceration. Biopsy specimens of the lesion indicated KIT-positive gastrointestinal stromal tumor (GIST) with a probability of high risk. Total gastrectomy was carried out and the resected GIST was found to comprise spindle-shaped tumor cells with 23 mitoses in 10 high-power fields. Mutation of the c-kit gene was studied using the surgical specimens, and deletion of five amino acids from codons 554-558 in exon 11 was detected. Liver metastasis was found 6 months postoperatively, and molecular target therapy was carried out. However, the patient died 2 years after the finding of liver metastasis.

Management of early asymptomatic gastrointestinal stromal tumors of the stomach

“…If initial cytohistological assessment of early gastric GIST has not been performed or has not been conclusive and if there is strong clinical suspicion of early GIST, endoscopic ultrasound of the stomach should be repeated already after an interval of 2-3 mo. This short interval is not due to the (very low) probability of rapidly progressive GIST [30] but takes into account the (low) risk of a subepithelial lesion different from GIST. The correct evaluation of a subepithelial lesion by endoscopic ultrasound relies on an experienced team of endoscopists.…”

Forward-viewing versus oblique-viewing echoendoscopes in the diagnosis of upper GI subepithelial lesions with EUS-guided FNA: a prospective, randomized, crossover study

“…1,2,5 However, rapid growth of such tumors was reported, and accurate prediction remains difficult. 41 Management strategies, including tissue sampling of subepithelial lesions !2 cm, may need to be revised. 27 Therefore, tumors !20 mm (n Z 15) were included in our study.…”

Clinical implications of doubling time of gastrointestinal submucosal tumors

“…They reported that tumors 2 cm or less in diameter have no risk of postoperative metastasis. However, metastasis has been associated with even small GISTs[12]. It is therefore difficult to conclude that small tumors are benign.…”