Gastrointestinal stromal tumor of the stomach with lymph node metastasis.
BACKGROUND
Lymph node (LN) metastasis of gastrointestinal stromal tumors (GIST) is unusual. Unlike gastric adenocarcinomas, routine lymphadenectomy is not recommended unless there is no suspicion for LN metastasis. Herein, we report a case of GIST of the stomach with LN metastasis treated with distal gastrectomy with perigastric LN dissection followed by adjuvant imatinib therapy.


METHODS
A 32-year-old female presented with anemia. Diagnostic investigations including thoracoabdominopelvic computed tomography (CT) scan and gastroscopy revealed a 8 cm gastric antral submucosal tumor without any metastasis. Enlarged periantral LNs were detected during laparotomy and patient underwent distal gastrectomy with en bloc perigastric LN dissection. Pathologic investigation revealed antral stromal tumor with high mitotic and Ki-67 index. Lymph node metastasis was observed in 7 of 12 resected perigastirc nodes. Immunohistochemically, tumor cells were positive for CD117. She was diagnosed as high grade gastric GIST due to the presence of LN metastasis, large tumor size and unfavorable histopathologic features thus underwent adjuvant imatinib treatment (400 mg, daily). No recurrence or metastasis has been detected during a 12-month of postoperative follow-up.


CONCLUSIONS
Surgery remains the mainstay of treatment in patients with localized, resectable GISTs. Although lymphatic metastasis rarely occurs in patients with GIST, LN dissection should be considered for patients with any suspicion of nodal metastasis. Adjuvant imatinib treatment is recommended according to the well defined prognostic factors.
Canda
Aras Emre
AE
Department of Surgery, Manisa State Hospital, Manisa, Turkey. emre.canda@deu.edu.tr
Ozsoy
Yucel
Y
Nalbant
Olcay Ak
OA
Sagol
Ozgul
O
D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001549:Benzamides; D003131:Combined Modality Therapy; D005260:Female; D005743:Gastrectomy; D046152:Gastrointestinal Stromal Tumors / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D000068877:Imatinib Mesylate; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D010879:Piperazines / Q000627:therapeutic use; D011743:Pyrimidines / Q000627:therapeutic use; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery*
D000970:Antineoplastic Agents; D001549:Benzamides; D010879:Piperazines; D011743:Pyrimidines; D000068877:Imatinib Mesylate
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