title: Sphincter sparing resection of a large obstructive distal rectal gastrointestinal stromal tumour after neoadjuvant therapy with imatinib (Glivec).
abstract: Gastrointestinal stromal tumours (GISTs) are generally rare but are known to be the most common mesenchymal tumours of the gastrointestinal tract. We present a case of a patient who presented with persistent obstructive gastrointestinal and urological symptoms, a sense of incomplete evacuation and bleeding per rectum. A colonoscopy was performed and a biopsy was taken of a submucosal mass in the distal rectum that revealed a GIST with positive KIT immunostaining. A positron emission tomography (PET)/CT scan showed a large metabolically active distal rectal tumour of 8 cm with macroscopic invasion of surrounding structures. Neoadjuvant therapy with receptor tyrosine kinase inhibitor imatinib (400 mg orally daily) was initiated and an excellent partial response consisting of a significant decrease in the size of the tumour with complete metabolic resolution was observed within 3 months. Six months after initiation of the neoadjuvant therapy a rectum resection with manual side-to-end coloanal anastomosis was performed. Pathology showed a GIST of 5 cm located 0.1 cm from the distal section plane. Our case shows that in patients with a large invasive distal rectal GIST, neoadjuvant imatinib therapy can facilitate anal sphincter sparing surgery.
authors.affiliation: Department of Surgery, Medical Centre Leeuwarden, Leeuwarden, Friesland, The Netherlands.
authors.forename: Kelvin Harvey
authors.initials: KH
authors.lastname: Kramp
authors.affiliation: Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Mohab Galal
authors.initials: MG
authors.lastname: Omer
authors.affiliation: Department of General Medicine Oncology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Patrick
authors.initials: P
authors.lastname: Schoffski
authors.affiliation: Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Andre
authors.initials: A
authors.lastname: d'Hoore
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000601:surgery*; D000714:Anastomosis, Surgical; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001549:Benzamides / Q000627:therapeutic use; D003106:Colon / Q000601:surgery*; D046152:Gastrointestinal Stromal Tumors / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D006801:Humans; D000068877:Imatinib Mesylate; D008297:Male; D020360:Neoadjuvant Therapy; D010879:Piperazines / Q000627:therapeutic use; D011743:Pyrimidines / Q000627:therapeutic use; D012004:Rectal Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D012007:Rectum / Q000601:surgery*
chemical_list: D000970:Antineoplastic Agents; D001549:Benzamides; D010879:Piperazines; D011743:Pyrimidines; D000068877:Imatinib Mesylate