title: [A Case of Intraductal Growth Pattern Gastrointestinal Stromal Tumor of the Stomach That Was Difficult to Diagnose by Biopsy].
abstract: The patient, a 76-year-old man, presented to his local doctor's clinic with complaints of fatigue and lightheadedness. Because blood test results indicated anemia, he was referred to our hospital. Upper gastrointestinal endoscopy indicated a type 2 tumor of approximately 5 cm at the top of the gastric corpus. Biopsy results indicated that the lesion was a poorly differentiated adenocarcinoma. Computed tomography showed multiple liver metastases and the patient was diagnosed with stage Ⅳ gastric cancer. After a blood transfusion, chemotherapy with S-1 was started. However, as the patient experienced continued hemorrhage from the primary lesion, treatment was changed to total gastrectomy in order to control the bleeding. The pathologic examination of the resected specimen indicated that the tumor was located in the muscle and subserosal layers. The tumor cells were spindle-shaped, c-kit positive, cytokeratin-negative, and Dog-1 positive. Therefore, a diagnosis of gastrointestinal stromal tumor (GIST) was made. Postoperatively, chemotherapy with imatinib was administered and the patient was alive with no progression of disease 1 year following surgery. Intraductal growth pattern GISTs of the stomach that protrude into the epithelium and exhibit ulceration can be difficult to distinguish from gastric carcinomas. We experienced a case of gastric GIST that was difficult to diagnose preoperatively.
authors.affiliation: Dept. of Surgery, Osaka Rosai Hospital.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Ozato
authors.forename: Ryohei
authors.initials: R
authors.lastname: Kawabata
authors.forename: Masato
authors.initials: M
authors.lastname: Yoshikawa
authors.forename: Chizu
authors.initials: C
authors.lastname: Kameda
authors.forename: Chikato
authors.initials: C
authors.lastname: Koga
authors.forename: Masahiro
authors.initials: M
authors.lastname: Murakami
authors.forename: Masaki
authors.initials: M
authors.lastname: Hirota
authors.forename: Shingo
authors.initials: S
authors.lastname: Noura
authors.forename: Masakazu
authors.initials: M
authors.lastname: Ikenaga
authors.forename: Junzo
authors.initials: J
authors.lastname: Shimizu
authors.forename: Hideaki
authors.initials: H
authors.lastname: Miwa
authors.forename: Junichi
authors.initials: J
authors.lastname: Hasegawa
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001706:Biopsy; D004338:Drug Combinations; D005743:Gastrectomy; D046152:Gastrointestinal Stromal Tumors / Q000188:drug therapy / Q000556:secondary / Q000601:surgery; D006801:Humans; D000068877:Imatinib Mesylate / Q000627:therapeutic use; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary; D008297:Male; D010094:Oxonic Acid / Q000627:therapeutic use; D013274:Stomach Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D005641:Tegafur / Q000627:therapeutic use
chemical_list: D000970:Antineoplastic Agents; D004338:Drug Combinations; C079198:S 1 (combination); D005641:Tegafur; D010094:Oxonic Acid; D000068877:Imatinib Mesylate