title: Synchronous Large Gastrointestinal Stromal Tumor and Adenocarcinoma in the Stomach Treated with Imatinib Mesylate Followed by Total Gastrectomy.
abstract: Herein we report on a case of synchronous large gastrointestinal stromal tumor (GIST) and adenocarcinoma of the stomach treated with radical surgery following neoadjuvant therapy with imatinib mesylate. A 58-year-old man was referred to our hospital with a large mass in the peritoneal cavity. Abdominal computed tomography showed a large mass measuring 21×20×14 cm in the left upper peritoneal cavity. Esophagogastroduodenoscopy revealed a large elevated lesion in the upper body and a depressed lesion in the lower gastric body near the lesser curvature. Biopsy specimens revealed GIST in the large elevated lesion and signet-ring cell carcinoma in the depressed lesion. Because of the large size of the GIST, the patient was treated with neoadjuvant therapy with imatinib mesylate (400 mg/day) for 5 months. After confirmation of a marked decrease in tumor size following imatinib mesylate therapy, the patient underwent total gastrectomy and regional lymph-node dissection with distal pancreatectomy and splenectomy. Pathological examination confirmed the diagnosis of high-risk GIST and signet-ring cell carcinoma invading the muscularis propria with one lymph-node metastasis. At the time of writing, the patient was receiving postoperative chemotherapy using oral fluoropyrimidine (S-1) without evidence of disease recurrence for 4 months after surgery. In addition to the present case, we provide a retrospective review of another 15 patients who were diagnosed with synchronous GIST in the stomach and primary gastric adenocarcinoma.
authors.affiliation: Department of Surgery, Kochi Medical School, Kochi, Japan tsutomun@kochi-u.ac.jp.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Namikawa
authors.affiliation: Department of Surgery, Kochi Medical School, Kochi, Japan.
authors.forename: Eri
authors.initials: E
authors.lastname: Munekage
authors.affiliation: Department of Surgery, Kochi Medical School, Kochi, Japan.
authors.forename: Masaya
authors.initials: M
authors.lastname: Munekage
authors.affiliation: Cancer Treatment Center, Kochi Medical School Hospital, Kochi, Japan.
authors.forename: Michihiro
authors.initials: M
authors.lastname: Maeda
authors.affiliation: Department of Anesthesiology, Kochi Medical School, Kochi, Japan.
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Yatabe
authors.affiliation: Department of Surgery, Kochi Medical School, Kochi, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kitagawa
authors.affiliation: Department of Surgery, Kochi Medical School, Kochi, Japan.
authors.forename: Kouichi
authors.initials: K
authors.lastname: Sakamoto
authors.affiliation: Department of Surgery, Kochi Medical School, Kochi, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Obatake
authors.affiliation: Cancer Treatment Center, Kochi Medical School Hospital, Kochi, Japan Department of Human Health and Medical Sciences, Kochi Medical School, Kochi, Japan.
authors.forename: Michiya
authors.initials: M
authors.lastname: Kobayashi
authors.affiliation: Department of Surgery, Kochi Medical School, Kochi, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Hanazaki
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D005743:Gastrectomy; D005770:Gastrointestinal Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery; D046152:Gastrointestinal Stromal Tumors / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery; D006801:Humans; D000068877:Imatinib Mesylate / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use*; D011859:Radiography
chemical_list: D000970:Antineoplastic Agents; D047428:Protein Kinase Inhibitors; D000068877:Imatinib Mesylate
keywords: Gastrointestinal stromal tumor; adenocarcinoma; imatinib mesylate; signet ring cell carcinoma