title: Wide local excision for anal GIST: A case report and review of literature.
abstract: BACKGROUND
  Gastrointestinal stromal tumors (GIST) are tumors of mesenchymal origin commonly detected in stomach and small bowel. GIST arising primarily from the anal canal is extremely rare. Due to the malignant potential, these tumors are treated with radical surgery like abdominoperineal resection. But with the advent of imatinib therapy and a better understanding of the tumor biology, some cases have been successfully treated with wide local excision.
  
  
  METHODS
  We describe a case of a 70-year-old lady presenting with a 2cm mass in the anal canal. Endoanal ultrasound revealed a well-circumscribed solid nodule in the intersphincteric space. The patient was successfully treated by wide local excision and adjuvant therapy with imatinib mesylate.
  
  
  CONCLUSIONS
  Only 14 confirmed cases of primary anal GIST have been reported in the literature. It appears as a well circumscribed hypoechoic mass arising from the intersphincteric space encroaching into the lumen on endorectal ultrasound. Lymphadenopathy is absent. Anal sphincters get involved as the lesion increases in size. Treatment is often planned based on the extent of the disease, the mitotic rate, patient's general condition and willingness for a permanent colostomy.
  
  
  CONCLUSIONS
  Small lesions (<2cm) with low mitotic rate may be successfully managed by local excision. Radical surgery should be reserved for large, aggressive tumors.
authors.affiliation: Department of Digestive Surgery, Hospital Sahloul, Sousse, Tunisia.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Azzaza
authors.affiliation: Department of Digestive Surgery, Hospital Sahloul, Sousse, Tunisia.
authors.forename: Houssem
authors.initials: H
authors.lastname: Ammar
authors.affiliation: Department of Pathology, Farhat Hached Hospital, Sousse, Tunisia.
authors.forename: Nihed
authors.initials: N
authors.lastname: Abdessayed
authors.affiliation: Department of HPB Surgery, CARE Hospital, Hyderabad, India.
authors.forename: Rahul
authors.initials: R
authors.lastname: Gupta
authors.affiliation: Department of Anaesthesia, Hospital Sahloul, Sousse, 4011, Tunisia. Electronic address: mohamedsaid.nakhli@rns.tn.
authors.forename: Mohamed Said
authors.initials: MS
authors.lastname: Nakhli
authors.affiliation: Department of Digestive Surgery, Hospital Sahloul, Sousse, Tunisia.
authors.forename: Amine
authors.initials: A
authors.lastname: Chhaider
authors.affiliation: Department of Digestive Surgery, Hospital Sahloul, Sousse, Tunisia.
authors.forename: Nafis
authors.initials: N
authors.lastname: Abdennaceur
authors.affiliation: Department of Digestive Surgery, Hospital Sahloul, Sousse, Tunisia.
authors.forename: Ali Ben
authors.initials: AB
authors.lastname: Ali
keywords: Abdominoperineal resection; Anal canal; Gastrointestinal stromal tumor