A Case of Gastrointestinal Stromal Tumor of the Jejunum Categorized to Low Risk which Metastasized to Omentum 2 Years Postoperatively

Takashi Akiyoshi, Masanori Tokunaga, Toshitatsu Ogino, Makoto Morita, Kazuharu Yamamoto, Shigeki Wakiyama, Mitsunori Hashimoto, Taisuke Toyomasu, Takashi Nagaie and Hidetaka Yamamoto*

Department of Surgery, Aso Iizuka Hospital
Department of Pathology, National Kyushu Cancer Center*

A 75-year-old man undergoing emergency laparotomy for a ruptured abdominal aortic aneurysm in January 2001 was found incidentally to have a solid tumor of the jejunum 3 cm in diameter, necessitating Y graft replacement and partial jejunal resection. Microscopically, the tumor consisted of fascicles of spindle cells and stained positive for CD34 and KIT, leading to a histological diagnosis of gastrointestinal stromal tumor (GIST). Low mitotic figures (1/50 high-power field) and a low MIB-1 labeling index (3%) evidenced no malignancy. Abdominal computed tomography showed an intrabdominal mass 8 cm in diameter in September 2003, so we conducted laparotomy in October 2003, resecting the main omental tumor and 2 small nearby lesions. Microscopically, the tumor morphologically resembled the previous intestinal GIST, but mitotic figures were frequent (16/50 high-power field). C-kit mutation analysis showed both tumors to have the same mutation at exon 11 of the c-kit gene (deletion of codon 564-576). The omental tumor was diagnosed as recurrent intestinal GIST. The patient is doing well 8 months postoperatively without any sign of recurrence.

Key words
gastrointestinal stromal tumor, c-kit, low risk

Reprint requests
Takashi Akiyoshi Department of Cancer Therapy and Research, Graduate School of Medical Sciences, Kyushu University
3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 JAPAN

Accepted
January 26, 2005

To read the PDF file you will need Abobe Reader installed on your computer.