A Case of Postoperative Recurrence of Peritoneal Dissemination due to Gastrointestinal Stromal Tumor of the Ileum Responding to Imatinib Mesylate

Satoshi Suzuki, Takeshi Mishina, Ko-ei Nihei, Ken-ichiro Hirano, Mami Watanabe, Maya Watanabe and Yo-ichi Matsubara

Department of Surgery, Tsuruoka Municipal Shonai Hospital

We report a case of peritoneal dissemination due to gastrointestinal stromal tumor (GIST) recurring almost 2 years postoperatively. The condition responded very favorably to treatment involving imatinib mesylate, after other therapy including 2 resections of peritoneally disseminated tumors, conventional immunochemotherapy, and continuous hyperthermic peritoneal perfusion (CHPP), proved ineffective. A 55-year-old man undergoing resection of the small intestine due to a 13 cm giant ileal tumor 6 years earlier found histologically to consist of a fascicular proliferation of spindle-shaped cells with marked mitosis immunohistochemically positive for c-kit and the finally diagnosed with malignant GIST, was hospitalized 2 years later for lower abdominal pain and slight fever. Abdominal computed tomography (CT) showed multiple intraabdominal abscesses which finally diagnosed as peritoneal dissemination of GIST, necessitating 2 tumor resections. CHPP and intraabdominal infusion of CDDP at the second reduction surgery, conventional ADIC chemotherapy, and Krestin immunotherapy proved ineffective against the recurrent tumor. In Feb. 2002, oral administration of imatinib mesylate at 400 mg/day was started. An abdominal CT showed rapid tumor disappearance. Response to treatment has continued up to the 30 months as of this writing. Drug toxicity resulting in facial edema and appetite loss were mild and tolerable. Our results strongly suggest that imatinib mesylate is potentially very effective and safe in treating recurrence of malignant GIST.

Key words
imatinib mesylate, gastrointestinal stromal tumor, peritoneal dissemination

Reprint requests
Satoshi Suzuki Department of Surgery, Tsuruoka Municipal Shonai Hospital
4-20 Izumi-cho, Tsuruoka, 997-8515 JAPAN

Accepted
February 23, 2005

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