A Case of the Small Intestine Primary Gastrointestinal Stromal Tumor that Several Reoperation and Treatment of Imatinib Mesylate Succeeded

Eiichiro Seki, Hirofumi Gonda, Tetsuya Sato, Yutaka Kojima, Tsutomu Maeda and Hideki Sakurai

Department of Surgery, Oota General Hospital

We report a case of gastrointestinal stromal tumor (GIST) of the ileum in which complete remission (CR) on computed tomography (CT) scan was achieved by imatinib mesylate treatment. In October 2000, a 70-year-old man visited our hospital, complaining of lower abdominal pain. A contrast abdominal CT showed a 15-cm tumor with solid and cystic components and a clear margin. A communication between a tumor and intestinal lumen was found in intestinal series and a CT with gastrografin contrast. The tumor was resected along with adjacent intestine. Immunohistochemistry showed positive staining for c-kit and CD34, and the diagnosis of GIST was confirmed. Peritoneal recurrence was observed 3 times in the next 3 years and the recurrent tumors were surgically removed. At the 3rd recurrence, multiple hepatic metastases were found. Because genetic analysis revealed the sequence variation in exon11 of the c-kit, the main tumors were surgically removed and imatinib mesylate treatment was selected for residual tumors in September 2003. After a 1-month of imatinib 300 mg per day, reduction of tumors was confirmed. Imatinib mesylate was increased to 400 mg per day. After a 10-month treatment, CR of the recurrent tumors and hepatic metastases was confirmed on CT. Imatinib mesylate treatment was continued. No side effects have been observed up to April 2005.

Key words
gastrointestinal stromal tumor, imatinib mesylate, reoperation

Reprint requests
Eiichiro Seki Department of Surgery, Oota General Hospital
1-50 Nisshinn-cho Kawasaki-ku Kawasaki city, 210-0024 JAPAN

Accepted
September 28, 2005

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