Esophageal Gastrointestinal Stromal Tumor -Incidence and Prognosis after Enucleation

Kohei Nishimura, Toshiaki Tanaka, Yuichi Tanaka, Satoru Matono, Kazutaka Murata, Yoshiki Naito*, Kazuo Shirouzu and Hiromasa Fujita

Department of Surgery and Department of Pathology*, Kurume University School of Medicine

Background: It has been generally accepted while leiomyoma is generally assumed to be the predominant esophageal submucosal tumor, the incidence of esophageal gastrointestinal stromal tumor (GIST) appears to be increasing, particularly following the standardization of GIST diagnosis. Methods: We retrospectively reviewed 13 cases of patients undergoing esophageal submucosal tumor resection between 1997 and 2008, then evaluated the GIST incidence after immunohistochemical rediagnosis. We also looked at the post-enucleation outcome. Results: Among our 13 subjects, initially diagnosed with GIST, 3 (23%) were, 6 with leiomyoma, 2 with leiomyosarcoma, and 1 each malignant lymphoma or granular cell tumor. Following histochemical reevaluation, 2 initially diagnosed with leiomyoma were rediagnosed with GIST, 5 (38%) of the 13 were confirmed to have GIST, 4 to have leiomyoma, 2 to have leiomyosarcoma, and 1 each to have malignant lymphoma or granular cell tumor. Among the 5 with GIST, 4 patients underwent tumor enucleation alone, and had no recurrence. We looked at the post-enucleation outcome in these 4 cases and in 12 other reported cases. Post-enucleation, recurrence occurred in 4 of these 16 patients (25%), but none in those with tumors of less than 4 cm and classified in the very low or low-risk group. Conclusions: Our results indicated that esophageal GIST may be initially misdiagnosed as leiomyoma, meaning that the incidence of GIST is actually not rare among esophageal submucosal tumors. Enucleation for esophageal GIST is recommended in patients whose tumors are small. Careful follow-up is required due to the high possibility of recurrence in cases with high mitosis and a high MIB-1 index.

Key words
esophageal, gastrointestinal sromal tumor (GIST), enucleation, incidence, submucosal tomor

Reprint requests
Kohei Nishimura Department of Surgery, Kurume University School of Medicine
67 Asahimachi, Kurume, 830-0011 JAPAN

Accepted
March 25, 2009

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