A Case of Surgical Resection of Huge Esohageal Gastrointestinal Stormal Tumor after Neoadjuvant Chemotherapy

Hayato Nakamura, Kazuhiro Hiramatsu, Takehito Katoh, Masaomi Suzuki, Yoshihisa Shibata, Motoi Yoshihara and Takashi Ikeyama

Department of Surgery, Toyohashi Municipal Hospital

A 67-year-old man seen for dysphagia was found in upper gastric endoscopy to have a submucosal tumor at the gastric cardia. Computed tomography (CT) showed a huge tumor at the mid mediastinum, extending from the right pulmonary hilum to the gastric cardia. Biopsy yielded a pathological diagnosis of gastrointestinal stromal tumor (GIST) of the esophagogastric junction. To avoid excessive surgical invasion, we started neoadjuvant chemotherapy with imatinib at 400 mg/day to shrink the tumor. Two weeks later, the tumor had decreased, but CT after eight weeks showed air within the tumor and an esophago-tumor fistula. Upper gastrointestinal tract X-ray showed a cavity communicating with the esophageal lumen. When conservative 4-week treatment failed to alleviate the fistula, we conducted surgical intervention involving lower right thoracolaparotomic esophagectomy, proximal gastrectomy, intrathoracic esophagogastrostomy, and complete tumor resection. The 12×10× 8 cm tumor showed a fistula between the posterior wall and tumoral cavity. Pathologically, most tumor cells appeared atrophic with fibrotic changes throughout the tumor. The man has remained recurrence-free in the 16 months since surgery.

Key words
esophageal GIST, imatinib, neoadjuvant chemothrapy

Reprint requests
Hayato Nakamura Department of Surgery, Fukuroi Municipal Hospital
2515-1 Kuno, Fukuroi, 437-0061 JAPAN

Accepted
May 19, 2010

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