A Case of Gastrointestinal Stromal Tumor of the Stomach with Lymph Node Metastasis

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  • SUDA Takeshi
    Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University
  • HOSHINO Sumito
    Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University Department of Surgery, Shimadadai General Hospital
  • NAGAKAWA Yuichi
    Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University
  • SESHIMO Akiyoshi
    Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University Department of Surgery, Ushiku Aiwa General Hospital
  • KATSUMATA Kenji
    Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University
  • INOUE Rie
    Department of Diagnostic Pathology, Tokyo Medical University
  • TSUCHIDA Akihiko
    Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University

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Other Title
  • リンパ節転移を伴った胃GISTの1例
  • 症例 リンパ節転移を伴った胃GISTの1例
  • ショウレイ リンパセツ テンイ オ トモナッタ イ GIST ノ 1レイ

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Abstract

<p>Lymph node metastasis of gastrointestinal stromal tumor (GIST) is rare. A case of a patient with primary GIST of the stomach who developed lymph node metastasis is presented. A 68-year-old man was referred to our department after a submucosal tumor in the upper gastric corpus was identified on upper gastrointestinal endoscopy at a local clinic. Fine needle aspiration was conducted at our hospital, and GIST of the stomach was diagnosed. Abdominal contrast-enhanced computed tomography showed both the tumor and enlarged lesser curvature lymph nodes. Surgery was performed for the GIST of the stomach. During open surgery, signs indicative of lymph node metastasis were observed, and total gastrectomy and D2 lymph node dissection were therefore performed. Pathological testing showed that the tumor measured 40 × 30 mm with mitotic figures (63/50 high-power fields), and the patient was therefore classed as high risk according to Fletcher's risk classification. Postoperative adjuvant chemotherapy with imatinib mesylate was started, but after 1 month of oral treatment, the patient developed general malaise and discontinued is subsequent use. There have been no signs of recurrence to date. Because lymph node metastasis of GIST almost never occurs, lymph node dissection is usually of no value, and local resection without lymph node dissection is normally performed. However, lymph node dissection should be considered in cases of GIST with lymph node metastasis to ensure complete resection.</p>

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