Late recurrences of gastrointestinal stromal tumours (GISTs) after 5 years of follow-up

Late recurrence of low-risk gastrointestinal stromal tumor of jejunum diagnosed 30 years after tumor resection: A case report and literature review

Gastrointestinal stromal tumors (GISTs) have a significant risk of metastasis, although the degree varies in each case. The present report describes a case of late recurrence of GIST that was diagnosed 30 years after the primary tumor resection. An 80-year-old man was transported to Sanjo General Hospital (Sanjo, Japan) with hemorrhagic shock from gastrointestinal bleeding. Abdominal contrast-enhanced computed tomography revealed an 11.7-cm heterogenous tumor in the retroperitoneum adjacent to the third portion of the duodenum. The patient had a medical history of resection of 'leiomyoma' of the upper jejunum when he was 50 years old. Pathological examination using archival pathological samples revealed that the previously excised tumor was GIST because the tumor cells showed positive immunoreactivity for KIT and DOG1. Treatment was started with imatinib, a selective KIT tyrosine inhibitor, even though endoscopy failed to provide biopsy specimens. Positron emission tomography conducted on the 28th treatment day revealed that imatinib completely shut down ¹⁸F-fluorodeoxyglucose uptake in the tumor, confirming that the tumor was imatinib-sensitive. A literature review yielded 12 GIST cases wherein metastases were diagnosed >10 years after primary tumor resection. Of the 12, four were originally diagnosed as benign. Clinicians should keep in mind that GISTs were formerly confused with non-GIST tumors and that there is a risk of relapse 10 years or later after curative surgery.

Controversies in the management of gastrointestinal stromal tumors

Major advances in the medical treatment of gastrointestinal tumors (GISTs) have improved survival for both patients with advanced disease and those diagnosed with high-risk primary tumors. The Consensus approaches to best practice management of gastrointestinal stromal tumors, published in this journal in 2008, provided guidance for the management of GIST to both clinicians and regulatory authorities. Since then, clinical trials have demonstrated the benefit of adjuvant imatinib in high-risk patients, and mature data from advanced GIST studies suggest that a small but significant proportion of patients with advanced disease can achieve long-term benefit with ongoing imatinib treatment. Other evolving management strategies include the controversial use of palliative or debulking surgery to improve outcomes in advanced GIST and the development of promising new multikinase inhibitors, such as regorafenib, which has established benefit in the third-line setting. This review provides an update of recent developments in GIST management and discusses new controversies that these advances have generated.

Clinical features and treatment of gastrointestinal stromal tumors: Recent advances

Gastrointestinal stromal tumors (GISTs) are the most common gastrointestinal mesenchymal tumors. The development of molecular biology, pathology and clinical medicine in recent years has deepened our understanding of GISTs. The combination of traditional surgery and molecular targeted drugs is particularly important for the treatment of GISTs. Multi-target and multi-kinase inhibitors such as imatinib and sunitinib have been used for the treatment of unresectable and recurrent GISTs. This paper provides a brief review of gene analysis, pathological characteristics, operational and adjuvant therapy of GISTs.