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Dong RX, Wang C, Zhou H, Yin HQ, Liu Y, Liang HT, Pan YB, Wang JW, Cao YQ. Rare rectal gastrointestinal stromal tumor case: A case report and review of the literature. World J Clin Cases 2023; 11:6797-6805. [PMID: 37901015 PMCID: PMC10600839 DOI: 10.12998/wjcc.v11.i28.6797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 08/18/2023] [Accepted: 09/04/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND Gastrointestinal stromal tumors (GISTs) are rare tumors of the gastrointestinal tract accounting for less than 1% of all gut tumors. GISTs occurring in the rectum are extremely rare, and these usually present at an advanced stage compared with other sites. CASE SUMMARY A 60-year-old male who presented with features of sensations of rectal tenesmus was referred to our department with a mass in the lower rectum that was detected during a routine checkup. Colonoscopy, transrectal ultrasound, perianal magnetic resonance imaging and ultrasonic contrast were used to diagnose the rectum GIST, and then the patient underwent complete transanal resection using the ultrasonic scalpel. The patient was discharged ten days after the operation and was defined as low risk. Therefore, he had no need to receive subsequent adjuvant therapies, and he had not suffered any anal dysfunction or had any evidence of recurrence at follow up. CONCLUSION Surgical resection with histologically negative margins is the standard curative treatment for rectal GISTs. Appropriate surgical techniques based on the location, size, and resectability of the tumor should attract great attention from clinicians.
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Affiliation(s)
- Ruo-Xi Dong
- Department of Anorectal Surgery, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
- Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Chen Wang
- Department of Anorectal Surgery, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Hao Zhou
- Department of Anorectal Surgery, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Hao-Qiang Yin
- Department of Ultrasound, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Yang Liu
- Department of Anorectal Surgery, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Hong-Tao Liang
- Department of Anorectal Surgery, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Yi-Bin Pan
- Department of Anorectal Surgery, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Jia-Wen Wang
- Department of Anorectal Surgery, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Yong-Qing Cao
- Department of Anorectal Surgery, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
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Ghobrial Y, Zackria R, Chauhan S, Brockway M, Shah P, Asgeri M. A Rare Case of a Rectal Gastrointestinal Stromal Tumor (GIST) Discovered During a Routine Colonoscopy. Cureus 2023; 15:e41030. [PMID: 37519537 PMCID: PMC10373512 DOI: 10.7759/cureus.41030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2023] [Indexed: 08/01/2023] Open
Abstract
A gastrointestinal stromal tumor (GIST) is a rare malignancy, accounting for only 0.1% to 3% of all gastrointestinal (GI) malignancies. Although GISTs are the most common mesenchymal tumor of the GI tract, they are primarily found within the stomach, with rectal GISTs rarely reported. They may present with rectal bleeding, constipation, pain, or a palpable mass while some are found incidentally. The incidence of GISTs has been on the rise, possibly due to advancements in diagnostic technology. In this case report, we present a 50-year-old female who presented with intermittent constipation and rectal pain and was found to have a submucosal rectal mass during a routine diagnostic colonoscopy. Further evaluation confirmed the presence of a spindle-cell neoplasm, which was mildly cellular and showed positive expression of CD34 and CD117 on immunohistochemistry, consistent with the diagnosis of GIST of the rectum. This case report emphasizes the importance of routine colonoscopies in the early detection of neoplastic lesions of the colon and highlights the rare incidence of GISTs, their risk factors, pathogenesis, and common sites of occurrence.
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Affiliation(s)
| | - Rasiq Zackria
- Gastroenterology and Hepatology, Sunrise Health Graduate Medical Education (GME) Consortium, MountainView Hospital, Las Vegas, USA
| | | | | | - Pranati Shah
- Internal Medicine, Touro College of Osteopathic Medicine, Las Vegas, USA
| | - Mehrdad Asgeri
- Gastroenterology, Desert Regional Medical Center, Palm Springs, USA
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Zhang Y, Huang Z. Ripretinib in combination with tyrosine kinase inhibitor as a late-line treatment option for refractory gastrointestinal stromal tumors: two case reports and literature review. Front Pharmacol 2023; 14:1122885. [PMID: 37288114 PMCID: PMC10242384 DOI: 10.3389/fphar.2023.1122885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 05/10/2023] [Indexed: 06/09/2023] Open
Abstract
Background: This case report presents two clinical cases of metastatic refractory gastrointestinal stromal tumor (GIST) with treatment history of 6-14 years. The follow-up treatment of both cases comprised ripretinib dose escalation and its combination with other tyrosine kinase inhibitors (TKIs). To the best of our knowledge, this is the first report that explored ripretinib combination therapy in the late-line treatment of GISTs. Case description: Case-1 represents a 57-year-old female patient who underwent surgical resection for retroperitoneal GIST in 2008. After tumor recurrence in 2009, imatinib was started with complete response for 8 years. Imatinib was followed by sunitinib and regorafenib treatment. In March 2021, due to progressive disease (PD), the patient started ripretinib (150 mg QD) and achieved partial response (PR). Six months later, the patient showed PD. Subsequently, ripretinib dose was increased (150 mg BID) followed by ripretinib (100 mg QD) and imatinib (200 mg QD) combination. CT performed in February 2022 revealed stable lesions with internal visible necrosis. Combination therapy achieved stable disease (SD) for 7 months. On further follow-up in July 2022, the patient showed PD and died in September 2022. Case-2: represents a 73-year-old female patient diagnosed with unresectable duodenal GIST with liver, lung, and lymph node metastases in 2016. After treatment with imatinib, followed by sunitinib, regorafenib, and imatinib rechallenge, ripretinib (150 mg QD) was administered in May 2021, and SD was achieved. Ripretinib dose was increased (200 mg QD) due to PD in December 2021. The tumor showed heterogeneous manifestations, with overall size increase and regression in right posterior lobe. In February 2022, ripretinib (150 mg) plus sunitinib (25 mg) QD was commenced. On follow-up in April 2022, the patient showed slightly improved symptoms with stable hematologic parameters. Combination therapy achieved SD for 5 months and the patient showed PD in July 2022 and discontinued the treatment later. The patient was in poor general condition and was receiving nutritional therapy until last follow-up in October 2022. Conclusion: This case report provides evidence that combination therapy of ripretinib with other TKIs could be an effective late-line treatment option for refractory GIST patients.
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Brucchi F, Lauricella S, Bottero L, Faillace GG. Anal canal gastrointestinal stromal tumour (GIST). BMJ Case Rep 2023; 16:e255040. [PMID: 37028821 PMCID: PMC10083735 DOI: 10.1136/bcr-2023-255040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023] Open
Abstract
SummaryGastrointestinal stromal tumours (GISTs) are malignant mesenchymal tumours that originate from the interstitial pacemaker cells of Cajal. They are particularly rare, comprising only 5% of all GISTs, and often present at an advanced stage. Treatment for these tumours is still a topic of debate due to their low incidence and insidious location. A woman in her mid-70s presented with rectal bleeding and anal discomfort. A 4.5×4 cm anal GIST was diagnosed. A local excision was performed and the patient was further treated with tyrosine kinase inhibitors. At a 6-month follow-up, the MRI showed that she was disease free. Anorectal GISTs are unusual and tend to be aggressive. Surgical resection is the first-line treatment for primary, localised GISTs. However, the appropriate surgical technique for these tumours is still a topic of debate. Further studies are needed to fully understand the oncologic behaviour of these rare neoplasms.
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Affiliation(s)
- Francesco Brucchi
- General Surgery Residency Program, University of Milan, Milan, Milano, Italy
| | - Sara Lauricella
- Department of Surgery, Ospedale Citta' di Sesto San Giovanni, Sesto San Giovanni, Lombardia, Italy
| | - Luca Bottero
- Department of Surgery, Ospedale Bassini, Cinisello Balsamo, Lombardia, Italy
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Andresciani F, Vertulli D, Pacella G, Altomare C, Bernetti C, Bitonti MT, Buoso A, Ferrari U, Zobel BB, Grasso RF. CT, MR, and CEUS imaging features of recurrent GIST of the pre-sacral space: A case report. Radiol Case Rep 2022; 18:145-149. [PMCID: PMC9626364 DOI: 10.1016/j.radcr.2022.09.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022] Open
Abstract
We present the case of a 50-year-old woman affected by a rectal gastrointestinal stromal tumor (GIST), with a recurrence in pre-sacral and pre-coccygeal space after surgery and Imatinib therapy. GISTs are the most common mesenchymal tumors of the gastrointestinal tract and rectal GISTs are rare (only 2% of cases); magnetic resonance and computed tomography are the main imaging techniques for diagnosis and follow-up, while ultrasound and contrast-enhanced ultrasound may be useful to perform a percutaneous biopsy, as in the case presented: the imaging features of the lesion in all these imaging methods are displayed.
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Liu XD, Zheng PF, Tang BY, Cheng ZB. Giant gastrointestinal stromal tumor of the jejunum combine with spontaneous rupture and hemorrhage: A case report. Asian J Surg 2022; 46:1799-1800. [PMID: 36307260 DOI: 10.1016/j.asjsur.2022.10.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 10/13/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- Xu-Dong Liu
- Department of General Surgery, Lanzhou University Second Hospital, Lanzhou, 730000, China
| | - Peng-Fei Zheng
- Department of General Surgery, Lanzhou University Second Hospital, Lanzhou, 730000, China
| | - Bao-Yuan Tang
- Department of General Surgery, Lanzhou University Second Hospital, Lanzhou, 730000, China
| | - Zhi-Bin Cheng
- Department of General Surgery, Lanzhou University Second Hospital, Lanzhou, 730000, China.
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Shigaki T, Tsukada Y, Teramura K, Hasegawa H, Ikeda K, Nishizawa Y, Sasaki T, Ito M. Trans-anal surgery with the taTME technique for rectal gastrointestinal stromal tumors: a retrospective study. Int J Colorectal Dis 2022; 37:1975-1982. [PMID: 35943579 DOI: 10.1007/s00384-022-04233-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/03/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE Rectal gastrointestinal stromal tumors (GISTs) surgery is often challenging owing to the anatomical constraints of the narrow pelvis and tumor hugeness. Despite the increasing number of patients undergoing trans-anal total mesorectal excision (taTME) globally, the feasibility of trans-anal surgery with the taTME technique for rectal GISTs remains unclear. We aimed to evaluate the feasibility of trans-anal surgery with the taTME technique for rectal GISTs. METHODS Using a prospectively collected database, we retrospectively analyzed the clinical findings, surgical outcomes, pathological outcomes, urinary and anal functions, and prognoses of patients who underwent trans-anal surgery with the taTME technique for primary rectal GISTs at the National Cancer Center Hospital East from September 2014 to March 2020. RESULTS Twenty-one patients with primary rectal GISTs were included in this study. The median distance from the anal verge to the lower edge of the tumor was 40 mm (range, 15-60 mm), and the median tumor size was 59 mm (range, 11-175 mm). Moreover, seven and 14 patients underwent one-team and two-team surgeries, respectively, with curative intent. Nineteen patients (90.5%) underwent anus-preserving surgery, and the urinary tracts were preserved in all cases. Two-team surgery showed a significantly lower blood loss volume and shorter operation time than one-team surgery (58 vs. 222 mL, P = 0.017; 184 vs 356 min, P = 0.041, respectively). The pathological negative-margin resection rate was 100%. During the follow-up period, no patient developed local GIST recurrence and one (4.8%) developed distant metastasis. CONCLUSION Trans-anal surgery with the taTME technique is feasible for rectal GISTs, and two-team surgery may be more advantageous than one-team surgery in terms of operation time and blood loss.
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Affiliation(s)
- Takahiro Shigaki
- Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Yuichiro Tsukada
- Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Koichi Teramura
- Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Hiro Hasegawa
- Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Koji Ikeda
- Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Yuji Nishizawa
- Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Takeshi Sasaki
- Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Masaaki Ito
- Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
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