[P311] Metastatic cutaneous duodenal gastrointestinal stromal tumor: a visible clue to multiple metastases

( Hak Tae Kim ),( Young Jae Kim ),( Woo Jin Lee ),( Chong Hyun Won ),( Sung Eun Chang ),( Jee Ho Choi ),( Mi Woo Lee ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1

We report a case of a 69-year-old man with metastatic cutaneous duodenal gastrointestinal stromal tumor, which led to find multiple metastases on orbital muscle and scalp. The patient presented with a rapidly growing chest nodule with mild tenderness. He underwent surgical resection for duodenal gastrointestinal stromal tumor and had been treated with imatinib for three years. Histopathological examination of the chest nodule was consistent with gastrointestinal stromal tumor. A brain magnetic resonance imaging of follow work-up revealed multiple metastases at the left superior rectus muscle and occipital scalp. Under the diagnosis with imatinib-resistant duodenal gastrointestinal stromal tumors, a second-line therapy with sunitinib was tried. After six weeks, all skin lesions were completely improved and other metastatic cancers showed a response of stable disease to sunitinib therapy. This is the first reported case of metastatic cutaneous duodenal gastrointestinal stromal tumor followed by multiple metastases. Cutaneous metastases from a gastrointestinal stromal tumor have been considered to be a late progressive manifestation suggested being an indicative of multiple metastases. This report emphasizes the importance of a full-skin examination in patients with a medical history of gastrointestinal stromal tumor which leads to find multiple metastases possibly treated with sunitinib.

소장에 발생한 신경형의 소화관 간질성종양 [증례]

김철남,장석효 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.3

A new type of neurogenic gastrointestinal stromal tumours(GIST) was described. This neoplasm represents a newly described entity that grossly and histologically resembles leiomyomas and showed neurogenic differentiation. Neural type of gastrointestinal stromal tumors contains neuroaxonal and Schwann cell elements arranged in a way that differs from the usual schwannoma orneurofibroma. The clinicopathologic, histologic, immunohistologic characterisctics of neural type of gastrointestinal stromal tumors are similar to GIST. Ultrastructural examination provides the definitive distinguishing criteria for diagnosing a neural type of gastrointestinal stromal tumor. The presence of electron-dense granules or small vesicles suggests the presence of post-ganglionic neurotransmitter vesicles. We experienced a 65-year-old female patient who complained bloody diarrhea. She was diagnosed as neural type of gastrointestinal stromal tumor by abdominal CT and operation. Thus we report a case of neural type of gastrointestinal stromal tumor with a review of relevant literatures.

Contrast Enhanced Endoscopic Ultrasound Imaging for Gastrointestinal Subepithelial Tumors

Takashi Tamura,Masayuki Kitano 대한소화기내시경학회 2019 Clinical Endoscopy Vol.52 No.4

Subepithelial tumors are divided into benign subepithelial and potentially malignant gastrointestinal stromal tumors. It is difficultto distinguish between these tumor types. Contrast-enhanced harmonic endoscopic ultrasound is reportedly useful for diagnosingsubepithelial tumors, can be safely and easily performed by understanding the principle and method, and can be used to distinguishbetween tumor types with high sensitivity on the basis of differences in contrast effect. The generated image shows a hyperenhancementpattern in gastrointestinal stromal tumors (sensitivity, 78%–100%; specificity, 60%–100%; accuracy, 60%–100%) and hypoenhancementpattern in benign subepithelial tumors. Contrast-enhanced harmonic endoscopic ultrasound can be used to estimatethe malignancy potential of gastrointestinal stromal tumors by evaluating the uniformity of the contrast and the blood vessels insidethe tumor, with abnormal intra-tumor blood vessels, heterogeneous enhancement, and non-enhancing spots suggesting malignancy. Contrast-enhanced harmonic endoscopic ultrasound has a higher sensitivity than other imaging modalities for the detection ofvascularity within gastrointestinal stromal tumors. Additionally, it has been reported that treatment effects can be estimated byevaluating the blood flow in the gastrointestinal stromal tumor before and after treatment with tyrosine kinase inhibitors using contrastenhancedultrasound. However, there will be subjective-bias and the results depends on the performer’s skill.

Gastrointestinal Stromal Tumor of the Colon Mimicking Inflammatory Fibroid Polyp with a Novel 63 bp c-kit Deletion Mutation - A Case Report -

도인구,박철근,윤성현,존 골드블름,김경미 대한병리학회 2009 Journal of Pathology and Translational Medicine Vol.43 No.4

Colonic gastrointestinal stromal tumors (GISTs) are rare and behave aggressively compared to GISTs in other parts of the gastrointestinal tract. Therefore, accurate diagnosis of GISTs and their distinction from other mesenchymal tumors is important for proper patient management and follow-up. Herein, we present an unusual case of a colonic GIST mimicking an inflammatory fibroid polyp with a novel 63 bp deletion mutation in exon 11 of the c-kit gene, which has not previously been reported. The tumor consisted of loosely arranged spindle cells and many inflammatory cells scattered throughout the tumor. Immunohistochemically, the tumor cells were focally and weakly positive for c-kit and diffusely positive for CD34, but were negative for PKC-theta, SMA, S-100 protein, ALK-1, and desmin. Our case re-emphasizes the broad morphologic spectrum of GISTs. Colonic gastrointestinal stromal tumors (GISTs) are rare and behave aggressively compared to GISTs in other parts of the gastrointestinal tract. Therefore, accurate diagnosis of GISTs and their distinction from other mesenchymal tumors is important for proper patient management and follow-up. Herein, we present an unusual case of a colonic GIST mimicking an inflammatory fibroid polyp with a novel 63 bp deletion mutation in exon 11 of the c-kit gene, which has not previously been reported. The tumor consisted of loosely arranged spindle cells and many inflammatory cells scattered throughout the tumor. Immunohistochemically, the tumor cells were focally and weakly positive for c-kit and diffusely positive for CD34, but were negative for PKC-theta, SMA, S-100 protein, ALK-1, and desmin. Our case re-emphasizes the broad morphologic spectrum of GISTs.

Metastatic Cutaneous Duodenal Gastrointestinal Stromal Tumor: A Possible Clue to Multiple Metastases

( Young Jae Kim ),( Woo Jin Lee ),( Chong Hyun Won ),( Jee Ho Choi ),( Mi Woo Lee ) 대한피부과학회 2018 Annals of Dermatology Vol.30 No.3

We report a case of a 69-year-old man with metastatic cutaneous duodenal gastrointestinal stromal tumor, which led to find multiple metastases on orbital muscle and scalp. The patient presented with a rapidly growing chest nodule with mild tenderness. He underwent surgical resection for duodenal gastrointestinal stromal tumor and had been treated with imatinib for three years. Histopathological examination of the chest nodule was consistent with gastrointestinal stromal tumor. A brain magnetic resonance imaging of follow work-up revealed multiple metastases at the left superior rectus muscle and occipital scalp. Under the diagnosis with imatinib-resistant duodenal gastrointestinal stromal tumors, a second- line therapy with sunitinib was tried. After six weeks, his skin lesion was completely improved and other metastatic cancers showed a response of stable disease. This is the first reported case of a cutaneous metastasis from duodenal GIST. This report emphasizes the importance of a full-skin examination in patients with a medical history of gastrointestinal stromal tumor which leads to find multiple metastases. (Ann Dermatol 30(3) 345∼347, 2018)

Clinicopathological Features of Primary Jejunoileal Tumors

김창현,계봉현,이재임,김수홍,김형진,강원경,오승택 대한대장항문학회 2010 Annals of Coloproctolgy Vol.26 No.5

Purpose: Tumors of the small bowel are rare, accounting for about 3-6% of all gastrointestinal neoplasms, though they cover more than 90% of the intestinal surface. However, diagnosis and treatment are difficult and present an ongoing challenge for both gastrointestinal surgeons and gastroenterologists. The aim of this study was to investigate the clinical features of small bowel tumors. Methods: Between November 1994 and November 2007, 81 patients underwent treatments for primary tumors in the jejuno-ileal region at the Department of Surgery, Kangnam St. Mary’s Hospital, the Catholic University of Korea. A retrospective review of the patients’ characteristics and variable tumor factors was performed. Results: The mean age of the patients was 53.2 years with 48 men and 33 women. The most common symptom was abdominal pain (59.3%), followed by bleeding (22.2%) and an abdominal mass (6.2%). We found that the patients with ileal tumors complained mainly of abdominal pain (72.9%) whereas the patients with jejunal tumors presented with gastrointestinal bleeding (36.4%) (P = 0.048). Seventy-six of the 81 patients (93.8%) had malignant tumors, including 40 (49.4%) gastrointestinal stromal tumors, 26 (32.1%) lymphomas and 5 (6.2%) adenocarcinomas. No postoperative mortalities were observed. The overall 5-year survival rate of the patients with malignant small bowel tumors was 31.8%. Conclusion: Because the clinical features of a primary tumor of the small bowel are obscure and its diagnosis is difficult,maintaining a high degree of suspicion and recognizing the possibility of a primary small bowel tumor are important.

Case Report : Parasitic Myoma In Mesentery Mimicking Gastrointestinal Stromal Tumor: A case of Laparoscopic Myomectomy with Single Port Approach

( Hyo Jeong Kim ),( Ju Hyun Ryu ),( Tae Joong Kim ),( Byoung Gie Kim ),( Duk Soo Bae ) 대한산부인과학회 2011 Obstetrics & Gynecology Science Vol.54 No.11

Gastrointestinal stromal tumor (GIST) is the most common non-epithelial tumor in the gastrointestinal tract, and express a highly specifi c marker called c-kit (CD117). The majorinty of GISTs arise in the stomach (60%) and small bowel (30%), and remaining 10% in the other gastrointestinal tract. It also occurs, rarely, in non-gastrointestinal tract. We experienced a 42-year-old woman who was transferred to our hospital with the impression of GIST by positron emission tomography-computed tomography, and after the single port approach laparoscopy, fi nally diagnosed as parasitic myoma. Hysterectomy and complete resection of 14cm sized mesenteric mass was done via single port laparoscopy. After the immunohistochemistry test, the fi nal pathologic diagnosis was confi rmed the diagnosis of myoma. We report here the case of parasitic myoma mimicking GIST with brief review of articles.

Interpretation of Pathologic Margin after Endoscopic Resection of Gastrointestinal Stromal Tumor

Sang Gyun Kim 대한소화기내시경학회 2016 Clinical Endoscopy Vol.49 No.3

Interpretation of the pathologic margin of a specimen from a resected tumor is important because local recurrence can be predicted by the presence of tumor cells in the resection margin. Although a sufficient resection margin is recommended in the resection of gastrointestinal adenocarcinoma, it is not usually regarded strictly in cases of mesenchymal tumor, especially gastrointestinal stromal tumor (GIST), because the tumor is usually encapsulated or well demarcated, and not infiltrative. Therefore, margin positivity is not rare in the pathological evaluation of surgically or endoscopically resected GIST, and does not always indicate incomplete resection. Although a GIST may have a tumor-positive pathologic margin, complete resection may be achieved if no residual tumor is visible, and long-term survival can be predicted as in the cases with a negative pathologic margin.

출혈성 궤양을 동반한 십이지장의 위장관 간질종양 1예

권혁진,조현근,김명환,정진호,송지선,고근준 대한소화기내시경학회 2009 Clinical Endoscopy Vol.39 No.1

Duodenal gastrointestinal stromal tumors (GISTs) are relatively rare tumors that commonly present with gastrointestinal bleeding. Evaluation with endoscopic ultrasonography (EUS) is a useful technique for the differential diagnosis of GISTs from other submucosal tumors. A 58-year-old man presented with melena and anemia. An esophago-gastroduodenoscopy showed the presence of a submucosal tumor in the second portion of the duodenum with central ulceration and a flat spot. EUS showed the presence of a suspicious malignant GIST that originated from the proper muscle layer, which was successfully resected. We report a case of a duodenal GIST with a bleeding ulcer. Positive reactivity for CD117 and S-100 was demonstrated by immunohistochemical staining. 특별한 자각증상 없이 지내던 환자가 위장관 출혈을 주소로 내원하여 시행한 상부위장관 내시경 검사에서 십이지장 제 2부에서 출혈성 궤양을 동반한 점막하 종양이 발견되었다. 내시경 초음파 검사를 시행하였고 고유근층에서 기원한 악성 종양이 의심되는 GIST 소견을 보여 쐐기 절제술로 제거하였다. GIST는 수술 이전에 양성과 악성 종양을 감별하기 어려운 종양으로 EUS를 시행한다면 수술 전 감별 진단에 도움이 되며, 크기가 3 cm 이하의 양성 종양이 의심되는 경우 24개월 추적 관찰 동안 의미 있는 변화를 보이지 않은 보고가 있어 EUS를 통하여 추적 관찰이 가능하겠다. 따라서 GIST 등의 위장관 점막하 종양은 EUS를 시행하여 치료 방침을 결정하는 것이 도움이 된다. 저자들은 국내 문헌에서 수 차례 출혈성 십이지장 GIST가 보고되었으나 본 증례와 같이 수술 전 EUS를 시행한 보고가 없어 문헌 고찰과 함께 보고한다.

Extra-gastrointestinal Stromal Tumor on the Inner Urinary Bladder Wall

Jun Nyung Lee,Se Yun Kwon,Jeongshik Kim,Ghil Suk Yoon,Eun Sang Yoo,Hyun Tae Kim 대한비뇨기종양학회 2016 대한비뇨기종양학회지 Vol.14 No.1

A gastrointestinal stromal tumor is the most common mesenchymal tumor of the gastrointestinal tract, and is diagnosed on the basis of the combined expression of CD34 and CD117 (C-kit protein). An extragastrointestinal stromal tumor of the urinary bladder is a very rare neoplasm. In this report, we describe a case of an extragastrointestinal stromal tumor originating from the inner surface of the urinary bladder. A 46-year-old man presented with an incident bladder mass, and he was diagnosed with an extragastrointestinal stromal tumor after transurethral resection of the bladder tumor. A tumor on the inner urinary bladder wall is an unusual presentation of an extragastrointestinal stromal tumor. The patient is doing well with no recurrence at 18 months after surgery.