[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.

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.

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)

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.

복막파종 형태로 발생한 원발성 위장관외 간질종양

양홍준 ( Hong Jun Yang ),김태호 ( Tae Ho Kim ),박민경 ( Min Kyoung Park ),임창훈 ( Chang Hoon Lim ),이기현 ( Kee Hyun Lee ),김창환 ( Chang Whan Kim ),한석원 ( Sok Won Han ),김진아 ( Jean A Kim ) 대한소화기학회 2010 대한소화기학회지 Vol.56 No.5

Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of the gastrointestinal tract, but also occurs at a lower frequency in extra-gastrointestinal regions such as omentum, mesentery, retroperitoneum and undefined abdominal sites. This tumor is called extragastrointestinal stromal tumor (EGIST). EGIST is mostly diagnosed as a cystic mass, but rarely occurs as a disseminated abdominal tumor. We experienced a 70-year-old man with primary EGIST presenting as peritoneal dissemination. Abdominal CT showed diffuse peritoneal thickening with a large amount of ascites, but no definite mass lesion. Laparoscopic biopsy was performed and histologic findings showed tumor composed of epithelioid cells. In the results of immunohistochemical stains, the tumor showed positive reactivity with CD117 (c-kit), CD34, vimentin and actin, but negative reactivity with desmin and S-100 protein. On account of unresectability and histologic parameters of malignant behavior, he was started on imatinib. (Korean J Gastroenterol 2010;56:319-323)

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.

Morphological Features of Metastatic Gastrointestinal Stromal Tumors after Gleevec Treatment - Two Cases Report -

최준혁,배영경,송선교,김홍진,심민철,이경희 대한병리학회 2009 Journal of Pathology and Translational Medicine Vol.43 No.4

We report two patients with metastatic gastrointestinal stromal tumors (GISTs) with a focus on the morphological features related to Gleevec treatment. In case 1, a 50-year-old woman presented with a 1.8 ㎝ metastatic GIST in the liver after resection of a gastric GIST. Majority of the metastatic tumor showed fibrosis and hyalinization after 8 weeks of Gleevec treatment. CD117-positive cells were present in approximately 1% of the overall tumor. In case 2, a 2 ㎝ and 14 ㎝ metastatic liver masses were found in a 54-year-old man who had a rectal GIST. After 4 weeks of Gleevec treatment, metastatic tumors showed a decrease in size on CT scan. The metastatic tumors showed a decrease in number of tumor cells. The hemorrhage, cystic changes, necrosis, and fibrosis made up approximately 90% of the tumor. The morphological features related to Gleevec treatment are important for correct diagnosis and evaluation of tumor response and prognosis. We report two patients with metastatic gastrointestinal stromal tumors (GISTs) with a focus on the morphological features related to Gleevec treatment. In case 1, a 50-year-old woman presented with a 1.8 ㎝ metastatic GIST in the liver after resection of a gastric GIST. Majority of the metastatic tumor showed fibrosis and hyalinization after 8 weeks of Gleevec treatment. CD117-positive cells were present in approximately 1% of the overall tumor. In case 2, a 2 ㎝ and 14 ㎝ metastatic liver masses were found in a 54-year-old man who had a rectal GIST. After 4 weeks of Gleevec treatment, metastatic tumors showed a decrease in size on CT scan. The metastatic tumors showed a decrease in number of tumor cells. The hemorrhage, cystic changes, necrosis, and fibrosis made up approximately 90% of the tumor. The morphological features related to Gleevec treatment are important for correct diagnosis and evaluation of tumor response and prognosis.

44개월간의 경과관찰 중에 악성으로 변화한 위 간질종양 1예

류충헌,김지현,박관식,서효림,최윤정,하승인,김윤정,설상영 대한소화기내시경학회 2010 Clinical Endoscopy Vol.41 No.1

Gastrointestinal stromal tumor is a common type of gastrointestinal mesenchymal tumor. Depending on the patient’s age, compliance and health status, and the level of suspicion of malignancy, tumors ≤3 cm in size are typically monitored annually by endoscopic ultrasonography. The examination interval can be extended if no size change is noted on consecutive examinations. We report here on a 44-year-old female who presented with abdominal discomfort and displayed no size change of her gastrointestinal stromal tumor on three consecutive endoscopies over a 44- month interval. The patient was diagnosed with malignant gastrointestinal stromal tumor on the basis of the evident ulceration seen on esophagogastroduodenoscopy and the inhomogenous echo noted on the endoscopic ultrasonography and the pathologic findings by gastric wedge resection. 위장관 간질종양은 간엽조직 기원의 종양 중 가장 흔한 종양이다. 위장관 간질 종양은 3 cm 이하의 크기인 경우 환자의 나이, 순응도, 건강상태, 검사자의 악성 의심 정도에 따라 추적검사를 해야 한다고 알려져 있고, 약 2년마다 내시경초음파 추적 검사를 하여, 2번의 내시경초음파에서 크기의 변화가 없다면, 추적검사기간을 늘릴 수 있다고 하였다. 하지만 저자들은 양성의 내시경초음파 소견 및 3 cm 이하의 위장관 간질종양으로 내원한 45세 여자에서 약 44개월간 3번의 추적 내시경 검사에서 크기 변화가 없다가, 마지막 추적 내시경 검사 6개월 후 복부 불편감으로 내원하여 시행한 내시경초음파 검사에서 크기의 변화는 없으나, 표면에 궤양 형성을 보이고, 내부의 비 균질 에코를 보여 시행한 쐐기 절제술에서 악성 위장관 간질종양으로 확진한 증례를 경험하여 고찰과 함께 보고한다.

Correlation between Computed Tomography and Pathological Findings of Gastrointestinal Stromal Tumors Treated with Imatinib Mesylate

심기춘,박범진,한나연,성득제,김민주,조성범,하현권,김형래 대한영상의학회 2014 대한영상의학회지 Vol.71 No.5

Purpose: To evaluate the correlation between pathological and computed tomography (CT) findings of gastrointestinal stromal tumors (GISTs) after imatinib mesylate (imatinib) treatment. Materials and Methods: Twenty-six patients with GIST (17 men, 9 women; mean age, 56 years) who underwent treatment with imatinib and who were registered at our institution were included. Eight patients had primary and 18 had metastatic tumors. The correlation between CT and pathological findings was evaluated for all 26 tumors, which were resected after imatinib treatment. Results: The mean size change in the tumors after imatinib treatment was -1.4 cm (range, -7.8—2.5 cm). A reduction in tumor CT attenuation value was observed after imatinib treatment (mean, 29.1 Hounsfield units) in 20 of 26 tumors. Reduced attenuation was associated with non-tumorous pathological findings, including cystic degeneration (6/20), hemorrhagic necrosis (6/20), hyaline degeneration (6/20), and combined pathology without a viable portion (2/20). Of six tumors showing increased attenuation values after treatment, four (66.7%) showed an abundant viable portion. The increase in tumor size was not associated with the presence of a viable portion in any tumor. Conclusion: CT attenuation changes in GISTs may adequately reflect the pathological findings in GISTs after imatinib treatment.

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.