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Japanese Journal of Clinical Oncology 2008 38(11):790; doi:10.1093/jjco/hyn128
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© The Author (2008). Published by Oxford University Press. All rights reserved

A Case of Huge GIST of the Stomach Successfully Resected Following Effective Neoadjuvant Chemotherapy

Norimitsu Tanaka and Makoto Saka

Gastric Surgery Division
National Cancer Center Hospital
Tokyo, Japan

A 69-year-old male presenting with abdominal pain was referred to our institute. Computed tomography (CT) image revealed a huge tumor with central necrosis (23 x 14 x 12 cm in size) adjacent to the greater curvature of the stomach, the pancreatic tail and the descending colon (Fig. 1). There was no nodal or distant metastasis on the CT scan. A fine-needle aspiration biopsy under the guidance of endoscopic ultrasonography revealed spindle-shaped cells positive for c-kit staining, suggesting gastrointestinal stromal tumor (GIST). The tumor appeared to be resectable on the image; however, the proposed surgical procedure would be very extensive involving total gastrectomy, distal pancreatectomy and hemicolectomy. Therefore, neoadjuvant chemotherapy using imatinib mesylate (Gleevec®) at a dose of 400 mg daily was preceded. After 4 months of chemotherapy, the tumor size was reduced to 7 x 6 x 6 cm (Fig. 2), and we successfully excised the tumor by partial resection of the stomach. Pathological examination of the specimen showed that 70% of the tumor cells were degenerated or necrotic, and the surgical margin was negative. The patient is doing well 3 years and 6 months after primary treatment, keeping good control of locally recurrent foci on the stomach and the peritoneum.


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This Article
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