Skip to main content

Advertisement

SpringerLink
Log in

Successful Resection of an Advanced Duodenal Gastrointestinal Stromal Tumor After Down-Staging with Imatinib: Report of a Case

  • Case Reports
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

The diagnosis of gastrointestinal stromal tumor (GIST) relies on a combination of the following criteria: anatomic location, typical histopathology, and the presence of CD 117-antigen (the tyrosine kinase receptor, c-kit) or CD 34-antigen. Imatinib mesylate, a specific tyrosine kinase inhibitor, is highly efficient against locally advanced or metastatic GIST. We report a case of unresectable duodenal GIST, which we were able to resect with curative intent after down-staging treatment with a dosage of imatinib 400 mg daily for 8 months. We performed Whipple's procedure combined with en bloc resection of the right kidney and adrenal gland. The patient was recurrence free at his 24-month follow-up examination. Down-staging treatment may be worthwhile in selected patients, but further prospective studies of imatinib in this setting are necessary. We think that imatinib should be continued postoperatively, as the risk of recurrence in these patients may be high.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. MT Mazur HB Clark (1983) ArticleTitleGastric stromal tumors: reappraisal of histogenesis Am J Surg Pathol 7 507–19 Occurrence Handle6625048 Occurrence Handle1:STN:280:DyaL2c%2FitFGitw%3D%3D

    PubMed  CAS  Google Scholar 

  2. S Hirota K Isozaki Y Moriyama K Hashimoto T Nishida S Ishiguro et al. (1998) ArticleTitleGain-of-function mutations of c-kit in human gastrointestinal stromal tumors Science 279 577–80 Occurrence Handle9438854 Occurrence Handle10.1126/science.279.5350.577 Occurrence Handle1:CAS:528:DyaK1cXotVyhsw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  3. BP Rubin S Singer C Tsao A Duensing ML Lux R Ruiz et al. (2001) ArticleTitleKIT activation is a ubiquitous feature of gastrointestinal stromal tumors Cancer Res 61 8118–21 Occurrence Handle11719439 Occurrence Handle1:CAS:528:DC%2BD3MXovVShs7w%3D

    PubMed  CAS  Google Scholar 

  4. CD Fletcher JJ Berman C Corless F Gorstein J Lasota BJ Longley et al. (2002) ArticleTitleDiagnosis of gastrointestinal stromal tumors: a consensus approach Hum Pathol 33 459–65 Occurrence Handle12094370 Occurrence Handle10.1053/hupa.2002.123545

    Article  PubMed  Google Scholar 

  5. JY Blay S Bonvalot P Casali H Choi M Debiec-Richter AP Dei Tos et al. (2005) ArticleTitleConsensus meeting for the management of gastrointestinal stromal tumors: report of the GIST Consensus Conference of 20–21 March 2004, under the auspices of ESMO Ann Oncol 16 566–78 Occurrence Handle15781488 Occurrence Handle10.1093/annonc/mdi127

    Article  PubMed  Google Scholar 

  6. LG Kindblom HE Remotti F Aldenborg JM Meis-Kindblom (1998) ArticleTitleGastrointestinal pacemaker cell tumor (GIPACT): gastrointestinal stromal tumors show phenotypic characteristics of the interstitial cells of Cajal Am J Pathol 152 1259–69 Occurrence Handle9588894 Occurrence Handle1:STN:280:DyaK1c3kvVejug%3D%3D

    PubMed  CAS  Google Scholar 

  7. H Joensuu PJ Roberts M Sarlomo-Rikala LC Andersson P Tervahartiala D Tuveson et al. (2001) ArticleTitleEffect of the tyrosine kinase inhibitor STI571 in a patient with a metastatic gastrointestinal stromal tumor N Engl J Med 344 1052–6 Occurrence Handle11287975 Occurrence Handle10.1056/NEJM200104053441404 Occurrence Handle1:STN:280:DC%2BD3M3gvVekuw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  8. GD Demetri M von Mehren CD Blanke AD Van den Abbeele B Eisenberg PJ Roberts et al. (2002) ArticleTitleEfficacy and safety of imatinib mesylate in advanced gastrointestinal stromal tumors N Engl J Med 347 472–80 Occurrence Handle12181401 Occurrence Handle10.1056/NEJMoa020461 Occurrence Handle1:CAS:528:DC%2BD38XmtV2nt7s%3D

    Article  PubMed  CAS  Google Scholar 

  9. J Verweij PG Casali J Zalcberg A LeCesne P Reichardt JY Blay et al. (2004) ArticleTitleProgression-free survival in gastrointestinal stromal tumours with high-dose imatinib: randomised trial Lancet 364 1127–34 Occurrence Handle15451219 Occurrence Handle10.1016/S0140-6736(04)17098-0 Occurrence Handle1:CAS:528:DC%2BD2cXnvVOiu7o%3D

    Article  PubMed  CAS  Google Scholar 

  10. BL Eisenberg I Judson (2004) ArticleTitleSurgery and imatinib in the management of GIST: emerging approaches to adjuvant and neoadjuvant therapy Ann Surg Oncol 11 465–75 Occurrence Handle15123459 Occurrence Handle10.1245/ASO.2004.09.011

    Article  PubMed  Google Scholar 

  11. TS Emory LH Sobin L Lukes DH Lee TJ O'Leary (1999) ArticleTitlePrognosis of gastrointestinal smooth-muscle (stromal) tumors: dependence on anatomic site Am J Surg Pathol 23 82–7 Occurrence Handle9888707 Occurrence Handle10.1097/00000478-199901000-00009 Occurrence Handle1:STN:280:DyaK1M7gtlOrsA%3D%3D

    Article  PubMed  CAS  Google Scholar 

  12. JK Greenson (2003) ArticleTitleGastrointestinal stromal tumors and other mesenchymal lesions of the gut Mod Pathol 16 366–75 Occurrence Handle12692202 Occurrence Handle10.1097/01.MP.0000062860.60390.C7

    Article  PubMed  Google Scholar 

  13. RP DeMatteo JJ Lewis D Leung SS Mudan JM Woodruff MF Brennan (2000) ArticleTitleTwo hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival Ann Surg 231 51–8 Occurrence Handle10636102 Occurrence Handle10.1097/00000658-200001000-00008 Occurrence Handle1:STN:280:DC%2BD3c7gtVSmtQ%3D%3D

    Article  PubMed  CAS  Google Scholar 

  14. EH Ng RE Pollock MF Munsell EN Atkinson MM Romsdahl (1992) ArticleTitlePrognostic factors influencing survival in gastrointestinal leiomyosarcomas: implications for surgical management and staging Ann Surg 215 68–77 Occurrence Handle1731651 Occurrence Handle1:STN:280:DyaK387hslOntw%3D%3D Occurrence Handle10.1097/00000658-199201000-00010

    Article  PubMed  CAS  Google Scholar 

  15. PC McGrath JP Neifeld W Lawrence SuffixJr S Kay JS Horsley SuffixIII GA Parker (1987) ArticleTitleGastrointestinal sarcomas: analysis of prognostic factors Ann Surg 206 706–10 Occurrence Handle3689007 Occurrence Handle10.1097/00000658-198712000-00004 Occurrence Handle1:STN:280:DyaL1c%2Fns1WlsA%3D%3D

    Article  PubMed  CAS  Google Scholar 

  16. M Van Glabbeke J Verweij PG Casali A Le Cesne P Hohenberger I Ray-Coquard et al. (2005) ArticleTitleInitial and late resistance to imatinib in advanced gastrointestinal stromal tumors are predicted by different prognostic factors: a European Organisation for Research and Treatment of Cancer-Italian Sarcoma Group-Australasian Gastrointestinal Trials Group study J Clin Oncol 23 5795–804 Occurrence Handle16110036 Occurrence Handle10.1200/JCO.2005.11.601 Occurrence Handle1:CAS:528:DC%2BD2MXhtVersrzF

    Article  PubMed  CAS  Google Scholar 

  17. H Choi (2005) ArticleTitleCritical issues in response evaluation on computed tomography: lessons from the gastrointestinal stromal tumor model Curr Oncol Rep 7 307–11 Occurrence Handle15946591 Occurrence Handle10.1007/s11912-005-0055-4

    Article  PubMed  Google Scholar 

  18. P Bümming J Andersson JM Meis-Kindblom H Klingenstierna K Engstrom U Stierner et al. (2003) ArticleTitleNeoadjuvant, adjuvant and palliative treatment of gastrointestinal stromal tumours (GIST) with imatinib: a centre-based study of 17 patients Br J Cancer 89 460–4 Occurrence Handle12888812 Occurrence Handle10.1038/sj.bjc.6600965 Occurrence Handle1:CAS:528:DC%2BD3sXlsl2rsL0%3D

    Article  PubMed  CAS  Google Scholar 

  19. D Katz A Segal Y Alberton O Jurim P Reissman R Catane et al. (2004) ArticleTitleNeoadjuvant imatinib for unresectable gastrointestinal stromal tumor Anticancer Drugs 15 599–602 Occurrence Handle15205603 Occurrence Handle10.1097/01.cad.0000132236.38297.a7 Occurrence Handle1:CAS:528:DC%2BD2cXkvV2ntb4%3D

    Article  PubMed  CAS  Google Scholar 

  20. CL Scaife KK Hunt SR Patel RS Benjamin MA Burgess LL Chen et al. (2003) ArticleTitleIs there a role for surgery in patients with “unresectable” cKIT + gastrointestinal stromal tumors treated with imatinib mesylate? Am J Surg 186 665–9 Occurrence Handle14672776 Occurrence Handle10.1016/j.amjsurg.2003.08.023

    Article  PubMed  Google Scholar 

  21. PC Wu A Langerman CW Ryan J Hart S Swiger MC Posner (2003) ArticleTitleSurgical treatment of gastrointestinal stromal tumors in the imatinib (STI-571) era Surgery 134 656–65 Occurrence Handle14605627 Occurrence Handle10.1016/S0039-6060(03)00314-3

    Article  PubMed  Google Scholar 

  22. JN Shah W Sun RR Seethala VA Livolsi RD Fry GG Ginsberg (2005) ArticleTitleNeoadjuvant therapy with imatinib mesylate for locally advanced GI stromal tumor Gastrointest Endosc 61 625–7 Occurrence Handle15812427 Occurrence Handle10.1016/S0016-5107(04)02642-2

    Article  PubMed  Google Scholar 

  23. SS Lo GI Papachristou SD Finkelstein WP Conroy WH Schraut RK Ramanathan (2005) ArticleTitleNeoadjuvant imatinib in gastrointestinal stromal tumor of the rectum: report of a case Dis Colon Rectum 48 1316–9 Occurrence Handle15793646 Occurrence Handle10.1007/s10350-004-0922-3

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgical Gastroenterology, University of Copenhagen, Herlev Hospital, DK-2730, Herlev, Denmark

    Lisbeth Ludvigsen & Magnus Bergenfeldt

  2. Department of Pathology, University of Copenhagen, Herlev Hospital, DK-2730, Herlev, Denmark

    Anders Toxværd

  3. Department of Radiology, University of Copenhagen, Herlev Hospital, DK-2730, Herlev, Denmark

    Bassam Mahdi

  4. Department of Oncology, University of Copenhagen, Herlev Hospital, DK-2730, Herlev, Denmark

    Anders Krarup-Hansen

Authors
  1. Lisbeth Ludvigsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anders Toxværd
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bassam Mahdi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Anders Krarup-Hansen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Magnus Bergenfeldt
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ludvigsen, L., Toxværd, A., Mahdi, B. et al. Successful Resection of an Advanced Duodenal Gastrointestinal Stromal Tumor After Down-Staging with Imatinib: Report of a Case. Surg Today 37, 1105–1109 (2007). https://doi.org/10.1007/s00595-007-3544-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-007-3544-2

Key words

Search

Navigation