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Tumor Symbiosis: Gastrointestinal Stromal Tumor as a Host for Primary Peritoneal Mesothelioma

  • Jorge de la Torre
  • Sudeep Banerjee
  • Joel Baumgartner
  • Grace Y. Lin
  • Adam M. Burgoyne
  • Amanda Kirane
  • Jason Sicklick
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Case Presentation

A 57-year-old man with a history of polycythemia vera presented for routine primary care follow-up and was found to have anemia with hemoglobin level of 12 mg/dL from 16 mg/dL. He was referred to gastroenterology for upper and lower endoscopies, which revealed an ulcerated submucosal mass in the gastric antrum. Endoscopic ultrasound (EUS) with core needle biopsy revealed a spindle cell neoplasm on hematoxylin and eosin (H&E) staining. Immunohistochemical analyses were positive for CD117 (KIT) and DOG-1, consistent with a gastrointestinal stromal tumor (GIST). Staging computed tomography (CT) of the abdomen/pelvis demonstrated a 15 × 12 × 13 cm gastric mass with effacement of the left liver. He was started on neoadjuvant imatinib (Gleevec, Novartis). Follow-up CT after 3 months of therapy demonstrated a 19% increase in tumor volume and new omental nodules (Fig.  1a). Tumor sequencing revealed a PDGFRAD842V mutation, which is known to be imatinib resistant. Thus, he...

Keywords

GIST Cancer Additional Multiple Primary Synchronous Neoplasm Commensal relationship 

Notes

Financial Support

This work was supported by the UC San Diego GIST Research Fund, NIH K08CA168999 and NIH R21CA192072 (J.K. Sicklick).

Authors’ Disclosures

Jason Sicklick receives research funds from Foundation Medicine Inc. and Novartis Pharmaceuticals, as well as consultant fees from Loxo, Biotheranostics, and Grand Rounds. All other authors have no relationships to disclose.

Author Contributions

Jorge de la Torre - Contributed to the acquisition, analysis, and interpretation of patient data and the drafting of the manuscript. He approves of the final version to be published. He agrees to be accountable for all aspects of the work in ensuring that questions related to any part of the work are appropriately investigated and resolved.

Sudeep Banerjee - Contributed to the acquisition, analysis, and interpretation of patient data and the drafting of the manuscript. He approves of the final version to be published. He agrees to be accountable for all aspects of the work in ensuring that questions related to any part of the work are appropriately investigated and resolved.

Grace Lin - Contributed to the acquisition, analysis, and interpretation of patient data and the drafting of the manuscript. She approves of the final version to be published. She agrees to be accountable for all aspects of the work in ensuring that questions related to any part of the work are appropriately investigated and resolved.

Amanda Kirane - Contributed to the acquisition, analysis, and interpretation of patient data. She approves of the final version to be published. She agrees to be accountable for all aspects of the work in ensuring that questions related to any part of the work are appropriately investigated and resolved.

Adam M. Burgoyne - Contributed to the acquisition, analysis, and interpretation of patient data and the drafting of the manuscript. He approves of the final version to be published. He agrees to be accountable for all aspects of the work in ensuring that questions related to any part of the work are appropriately investigated and resolved.

Joel Baumgartner - Contributed to the acquisition, analysis, and interpretation of patient data and the drafting of the manuscript. He approves of the final version to be published. He agrees to be accountable for all aspects of the work in ensuring that questions related to any part of the work are appropriately investigated and resolved.

Jason Sicklick - Contributed to the acquisition, analysis, and interpretation of patient data and the drafting of the manuscript. He approves of the final version to be published. He agrees to be accountable for all aspects of the work in ensuring that questions related to any part of the work are appropriately investigated and resolved.

References

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    Murphy, J. D., et al. (2015). "Increased risk of additional cancers among patients with gastrointestinal stromal tumors: A population-based study." Cancer 121(17): 2960–2967.CrossRefPubMedPubMedCentralGoogle Scholar
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    Strizzi, L., et al. (2001). "Vascular endothelial growth factor is an autocrine growth factor in human malignant mesothelioma." J Pathol 193(4): 468–475.CrossRefPubMedGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2018

Authors and Affiliations

  1. 1.Division of Surgical Oncology, Department of Surgery, Moores Cancer CenterUniversity of California, San Diego, UC San Diego Health SciencesLa JollaUSA
  2. 2.Department of SurgeryDavid Geffen School of Medicine at UCLALos AngelesUSA
  3. 3.Division of Anatomic Pathology, Department of PathologyUniversity of California, San DiegoLa JollaUSA
  4. 4.Division of Hematology Oncology, Department of Medicine, Moores Cancer CenterUniversity of California, San DiegoLa JollaUSA
  5. 5.Division of Surgical Oncology, Department of SurgeryUniversity of California, DavisSacramentoUSA

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