Abstract
We report a case of a 74-year-old woman with an esophageal gastrointestinal stromal tumor (GIST). Endoscopic examination suggested a submucosal tumor in the middle-lower thoracic esophagus. Computed tomography showed a solid mass 95 × 56 × 44 mm in size, suggesting an esophageal mesenchymal tumor. Endoscopic ultrasonography-guided fine-needle aspiration biopsy was positive for c-kit and CD34, and negative for both S-100 and desmin, on immunohistochemical examination, confirming this to be a GIST. The patient underwent transthoracic esophagectomy with esophageal reconstruction using a gastric tube through the subcutaneous route. The tumor was completely resected, and there was no lymph node metastasis. The pathological examination confirmed the tumor to be at high risk for recurrence because of its size and the presence of necrosis. We are carefully following the patient conservatively with no adjuvant chemotherapy such as imatinib mesylate.
Similar content being viewed by others
References
Fletcher CD, Berman JJ, Corless C, Gorstein F, Lasota J, Longley BJ, et al. Diagnosis of gastrointestinal stromal tumors: a consensus approach. Hum Pathol 2002;33:459–465.
Miettinen M, Sarlomo-Rikala M, Lasota J. Gastrointestinal stromal tumors. Ann Chir Gynaecol 1998;87:278–281.
Miettinen M, Majidi M, Lasota J. Pathology and diagnostic criteria of gastrointestinal stromal tumors (GISTs): a review. Eur J Cancer 2002;38(suppl 5):S39–51.
Japan Esophageal Society. Japanese Classification of Esophageal Cancer. 10th edn. Tokyo: Kanehara; 2007. p. 90
Kindblom LG, Remotti HE, Aldenborg F, Meis-Kindblom JM. Gastrointestinal pacemaker cell tumor (GIPACT): gastrointestinal stromal tumors show phenotypic characteristics of the interstitial cells of Cajal. Am J Pathol 1998;152:1259–1269.
Miettinen M, Sarlomo-Rikala M, Sobin LH, Lasota J. Esophageal stromal tumors: a clinicopathologic, immunohistochemical, and molecular genetic study of 17 cases and comparison with esophageal leiomyomas and leiomyosarcomas. Am J Surg Pathol 2000;24:211–222.
Kamei T, Miyazaki S, Miyata G, Mori T, Onodera K, Ichikawa H, et al. Esophageal gastrointestinal stromal tumors (GISTs): report of three cases. Esophagus 2005;2:209–216.
Ertem M, Baca B, Doğusoy G, Ergüney S, Yavuz N. Thoracoscopic enucleation of a giant submucosal tumor of the esophagus. Surg Laparosc Endosc Percutan Tech 2004;14:87–90.
Gouveia AM, Pimenta AP, Lopes JM, Capelinha AF, Ferreira SS, Valbuena C, et al. Esophageal GIST: therapeutic implications of an uncommon presentation of a rare tumor. Dis Esophagus 2005;18:70–73.
Manu N, Richard P, Howard S. Bleeding esophageal GIST. Dis Esophagus 2005;18:281–282.
Padula A, Chin NW, Azeez S, Resetkova E, Andriko JA, Miettinen M. Primary gastrointestinal stromal tumor of the esophagus in an HIV-positive patient. Ann Diagn Pathol 2005;9:49–53.
Masuda T, Toh Y, Kabashima A, Aoki Y, Harimoto N, Ito S, et al. Overt lymph node metastases from a gastrointestinal stromal tumor of the esophagus. J Thorac Cardiovasc Surg 2007;134:810–811.
Blum MG, Bilimoria KY, Wayne JD, de Hoyos AL, Talamonti MS, Adley B. Surgical considerations for the management and resection of esophageal gastrointestinal stromal tumors. Ann Thorac Surg 2007;84:1717–1723.
Portale G, Zaninotto G, Costantini M, Rugge M, Pennelli GM, Rampado S, et al. Esophageal GIST: case report of surgical enucleation and update on current diagnostic and therapeutic options. Int J Surg Pathol 2007;15:393–396.
Arantes V, Logroño R, Faruqi S, Ahmed I, Waxman I, Bhutani MS. Endoscopic sonographically guided fine-needle aspiration yield in submucosal tumors of the gastrointestinal tract. J Ultrasound Med 2004;23:1141–1150.
Demetri GD, Benjamin RS, Blanke CD, Blay JY, Casali P, Choi H, et al. NCCN Task Force report: management of patients with gastrointestinal stromal tumor (GIST): update of the NCCN clinical practice guidelines. J Natl Compr Cancer Netw 2007;5(suppl 2):S1–29.
Miettinen M, Lasota J. Gastrointestinal stromal tumors: review on morphology, molecular pathology, prognosis, and differential diagnosis. Arch Pathol Lab Med 2006;130:1466–1478.
Fong Y, Coit DG, Woodruff JM, Brennan MF. Lymph node metastasis from soft tissue sarcoma in adults. Analysis of data from a prospective database of 1772 sarcoma patients. Ann Surg 1993;217:72–77.
Blay JY, Bonvalot S, Casali P, Choi H, Debiec-Richter M, Dei Tos AP, et al. GIST consensus meeting panelists. Consensus 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 2005;16:566–578.
Hasegawa T, Matsuno Y, Shimoda T, Hirohashi S. Gastrointestinal stromal tumor: consistent CD117 immunostaining for diagnosis, and prognostic classification based on tumor size and MIB-1 grade. Hum Pathol 2002;33:669–676.
Scaife CL, Hunt KK, Patel SR, Benjamin RS, Burgess MA, Chen LL, et al. Is there a role for surgery in patients with “unresectable” cKIT+ gastrointestinal stromal tumors treated with imatinib mesylate? Am J Surg 2003;186:665–669
DeMatteo RP, Lewis JJ, Leung D, Mudan SS, Woodruff JM, Brennan MF. Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival. Ann Surg 2000;231:51–58.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Matono, S., Fujita, H., Tanaka, T. et al. Giant gastrointestinal stromal tumor in the esophagus. Esophagus 6, 49–54 (2009). https://doi.org/10.1007/s10388-008-0177-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10388-008-0177-5