Unusual metastases of gastrointestinal stromal tumor and genotypic correlates: Case report and review of the literature

Rare Presentation of a Gastrointestinal Stromal Tumor Encapsulating the Spleen: A Case Report

Gastrointestinal stromal tumors (GISTs) are rare tumors of the digestive tract, often found incidentally on imaging. Although these tumors possess malignant potential, splenic encapsulation has not yet been described in the literature. A 74-year-old male fell and suffered blunt abdominal trauma followed by a 20-pound weight loss, early satiety, and left-sided abdominal pain. Computed tomography (CT) imaging showed splenomegaly with gastric compression. At the time of surgery, it was felt that this was a neoplastic process. He underwent a subsequent splenectomy and en bloc wedge gastrectomy. Further analysis revealed a GIST, of gastric origin, encapsulating the spleen and invading the diaphragm. Specimen stained strongly positive for the cluster of differentiation (CD) 117 mutation. Following recovery from the operation, the patient was started on Imatinib (Gleevec) therapy and will continue treatment for five years. Splenic metastasis and contiguous spread are rare sequelae of GISTs. While these tumors hold the potential for metastasis, the primary locations are the liver and peritoneum. This case illustrates the importance of considering malignancy as a possible underlying etiology when presented with an apparent splenic hematoma and abdominal pain. Since this patient possessed the CD117 mutation, Imatinib is an appropriate therapeutic choice in addition to surgical resection of the neoplasm.

Radiotherapy in the Management of Gastrointestinal Stromal Tumors: A Systematic Review

Simple Summary

Gastrointestinal stromal tumors are considered to be insensitive to radiotherapy. However, with the development of radiation techniques and the accumulation of cases, some studies have indicated that radiotherapy could help achieve objective response in advanced or metastatic gastrointestinal stromal tumors. Therefore, it is necessary to conduct a systematic review to reassess the role of radiotherapy in gastrointestinal stromal tumors. The purpose of this study was to draw the attention of scholars and clinicians to radiotherapy and promote further research on radiotherapy in gastrointestinal stromal tumors.

Abstract

Gastrointestinal stromal tumors (GISTs) are considered insensitive to radiotherapy. However, a growing number of case reports and case series have shown that some lesions treated by radiotherapy achieved an objective response. The aim of the study was to perform a systematic review of all reported cases, case series, and clinical studies of GISTs treated with radiotherapy to reevaluate the role of radiotherapy in GISTs. A systematic search of the English-written literature was conducted using PubMed, Web of Science, and Embase databases. Overall, 41 articles describing 112 patients were retrieved. The included articles were of low to moderate quality. Bone was the most common site treated by radiotherapy, followed by the abdomen. In order to exclude the influence of effective tyrosine kinase inhibitors (TKIs), a subgroup analysis was conducted on whether and which TKIs were concurrently applied with radiotherapy. Results showed that radiotherapy alone or combined with resistant TKIs could help achieve objective response in selected patients with advanced or metastatic GISTs; however, survival benefits were not observed in the included studies. Pain was the most common symptom in symptomatic GISTs, followed by neurological dysfunction and bleeding. The symptom palliation rate was 78.6% after excluding the influence of effective TKIs. The adverse reactions were mainly graded 1–2. Radiotherapy was generally well-tolerated. Overall, radiotherapy may relieve symptoms for GIST patients with advanced or metastatic lesions and even help achieve objective response in selected patients without significantly reducing the quality of life. In addition to bone metastases, fixed abdominal lesions may be treated by radiotherapy. Publication bias and insufficient quality of included studies were the main limitations in this review. Further clinical studies are needed and justified.

Small bowel gastrointestinal stromal tumor presenting with involvement of the adjacent small bowel and hemoperitoneum case report

Accounting for less than one percent of all GI tumors, gastrointestinal stromal tumors are uncommon neoplasms that arise from the intestinal cells of Cajal. They can arise anywhere along the gastrointestinal tract, but most often arise from the stomach or small bowel. Usually, they are small and present with vague symptoms such as abdominal pain and are found incidentally. They usually don't involve other structures unless they metastasize. Here, we present a case of small bowel GIST. The patient is a 72-year-old male who was seen in the clinic with symptoms of abdominal pain for 4 months along with intermittent gastrointestinal bleeding for 6 years. Imaging studies revealed a mass in the small bowel with no signs of obstruction. During surgery, a 9 cm by 9 cm small bowel mass was identified with adhesions to the appendix, omentum, and a segment of small bowel. There was also a hemoperitoneum. En bloc resection was performed with clean margins. Histopathology report showed malignant gastrointestinal stromal tumor with focal involvement of adjacent small bowel loop.

Bone Metastases of Gastrointestinal Stromal Tumor: A Review of Published Literature

Background

With the occurrence and improvement of immunohistochemistry and other pathological diagnostic techniques, gastrointestinal stromal tumor (GIST) has been gradually recognized. With the prolonged survival of patients with GISTs, reports about the bone metastasis of GIST increased. However, the knowledge of GISTs is rather limited due to its very low incidence.

Methods

Cochrane and Medline database (via PubMed) were searched in July 2019 with related keywords to acquire the literature related to the bone metastasis of GIST. Then, the literature was reviewed and references were also scanned to identify the possible related reports. Study data comprising age, sex, primary location, metastasis interval time, immunohistochemistry index, management and prognosis were recorded and analyzed.

Results

Forty-five patients with bone metastases of GIST, with a mean age of 61.09 years, were included. The small intestine and stomach were the most common primary sites, followed by the rectum. Patients with small intestine primary sites had bone metastases that occurred earlier than the bone metastases stomach and rectum primary sites. The spine was the most common site of bony metastases. The mean survival time after GIST diagnosis was more than 64.02 months. Patients younger than 60 years old had a worse prognosis than those older than 60 years old. Furthermore, patients with spinal involvement had a worse prognosis than those without spinal involvement. Surgical interventions combined with targeted therapies guaranteed a better prognosis.

Conclusion

Bone metastasis of GIST, which mainly occurs in the spine, is rather rare. Patients with GISTs of the small intestine and stomach suffered from bone metastasis more frequently and earlier than patients with GISTs in other primary sites. Age, sex, primary tumor location, treatment mode for the primary lesions and metastases, and spine involvement may be potential factors that affect the prognosis of GIST patients with bone metastases.

Stereotactic ablative radiotherapy for bone metastasis of gastrointestinal stromal tumor: Case report and review of the literature

Background

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. These tumors are rare and only make bone metastases at a rate of 5%.

Case summary

A 31-year-old male with a GIST presented with solitary bone metastasis at the right iliac bone. We performed stereotactic ablative radiotherapy (SABR) and achieved excellent local control. Herein, our case is presented, and a short review of the literature is carried out.

Conclusion

SABR should be considered as a treatment option in GIST with bone metastasis.

Long-Term Survival After Multidisciplinary Treatment Including Surgery for Metachronous Metastases of Small Intestinal Gastrointestinal Stromal Tumors after Curative Resection: A Case Report

Patient: Male, 56-year-old

Final Diagnosis: Metachronous metastases of small intestinal gastrointestinal stromal tumors

Symptoms: Abdominal and/or epigastric pain

Medication: —

Clinical Procedure: Operation • chemotharapy

Specialty: Gastroenterology and Hepatology

A Rare Case of a Ruptured Metastatic Hepatic Lesion from a Jejunal Gastrointestinal Stromal Tumor (GIST) Treated by Arterial Embolization

Patient: Male, 68

Final Diagnosis: Ruptured metastatic hepatic lesion from a jejunal GIST

Symptoms: Abdominal discomfort • hypotension

Medication: —

Clinical Procedure: —

Specialty: Gastroenterology and Hepatology

Clinical and pathological characteristics of gastrointestinal stromal tumor (GIST) metastatic to bone

Our aim in this study was to describe the clinical, morphological, and molecular profile of gastrointestinal stromal tumor (GIST) metastatic to bone. We analyzed the morphological, phenotypic, and molecular characteristics of seven cases, and in addition reviewed 17 cases from literature. Sequence analysis of KIT and PDGFRA genes was possible for six cases. For the GIST cases with bone metastasis, the most common primaries were small intestine (29%), stomach (25%), and rectum (21%). Sites of bone metastases were vertebrae (11), pelvis (8), femur (8), ribs (6), humerus (5), skull (3), scapula (1), and mandible (1). The size ranged from 1.5 to 13 cm (median, 3.8 cm). Bone metastases without involvement of any other organ were seen in 17% of the cases and were solitary in 14 (58%). Adjacent soft tissue involvement was present in nearly half of the patients. Bone metastasis was either manifest at the time of diagnosis (28%) or occurred after a mean period of 4.7 years (3 months-20 years). Morphologically, neoplastic cells were spindle in 67%, epithelioid in 13%, and mixed epithelioid and spindle in 20%. CD117, DOG1, and CD34 were positive in 88, 86, and 85% of the cases, respectively. KIT Exon 11 mutations were the most frequent gene alteration (78%), followed by KIT Exon 13 mutations. Of 17 of the cases with available follow-up information, 7 (41%) patients developed bone metastasis under imatinib therapy. Five patients (29%) died of disease within a mean of 17 months. Bone metastases from GIST are usually found in patients with advanced disease and typically present as lytic masses with occasional soft tissue involvement. We could not identify any KIT or PDGFRA alterations predisposing to bone metastasis.

Gastrointestinal Stromal Tumour with Synchronous Bone Metastases: A Case Report and Literature Review

Gastrointestinal stromal tumours (GISTs) are mesenchymal tumours of the digestive tract, derived from Cajal interstitial cells. Bone metastases are very rare, and there is no consensus regarding their treatment. Here, we present the unusual case of a 66-year-old man with a gastric GIST with synchronous bone and liver metastases, fully documented at the pathological and molecular levels with a KIT exon 11 mutation. After 9 months of imatinib, the scanner showed a 33% partial response of target lesions. We also review the literature and describe the characteristics, treatment, and outcome of all cases previously reported.

Skull Metastasis of Gastric Gastrointestinal Stromal Tumor Successfully Managed by Surgery

Gastrointestinal stromal tumors (GISTs) are rare, but are the most common mesenchymal neoplasm of the gastrointestinal tract. The most common sites of metastasis are liver and peritoneum, while bone metastasis is rare. We report on a patient with skull metastasis after seven years of treatment with imatinib for metastatic GIST. She underwent metastasectomy consisting of craniectomy with excision of the mass, and cranioplasty and continued treatment with imatinib and sunitinib, without evidence of cranial recurrence. She died of pneumonia sepsis one year after metastasectomy. Skull metastasis of GIST is a very rare presentation, and an aggressive multidisciplinary approach should be considered whenever possible.

Bone metastasis in gastrointestinal stromal tumors preferentially occurs in patients with original tumors in sites other than the stomach

Bone metastases are rare in gastrointestinal stromal tumors (GISTs) and data on the clinicopathological profiles are lacking. The purpose of this report was to identify the clinicopathological profiles of this rare clinical setting by evaluating 23 cases, four of which were our own and the additional 19 were from the relevant English literature. In 18 cases, the primary GISTs occurred in sites other than the stomach, although a high proportion of these tumors do arise in the stomach. All tumors at the disease presentation had more than a low risk of recurrence, with most tumors either at a high risk or initially malignant with liver metastasis. In four cases, bone metastasis was the primary metastatic manifestation. Although rare in GISTs, bone metastasis should be considered in patients with primary tumors at a high risk for recurrence or in initially malignant tumors with liver metastasis, especially with primary tumors in sites other than the stomach.

Bone metastasis of a gastrointestinal stromal tumor: A report of two cases

Gastrointestinal stromal tumors (GISTs) are the most frequently diagnosed mesenchymal tumors of the GI tract. GISTs usually arise from the stomach, followed by the small intestine, rectum and other locations in the GI tract. The most common metastatic sites are the liver and peritoneum, whereas GISTs rarely metastasize to the bone. Although a small number of previous studies have described bone metastases originating from GISTs, the true prevalence is yet to be elucidated. The present study describes two cases of bone metastasis in patients with GISTs and reviews the relevant literature. Case one was of a 78-year-old male who presented with bone metastasis to the femoral neck five years after the resection of a GIST. The metastasis was completely resected and the patient remains alive nine years after the initial diagnosis of the GIST. Case 2 was of a 41-year-old male who presented with bone metastases to the ribs following resection of GISTs seven and 17 years earlier. The metastases were completely resected and the patient remains alive 17 years after the initial diagnosis. In total, only 10 cases of GISTs with metastases to the bone have been reported in the English literature. The possibility of bone metastases originating from a GIST should be considered during clinical follow-up, particularly in the presence of liver metastases. If feasible, bone metastases should be completely surgically excised.

Bone metastases from gastrointestinal stromal tumor: a case report. Case Rep Oncol Med. 2012;2012:509845. [PMID: 23243532 PMCID: PMC3518093 DOI: 10.1155/2012/509845]

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract. Their most common metastatic sites are the liver and the peritoneum, but GISTs rarely metastasize to the bones. We report a case of a 58-year-old man with sternoclavicular joint metastasis from a GIST manifesting 28 months after surgical resection of the small intestine tumor. We will discuss through this paper and a literature review the clinical characteristics, imaging features, and management of this unusual metastatic location of GIST.