Neoadjuvant imatinib in a gastrointestinal stromal tumor of the rectum: Report of a case |
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Authors: | Yuma Ebihara Shunichi Okushiba You Kawarada Shuji Kitashiro Hiroyuki Katoh Satoshi Kondo |
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Institution: | (1) Department of Surgery, Tonan Hospital, N1W6, Chuo-ku, Sapporo, Hokkaido 060-0001, Japan;(2) Department of Surgical Oncology, Division of Cancer Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan |
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Abstract: | Gastrointestinal stromal tumors (GISTs) are rare tumors of the gastrointestinal tract, and of these, GISTs involving the rectum
are uncommon. This report describes a case of effective neoadjuvant therapy for a rectal GIST expressing the c-kit gene, where
a laparoscopic ultralow anterior resection was successfully performed, thus preserving the anus. A 57-year-old woman visited
our hospital due to constipation and was found by a digital examination to have a soft mass on the right wall of the rectum.
Computed tomography revealed an 8.0 × 5.0-cm mass with an unclear margin adjacent to the rectum. A biopsy specimen was positive
for CD34 and the c-kit gene product, but it was not positive for smooth muscle actin or S-100 protein, and thus the tumor
was diagnosed as GIST. An abdominoperineal resection is generally essential for large rectal GISTs; however, she refused this
operation. Neoadjuvant treatment with Imatinib decreased the tumor size (4.0 × 3.5 cm) and the anus was preserved by a laparoscopic
ultralow anterior resection with direct coloanal anastomosis. She had no evidence of disease for 24 months postoperatively.
To preserve the anus, a rectal GIST expressing the c-kit gene is best treated with Imatinib as neoadjuvant therapy. |
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Keywords: | Gastrointestinal stromal tumor Imatinib Laparoscopic ultralow anterior resection Coloanal anastomosis |
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