Libyan Journal of Medicine (Jan 2009)
Successful Surgical Resection of Advanced Gastrointestinal Stromal Tumor Post Neoadjuvent Therapy
Abstract
We report a case of a 48-year-old Indian male who presented with swelling and firmness in his leftupper part of the abdomen of one month duration with anorexia and weight loss. Initial examinationrevealed an intra abdominal mass of around 16.8x11.0x24.5cm with minimal left sided pleuraleffusion. A biopsy from the mass confirmed the diagnosis of gastrointestinal stromal tumour (GISTs)as supported by immmunohistochemistry results which showed strong positivity for c-kit while stainsfor smooth muscle actin, desmin, myoglobin, S100 Protein and cytokerstin remained negative. Thepatient was not suitable for surgical intervention in view of advanced tumor, and Imatinib Mesylate400mg daily was started with the aim of making the tumor operable. Such therapy lasted for twentymonths and was tolerated well by the patient. It then resulted in gradual tumor regression, followingwhich the patient underwent successful tumor resection. Post surgical resection patient had noradiological evidence of intra abdominal tumor but mild left sided pleural effusion with left lower lobeatelectasis. The patient had uneventful post operative recovery and he is currently on Imatinibmesylate and tolerating treatment well with mild skin rash. The experience with preoperative imatinibon surgical resection rates and post operative outcomes is limited especially with primary locallyadvanced GISTs. In our case successful surgical resection was possible for a huge locally advancedGIST with unusually prolonged treatment of twenty months with imatinib preoperatively.
