Late recurrence of low‑risk gastrointestinal stromal tumor of jejunum diagnosed 30 years after tumor resection: A case report and literature review

Kanda,Tatsuo; Naito,Tetsuya; Wakai,Atsuhiro; Iwafuchi,Yoichi; Hirota,Seiichi; Ajioka,Yoichi

doi:10.3892/ol.2022.13636

Late recurrence of low‑risk gastrointestinal stromal tumor of jejunum diagnosed 30 years after tumor resection: A case report and literature review

Authors:
- Tatsuo Kanda
- Tetsuya Naito
- Atsuhiro Wakai
- Yoichi Iwafuchi
- Seiichi Hirota
- Yoichi Ajioka
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Affiliations: Department of Surgery, Sanjo General Hospital, Sanjo, Niigata 955‑0055, Japan, Department of Surgery, Nagaoka Red Cross Hospital, Nagaoka, Niigata 940‑2085, Japan, Department of Internal Medicine, Sanjo General Hospital, Sanjo, Niigata 955‑0055, Japan, Department of Surgical Pathology, Hyogo Medical University School of Medicine, Nishinomiya, Hyogo 663‑8510, Japan, Division of Molecular and Diagnostic Pathology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Niigata 951‑8510, Japan
Published online on: December 15, 2022 https://doi.org/10.3892/ol.2022.13636
Article Number: 50
Copyright: © Kanda et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Gastrointestinal stromal tumors (GISTs) have a significant risk of metastasis, although the degree varies in each case. The present report describes a case of late recurrence of GIST that was diagnosed 30 years after the primary tumor resection. An 80‑year‑old man was transported to Sanjo General Hospital (Sanjo, Japan) with hemorrhagic shock from gastrointestinal bleeding. Abdominal contrast‑enhanced computed tomography revealed an 11.7‑cm heterogenous tumor in the retroperitoneum adjacent to the third portion of the duodenum. The patient had a medical history of resection of ‘leiomyoma’ of the upper jejunum when he was 50 years old. Pathological examination using archival pathological samples revealed that the previously excised tumor was GIST because the tumor cells showed positive immunoreactivity for KIT and DOG1. Treatment was started with imatinib, a selective KIT tyrosine inhibitor, even though endoscopy failed to provide biopsy specimens. Positron emission tomography conducted on the 28th treatment day revealed that imatinib completely shut down ¹⁸F‑fluorodeoxyglucose uptake in the tumor, confirming that the tumor was imatinib‑sensitive. A literature review yielded 12 GIST cases wherein metastases were diagnosed >10 years after primary tumor resection. Of the 12, four were originally diagnosed as benign. Clinicians should keep in mind that GISTs were formerly confused with non‑GIST tumors and that there is a risk of relapse 10 years or later after curative surgery.

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1	Hirota S, Isozaki K, Moriyama Y, Hashimoto K, Nishida T, Ishiguro S, Kawano K, Hanada M, Kurata A, Takeda M, et al: Gain-of-function mutations of c-kit in human gastrointestinal stromal tumors. Science. 279:577–580. 1998. View Article : Google Scholar : PubMed/NCBI
2	Heinrich MC, Corless CL, Duensing A, McGreevey L, Chen CJ, Joseph N, Singer S, Griffith DJ, Haley A, Town A, et al: PDGFRA activating mutations in gastrointestinal stromal tumors. Science. 299:708–710. 2003. View Article : Google Scholar : PubMed/NCBI
3	Joensuu H, Vehtari A, Riihimäki J, Nishida T, Steigen SE, Brabec P, Plank L, Nilsson B, Cirilli C, Braconi C, et al: Risk of recurrence of gastrointestinal stromal tumour after surgery: An analysis of pooled population-based cohorts. Lancet Oncol. 13:265–274. 2012. View Article : Google Scholar : PubMed/NCBI
4	Miettinen M, Sarlomo-Rikala M and Lasota J: Gastrointestinal stromal tumors: Recent advances in understanding of their biology. Hum Pathol. 30:1213–1220. 1999. View Article : Google Scholar : PubMed/NCBI
5	Iwafuchi Y, Arai F, Tsuruya T, Honda K, Ito T, Hasegawa A, Kamimura A, Takii Y, Kanahara H, Narisawa R, et al: A case of jejunal leiomyoma (in Japanese with English abstract). Endoscopic Forum for Digestive Disease. 7:223–227. 1991.
6	Nannini M, Biasco G, Pallotti MC, Di Battista M, Santini D, Paterini P, Maleddu A, Mandrioli A, Lolli C, Saponara M, et al: Late recurrences of gastrointestinal stromal tumours (GISTs) after 5 years of follow-up. Med Oncol. 29:144–150. 2012. View Article : Google Scholar : PubMed/NCBI
7	Ballarini C, Intra M, Ceretti AP, Prestipino F, Bianchi FM, Sparacio F, Berti E, Perrone S and Silva F: Gastrointestinal stromal tumors: A ‘benign’ tumor with hepatic metastasis after 11 years. Tumori. 84:78–81. 1998. View Article : Google Scholar : PubMed/NCBI
8	Furukawa M, Izumi S, Asano H, Tokumo M, Mano S and Shiota K: Late umbilical port-site recurrence of a gastrointestinal stromal tumor with an acquired PDGFRα mutation after laparoscopic resection: Report of a case. Surg Laparosc Endosc Percutan Tech. 22:e109–e111. 2012. View Article : Google Scholar : PubMed/NCBI
9	Ginori A, Scaramuzzino F, Marsili S and Tripodi S: Late hepatic metastasis from a duodenal gastrointestinal stromal tumor (29 years after surgery): Report of a case and review of the literature. Int J Surg Pathol. 23:317–321. 2015. View Article : Google Scholar : PubMed/NCBI
10	Ishizaki M, Uno F, Yoshida R, Miyauchi S and Honda O: Very delayed liver metastasis from small bowel gastrointestinal stromal tumor (32 years after resection of the small bowel GIST): Report of a case. Int J Surg Case Rep. 76:156–160. 2020. View Article : Google Scholar : PubMed/NCBI
11	Whang IY, Seo KJ, Kim HY, Kim CW and Won HS: A huge necrotic liver mass in a 45-year-old woman: Delayed hepatic metastasis of a gastrointestinal stromal tumor. Korean J Intern Med. 32:378–379. 2017. View Article : Google Scholar : PubMed/NCBI
12	Masuoka H, Kawagishi N, Inoue T, Ohkohchi N, Fujimori K, Koyamada N, Sekiguchi S, Tsukamoto S and Satomi S: Giant hepatic metastasis from gastrointestinal stromal tumor of the rectum 12 years after surgery. Hepatogastroenterology. 50:1454–1456. 2003.PubMed/NCBI
13	Nowain A, Bhakta H, Pais S, Kanel G and Verma S: Isolated hepatic metastasis from a gastrointestinal stromal tumor (GIST) 17 years after initial resection: Need for long-term surveillance. J Clin Gastroenterol. 39:9252005. View Article : Google Scholar : PubMed/NCBI
14	Matsuoka L, Stapfer M, Mateo R, Jabbour N, Naing W, Selby R and Gagandeep S: Left extended hepatectomy for a metastatic gastrointestinal stromal tumor after a disease-free interval of 17 years: Report of a case. Surg Today. 37:70–73. 2007. View Article : Google Scholar : PubMed/NCBI
15	Cahill RA, Mutter D, Bailey C, Varela D, Neuville A and Marescaux J: Primary resection of late, isolated secondary GIST. J Clin Gastroenterol. 43:288–289. 2009. View Article : Google Scholar : PubMed/NCBI
16	Grossi U, Ardito F, Petracca Ciavarella L, Goglia M and Giuliante F: Ultra-late recurrence of gastrointestinal stromal tumour: Case report and literature review. ANZ J Surg. 89:E224–E225. 2019. View Article : Google Scholar : PubMed/NCBI
17	Demetri GD, Benjamin R, Blanke CD, Choi H, Corless C, DeMatteo RP, Eisenberg BL, Fletcher CD, Maki RG, Rubin BP, et al: NCCN Task Force report: Optimal management of patients with gastrointestinal stromal tumor (GIST)-expansion and update of NCCN clinical practice guidelines. J Natl Compr Canc Netw. 2 (Suppl 1):S-1-26; quiz. 27–30. 2004.PubMed/NCBI
18	Sarlomo-Rikala M, Kovatich AJ, Barusevicius A and Miettinen M: CD117: A sensitive marker for gastrointestinal stromal tumors that is more specific than CD34. Mod Pathol. 11:728–734. 1998.PubMed/NCBI
19	Casali PG, Blay JY, Abecassis N, Bajpai J, Bauer S, Biagini R, Bielack S, Bonvalot S, Boukovinas I, Bovee JV, et al: Gastrointestinal stromal tumours: ESMO-EURACAN-GENTURIS clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 33:20–33. 2022. View Article : Google Scholar : PubMed/NCBI
20	Chen H, Pruitt A, Nicol TL, Gorgulu S and Choti MA: Complete hepatic resection of metastases from leiomyosarcoma prolongs survival. J Gastrointest Surg. 2:151–155. 1998. View Article : Google Scholar : PubMed/NCBI
21	DeMatteo RP, Shah A, Fong Y, Jarnagin WR, Blumgart LH and Brennan MF: Results of hepatic resection for sarcoma metastatic to liver. Ann Surg. 234:540–547; discussion 547-8. 2001. View Article : Google Scholar : PubMed/NCBI
22	Wada N, Takahashi T, Kurokawa Y, Nakajima K, Masuzawa T, Nakatsuka R, Kawada J, Nishida T, Kimura Y, Tanaka K, et al: Appropriate follow-up strategies for gastrointestinal stromal tumor patients based on the analysis of recurrent interval and patterns. Digestion. 95:115–121. 2017. View Article : Google Scholar : PubMed/NCBI
23	Yanagimoto Y, Takahashi T, Muguruma K, Toyokawa T, Kusanagi H, Omori T, Masuzawa T, Tanaka K, Hirota S and Nishida T: Re-appraisal of risk classifications for primary gastrointestinal stromal tumors (GISTs) after complete resection: Indications for adjuvant therapy. Gastric Cancer. 18:426–433. 2015. View Article : Google Scholar : PubMed/NCBI
24	D'Ambrosio L, Palesandro E, Boccone P, Tolomeo F, Miano S, Galizia D, Manca A, Chiara G, Bertotto I, Russo F, et al: Impact of a risk-based follow-up in patients affected by gastrointestinal stromal tumour. Eur J Cancer. 78:122–132. 2017. View Article : Google Scholar : PubMed/NCBI