Primary gastrointestinal stromal tumor of the liver treated with sequential therapy

Abstract

A 67-year-old female presented with a primary hepatic gastrointestinal stromal tumor that was detected by computed tomography and diagnosed based on histopathological and genetic analyses. The tumor was microscopically composed of spindle cells and epithelioid cells, and immunohistochemistry results showed positive staining for CD117 and CD34 expression. A genetic analysis revealed a heterozygous point mutation and deletion in exon 11 of c-KIT. After an R0 resection, imatinib mesylate was administered for 1 year until its use was discontinued due to severe side effects. Two years after the original operation, the tumor recurred in the residual liver and was completely resected again. Imatinib mesylate was administered for 2 years until it was replaced by sunitinib malate because of disease progression. The patient has survived for 53 mo after undergoing a sequential therapy consisting of surgical excision, imatinib and sunitinib.

Keywords: Gastrointestinal stromal tumor; Diagnosis and treatment; Tyrosine kinase inhibitor; Sequential therapy; Liver

Core tip: The tumor was detected by computed tomography and diagnosed based on histopathological and genetic analyses. Metastases from gastrointestinal stromal tumors were excluded using computed tomography, ultrasound, esophagogastroduodenoscopy and colonoscopy. The patient was treated with an extended sequential therapy consisting of surgery, imatinib mesylate, and sunitinib malate. The patient has survived for 53 mo after the start of therapy.