A rectal gastrointestinal stromal tumor—a plea for neoadjuvant imatinib and TAMIS

Abstract

Here we describe an infrequent case of gastrointestinal stromal tumor of the rectum in a 57 year-old man with spindle cell neoplasm probably gastrointestinal stromal tumor and CT scan showed tumor from the anterior rectal wall and offered abdominoperineal resection for the same. The patient was started on imatinib and had a significant reduction in symptoms. The patient was reassessed with the CT scan, which showed a reduction in tumor size and Transanal minimally invasive surgery was planned for the patient. Use of imatinib prior to surgical resection to attain the reduced size of the tumor within the limit of resection is an attractive approach. Since tumor development can happen rapidly again after substantial tumor shrinkage, the best time to operate depending on resectability and the maximum therapeutic outcome remains divisive.

Rectal Gastrointestinal Stromal Tumor (GIST): About a Rare and Unusual Case

“…Gastrointestinal stromal tumors (GIST) are uncommon digestive mesenchymal tumors that develop from Cajal-like interstitial cells expressing the CD-117 proto-oncogene in 80% of cases [3][4][5] . They are preferentially located in the gastric (in about 70% of cases) and intestinal (in about 30% of cases) regions [2] .…”

“…They are preferentially located in the gastric (in about 70% of cases) and intestinal (in about 30% of cases) regions [2] . Rectal localization is exceptional; with an incidence of approximately 0.1% of all rectal tumors and accounting for approximately 5% of all GIST [2,3] . Rectal GIST occur in the majority of cases sporadically, although predisposing and familial forms have been described [6] .…”

“…Gastrointestinal stromal tumors (GIST) constitute 1% of all gastrointestinal tumors [1] , and are found mainly in the stomach and intestine. Rectal localization, on the other hand, is very rare, accounting for 0.1% of all rectal tumors [2,3] . GIST usually expresses the CD-117 receptor (Kit), and less frequently the CD-34 receptor [3][4][5] .…”

“…Rectal localization, on the other hand, is very rare, accounting for 0.1% of all rectal tumors [2,3] . GIST usually expresses the CD-117 receptor (Kit), and less frequently the CD-34 receptor [3][4][5] . The interest of evoking this entity is to improve the prognosis of patients with this rare form of rectal tumor.…”

Gastrointestinal stromal tumors of the colon and rectum

“…In addition, the management of these tumors can be challenging as the pelvis anatomy can impede a proper surgical approach in particular cases, explaining the higher rates of disease progression [11]. Overall, evidence shows that rectal GISTs have a worse prognosis and can be labelled as high-risk tumors in the majority of cases [12,13,14,15,16,17].…”