Development of multiple myeloma in a patient with gastrointestinal stromal tumor treated with imatinib mesylate: A case report

Abstract

.In some rare cases coexistence of GIST with other malignancies has been reported [2][3][4][5][6] . Here we describe a case of a 74-year old male with GIST who developed multiple myeloma (MM) during the course of GIST treatment. To the best of our knowledge, the co-existence of GIST and multiple myeloma has not been reported so far. Case reportA 74-year old male was presented complaining of dyspepsia. Clinical examination revealed a palpable epigastric mass, with no other abnormal clinical findings. Computed tomography of the abdomen showed a 15 cm × 16 cm solid mass in the right side of abdomen, deriving from the gastric wall. A submucosal non-metastatic tumor was suspected ( Figure 1A). Endoscopy showed normal mucosa of the gastrointestinal tract. Laboratory tests were normal. During the surgery, a 5 cm × 11 cm mass of the posterior wall of the gastric antrum protruding from the inner muscularis propria to the mucosa was found. The mass was completely resected and the histological examination demonstrated whirling sheets of spindle cells which were stained positively for CD 117 (c-kit) and CD34, mitotic index > 10/50 HPF, while smooth muscle actin (SMA) and vimentin were focally positive, and keratine, desmin, S-100 protein were negative. This specific immunophenotype characterized GIST. No further therapy was applied. Physical examination, laboratory tests and computed tomography were performed when the patient was followed up at 3-month intervals.Fourteen months after resection, a CT scan of the abdomen showed liver metastases ( Figure 1B) and imatinib mesylate at a dose of 400 mg once daily, as the appropriate second line therapy, was administered. After one month of treatment, the patient reported persistent skeletal pain, especially on the thorax, accompanied with weakness and fatigue. X-ray bone survey showed lytic lesions. Laboratory examination revealed normocytic, normochromic anemia (Hb: 10.6 gr/dL), hypercalciemia (Ca: 11.7 mg/dL) and abnormal ESR (140 mm/h). Serum protein electrophoresis and immunofixation showed an AbstractGastrointestinal stromal tumors (GISTs) are rare tumors, which represent approximately 1% of the neoplasms of the gastrointestinal tract. These tumors rarely give extra-abdominal metastases. However, their clinical outcome is potentially adverse. In some rare cases, coexistance of GISTs with other malignancies has been reported. Here we present a case of a 74-year old male with GIST, which was managed by surgical resection. Fourteen months later, the patient presented with liver metastases and imatinib mesylated was administered. During treatment, the patient reported skeletal pain and plane X-rays revealed osteolytic bone lesions. Further investigation revealed the presence of multiple myeloma. To the best of our knowledge, this is the first report of the co-existence of multiple myeloma (MM) with GIST.

Coexistence of chronic myeloid leukemia and pulmonary plasmacytoma mimicking primary lung cancer

“…Furthermore, MM was reported to have developed in an IM-treated patient with a gastrointestinal stromal tumor [11]. These laboratory and observational findings might suggest that IM facilitates the development of MM.…”

Prostate cancer, chronic myelogenous leukemia and multiple myeloma in a single patient: a case report and review of the literature

“…In the literature, 8 of the nine patients who first had CML received Imatinib before MM was diagnosed. Moreover, it has been reported that an imatinib-treated patient developed MM after a gastrointestinal stromal tumor [ 12 ]. It can be proposed that imatinib mesylate treatment may promote the development of MM.…”

Uncommon case of chronic myeloid leukemia with multiple myeloma

“…In the literature, three of the four patients who first had CML and then MM received imatinib mesylate before MM was diagnosed [5][6][7]. Furthermore, MM was reported to have developed in an imatinib mesylate-treated patient with a gastrointestinal stromal tumor [26]. These clinical observations suggest that imatinib mesylate treatment may promote the development of MM.…”