Gastrointestinal stromal tumor of the stomach with axillary lymph node metastasis: A case report

Abstract

Gastrointestinal stromal tumors (GISTs) are the most common type of gastrointestinal mesenchymal tumors, although metastasis to the perigastric lymph nodes is relatively rare, compared with liver or peritoneal metastasis. In this report, we describe a case of stomach GIST with a solitary simultaneous metastasis in the left axillary lymph node. A 68-year-old man was diagnosed with a large upper-stomach GIST, and computed tomography and positron emission tomography revealed masses in the left axilla and right mediastinum. We did not detect evidence of metastases to the liver, or other sites including the perigastric lymph nodes, although findings from the surgically resected axillary lymph nodes were compatible with GIST metastasis. Treatment using imatinib markedly reduced the gastric and mediastinal lesions, and this response persisted for 3 years. The patient subsequently experienced rapid growth of the gastric lesion without mediastinal or axilla recurrence, which required palliative surgery. Despite continuing medical treatment (sunitinib and regorafenib), the patient died of liver metastases 23 mo after the surgery. Based on our findings, it appears that the axillary lymph nodes can be a potential metastatic site for GIST metastasis.

Value and impact factors of multidetector computed tomography in diagnosis of preoperative lymph node metastasis in gastric cancer

“…[ 56 ] Solitary lymph node metastasis mainly occurred in the perigastric node area, [ 57 , 58 ] but some appeared in extra-perigastric region or even distant area, which was named skip metastasis. [ 59 , 60 ] Sentinel node mapping are recommended in patients with EGC who underwent surgical excision to detect possible skip metastasis. [ 61 , 62 ] A single-skip metastasis located along the middle colic artery was unexpectedly detected in sentinel lymph node biopsy of EGC by Bara's group.…”

Gastrointestinal stromal tumor of the stomach with lymph node metastasis treated by laparoscopic and endoscopic cooperative surgery with lymph node pick-up resection: A case report and literature review

“…We performed literature searches with Google scholar and PubMed from 2000 to 2018. The keywords used were “GIST,” “stomach,” and “lymph node metastasis.” Eight studies [ [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] ] and 15 case reports were found ( Table 1 ).…”

“…GISTs of the stomach with lymph node metastasis are very rare [ 1 ]. Previous studies reported surgical treatment with gastrectomy and systematic lymphadenectomy [ [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] ]. According to a recent review of current international clinical guidelines by JNCCS and ESMO [ 11 , 12 ], the recommended surgical strategy is as follows.…”

“…In such cases, the primary lesion is usually large. Therefore, gastrectomy and systematic lymphadenectomy may be performed [ [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] ]. However, it has not been conclusively shown that gastrectomy and systematic lymphadenectomy are necessary.…”

GIST - An Unusual Cause of Upper GI Bleeding

“…Introductiono A GIST (gastrointestinal stromal tumor) is a neoplasm that arises out of the GI tract 1 o GISTs are the most common mesenchymal tumors of the GI tract2 …”