Metastatic Cerebellar Gastrointestinal Stromal Tumor with Obstructive Hydrocephalus Arising from the Small Intestine: A Case Report and Review of the Literature

Abstract

Gastrointestinal stromal tumor (GIST) is defined as a c-kit-positive gastrointestinal, mesenteric, or omental mesenchymal tumor that very rarely metastasizes to the brain. Metastasis to the cerebellum is particularly rare. An 80-year-old man presented with nausea and vomiting with disturbance of consciousness. Magnetic resonance imaging (MRI) revealed tumor in the cerebellar vermis causing obstructive hydrocephalus. The patient subsequently underwent midline suboccipital craniotomy, and the tumor was totally removed. Immunohistochemical analysis showed tumor cells positive for c-kit and CD34, and cerebellar metastasis of GIST was diagnosed. Postoperative radiotherapy was administered. Following surgery and radiotherapy, the patient developed ileus caused by tumor in the small intestine and underwent laparotomy for tumor removal. Following abdominal surgery, left hemiparesis and consciousness disturbance were noted. Computed tomography showed recurrent large tumor with perifocal edema in the right frontal lobe of the brain. The patient died 3 months after initial craniotomy. Intracranial metastasis of GIST is extremely rare. In cases such as the present, where the condition of the patient rapidly deteriorates and features such as rising intracranial pressure and ileus prevent the use of oral agents, molecular-targeted agents administered by intravenous infusion should be utilized.

Incidental micro-GIST found on post-sleeve gastrectomy. A case report and literature review

“…There are some factors which drive or predict its metastasis, such as tumour size, frequency of mitoses and presence of necrosis [21]. GISTs can also metastasise to remote sites, such as liver [22], lung [23], bone [24], ovary [25], brain [26], spleen [27] and orbit [28].…”

Cerebellar metastasis of gastrointestinal stromal tumor: A case report and review of the literature

“…Abdominal symptomatology frequently reveals the pathology [ 8 ]. However, extra digestive symptoms such as neurologic deficit or signs of intracranial hypertension [ [5] , [9] ] rarely disclose intestinal tumors. To our knowledge, only three cases in literature were described in which a gastro intestinal neoplasm was discovered following neurologic symptoms of an intracranial metastasis…”

“…Radiologically, intracranial metastases of GIST are generally solitary, larger than 3 cm and supratentorial [ 9 ]. Infratentorial metastases are very uncommon.…”

“…Infratentorial metastases are very uncommon. Only four cases of GIST infratentorial brain metastases have been reported [ [1] , [2] , [5] , [9] ].…”

A 40‐Year‐Old Female with Dural‐Based Lesions

“…It primarily affects patients between the ages of 60 and 65; however, familial cases may present at an earlier age. GIST, which occurs most frequently in the stomach and small intestine, is thought to arise from mesenchymal cells, the interstitial cells of Cajal, part of the autonomic nervous system of the gastrointestinal tract . The tumor cells typically harbor a driver mutation in CD117 (tyrosine protein kinase KIT receptor) or in approximately 10% cases, mutations in the platelet derived growth factor receptor A (PDGFRA receptors.…”