Transsacral excision with pre-operative imatinib mesylate treatment and approach for gastrointestinal stromal tumors in the rectum: A report of two cases

Abstract

Gastrointestinal stromal tumors (GISTs) are rare in the rectum. Radical surgery, such as an abdominoperineal resection, is necessary for large rectal GISTs, which can result in the loss of function of involved organs. Imatinib mesylate can be used as perioperative therapy and may reduce tumor size, and it is now approved for use in the adjuvant therapy of locally resected anorectal GISTs. The present study describes two cases of large rectal GISTs, for which abdominoperineal resections were initially planned. The two patients received pre-operative imatinib mesylate treatment, and the therapeutic response was assessed by magnetic resonance imaging. Finally, transsacral local resection was successfully performed for these two GISTs. A macroscopically complete resection was achieved, and microscopically, the resection margin was negative. One patient experienced the complication of rectal leakage, which was successfully managed by drainage. No recurrence occurred in the two patients after more than two years. Pre-operative imatinib mesylate therapy with subsequent transsacral local resection for selected rectal GISTs is a feasible treatment modality and can prevent extended surgery.

Clinicopathological features and prognosis of small gastrointestinal stromal tumors outside the stomach

“…Though rectal GISTs are less common than non-rectal GISTs, accounting for ~5% of total GISTs ( 28 ), they remain the focus of studies, as the symptoms for rectal GISTs appear earlier compared with the symptoms of GISTs located in the enterocoelia. Rectal GISTs may also be detected by digital rectal examination, fiber colonoscopy and ultrasonic endoscopy ( 29 ). The principle of surgery for rectal GISTs is different from the principle for rectal cancer, as no lymph node dissection or TME resection is required, but a tumor-free resection margin and complete resection are necessary ( 30 ).…”

Recent Advancements in the Treatment of Rectal Gastrointestinal Stromal Tumor: In Era of Imatinib

“… 29 IM is also the only TKI currently available for neoadjuvant therapy (nIM), and the standard dose is 400 mg/day. 30 , 31 However, a case report also showed that sunitinib was selected for neoadjuvant therapy for gastrointestinal stromal tumors firstly. First-line neoadjuvant therapy with sunitinib produced good clinical outcomes in 2 patients with very large rectal GISTs adjacent to the prostate and bladder.…”

Expression of C-Kit in Benign and Malignant Endometrial Lesions

“…Imatinib mesylate is a competitive inhibitor for kit, PDGFRA and for tyrosine kinases. And can give 80% to complete pathological response 17 . C-kit shows positivity in cytoplasm and in cell membrane.…”