2016 Volume 69 Issue 4 Pages 221-226
We describe a case of a huge lower rectal gastrointestinal stromal tumor (GIST) successfully treated with neoadjuvant imatinib mesylate (IM) followed by anus-preserving laparoscopic surgery. A 76-year-old male was referred to our hospital with a huge tumor in the pelvic cavity. On digital examination, an elastic hard tumor with a smooth surface was palpated in the posterior wall of the rectum. MRI showed the solid mass to measure 81 mm in diameter which compressed the rectum and sacrum. Endoscopic ultrasonography (EUS) revealed the lesion to originate from the fourth layer, and the internal echo was nonuniformly hypoechoic. The tumor was diagnosed as a rectal GIST by EUS-FNAB. Neoadjuvant IM (400mg/day) was administered for 4 months to decrease the risk of morbidity and prevent extensive surgery, the tumor volume reduced to 70%. We successfully performed laparoscopic super-low anterior resection without rupturing the tumor capsule. For a large lower rectal GIST, neoadjuvant IM could be anus-preserving and allow low invasive surgical treatment.
