A Case of Gastrointestinal Stromal Tumor of the Stomach with Lymph Node Metastasis Treated with Laparoscopic and Endoscopic Cooperative Surgery

Abstract

A submucosal tumor 30mm in diameter was pointed out in 37-year-old woman as a result of a medical check up. The tumor was pathologically diagnosed as GIST by EUS-FNA. Abdominal CT showed a mass 20mm in diameter near the primary gastric GIST. The mass was suspected of peritoneal or lymph node metastasis as a preoperative diagnosis. Because surgical finding revealed the mass near the primary GIST was likely to be a lymph node metastasis, we performed pick-up lymph node dissection. Then we performed laparoscopic and endoscopic cooperative surgery for the primary gastric GIST.
Histopathological examination showed gastrointestinal tumor which was 30×18×13mm in size. Immunohistochemically, tumor cells were positive for c-kit and CD34; negative for desmin and S-100. The mass near the gastric GIST was diagnosed as lymph node metastasis. Tumor cells were positive for c-kit and CD34 as with primary tumor. MIB-1 index of lymph node metastasis was smaller (4%) than that of primary tumor (6%). Currently, there is no accepted standard treatment with management of GISTs with lymph node metastasis. We presented a case of GIST of the stomach with lymph node metastasis including bibliographic consideration.