A Case of a Gastrointestinal Stromal Tumor of the Stomach with Lymph Node Metastasis

Abstract

A 74-year-old woman was found to have a gastric tumor during a medical check-up. Endoscopic examination revealed a submucosal tumor with ulceration in the cardiac region of the stomach, which was diagnosed as a gastrointestinal stromal tumor (GIST) following histopathological examination. In addition, swollen lymph nodes with the maximum diameter of 8 mm were identified close to the tumor on CT scan imaging. The patient underwent proximal gastrectomy with jejunal interposition. Neither liver metastasis nor peritoneal dissemination was observed in the intraoperative findings. Intraoperative frozen resection of the lymph nodes (#1, #7) near the tumor as identified by the preoperative CT showed metastasis of a #1 lymph node, for which lymph node dissection near the tumor was also performed. The tumor was 40 × 40 × 32 mm in size, and was c-kit- and CD34-positive on immunohistochemical staining, and the diagnosis of GIST was established. Lymph node metastasis was confirmed in 2 of the 16 lymph nodes dissected. As of 3 years after surgery, adjuvant chemotherapy is being performed without recurrence. Although liver metastasis and peritoneal dissemination are frequently observed in GISTs, lymph node metastasis is rare, and herein such a case is reported on herein with a literature review.