Abstract
A 67-year-old man seen for dysphagia was found in upper gastric endoscopy to have a submucosal tumor at the gastric cardia. Computed tomography (CT) showed a huge tumor at the mid mediastinum, extending from the right pulmonary hilum to the gastric cardia. Biopsy yielded a pathological diagnosis of gastrointestinal stromal tumor (GIST) of the esophagogastric junction. To avoid excessive surgical invasion, we started neoadjuvant chemotherapy with imatinib at 400 mg/day to shrink the tumor. Two weeks later, the tumor had decreased, but CT after eight weeks showed air within the tumor and an esophago-tumor fistula. Upper gastrointestinal tract X-ray showed a cavity communicating with the esophageal lumen. When conservative 4-week treatment failed to alleviate the fistula, we conducted surgical intervention involving lower right thoracolaparotomic esophagectomy, proximal gastrectomy, intrathoracic esophagogastrostomy, and complete tumor resection. The 12×10× 8 cm tumor showed a fistula between the posterior wall and tumoral cavity. Pathologically, most tumor cells appeared atrophic with fibrotic changes throughout the tumor. The man has remained recurrence-free in the 16 months since surgery.
