Abstract
A 57-year-old man referred for epigastragia was found on endoscopic examination to have a submucosal tumor in the lower thoracic esophagus. Esophagectomy with gastric tube reconstructuion was performed in October 2001. The histopathological diagnosis was GIST and because the tumor size was 5 cm, with 50 mitoses per 50 HPF, the tumor was considered to be a high-risk GIST (c-kit(+), CD34(+),α-SMA(+)). He came to our hospital with complaint of pain on his right upper arm and was found to have an upper arm bone tumor. So we performed a bone resection in April 2010. Hisotopathological examination was metastatic GIST with >50 mitoses per 50 HPF (c-kit(+), CD34(+), α-SMA(-)). He was found on abdominopelvic CT to have a cystic intrapelvic tumor and underwent an operation in August 2010. The tumor was found on the jejunum at 40 cm on the distal side from the Treiz ligament with extraluminal growth, and was resected by wedge excision. Histopathological diagnosis was a moderate-risk GIST because the tumor size was 6 cm, 2 mitoses per 50 HPF, c-kit(+), CD34(-), and α-SMA(+). Histopathological and immunohisitochemical findings suggested that the bone metastasis was a recurrence of the primary esophageal GIST 9 years after the esophagectomy and the intestinal GIST was a second primary tumor.
