A CASE OF GASTROINTESTINAL STROMAL TUMOR OF THE JEJUNUM WITH PERITONEAL METASTASIS 3.5 YEARS AFTER OPERATION

Abstract

We report a case of gastrointestinal stromal tumor of the jejunum with peritoneal metastasis 3.5 years after surgery, and discuss this case referencing the literature. A 52-year-old man hospitalized with melena and anemia. A solid 7×5×5cm hypervascular tumor of the jejunum with a delineated border was found in abdominal computed tomography. Superior mesenteric arteriography showed the tumor to be hypervascular, with a feeder from the jejunal artery, indicating a leiomyosarcoma of the jejunum necessitating partial jejuno resection. In the resected specimen, tumor cells were immunohistochemically positive for CD34 and c-kit protein, but not for α-smooth muscle actin or S-100 protein. It was diagnosed as a gastrointestinal stromal tumor (GIST), uncommitted. Histological examination showed high-grade malignancy. Follow-up CT 3.5 years after postoperatively showed a large number of small nodules in the abdomen, suggesting peritoneal metastasis. Experimental laparotomy showed numerous small nodules of the peritoneum diagnosed histochemically as peritoneal dissemination. Because of the poor prognosis of GIST in unresectable peritoneal dissemination, surgery should be performed as soon as possible.