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Metastatic gastrointestinal stromal tumor of the greater omentum. Case report

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1. Title Title of document Metastatic gastrointestinal stromal tumor of the greater omentum. Case report
2. Creator Author's name, affiliation, country Vladimir V. Yugay; Blokhin National Medical Research Center of Oncology; Russian Federation
2. Creator Author's name, affiliation, country Maxim P. Nikulin; Blokhin National Medical Research Center of Oncology; Yevdokimov Moscow State University of Medicine and Dentistry; Russian Federation
2. Creator Author's name, affiliation, country Natalya N. Mazurenko; Blokhin National Medical Research Center of Oncology; Russian Federation
2. Creator Author's name, affiliation, country Valerija V. Mochal'nikova; Blokhin National Medical Research Center of Oncology; Russian Federation
2. Creator Author's name, affiliation, country Dar'ja A. Filonenko; Loginov Moscow Clinical Scientific Center; Russian Federation
2. Creator Author's name, affiliation, country Andrey A. Meshherjakov; Blokhin National Medical Research Center of Oncology; Russian Federation
2. Creator Author's name, affiliation, country Vladislav E. Bugaev; Blokhin National Medical Research Center of Oncology; Russian Federation
2. Creator Author's name, affiliation, country Petr P. Arhiri; Blokhin National Medical Research Center of Oncology; Russian Medical Academy of Continuous Professional Education; Russian Federation
2. Creator Author's name, affiliation, country Anna M. Stroganova; Blokhin National Medical Research Center of Oncology; Russian Federation
2. Creator Author's name, affiliation, country Ivan S. Stilidi; Blokhin National Medical Research Center of Oncology; Russian Medical Academy of Continuous Professional Education; Pirogov Russian National Research Medical University; Russian Federation
3. Subject Discipline(s)
3. Subject Keyword(s) gastrointestinal stromal tumor; extragastrointestinal stromal tumor; greater omentum; GIST; EGIST
4. Description Abstract

Gastrointestinal stromal tumors (GIST) are the most common type of mesenchymal malignancies of the gastrointestinal (GI) tract. Almost 10% of them are originated outside of the GI tract (extra-GIST), while GIST of the greater omentum constitutes about 1% among stromal tumors. More than 80% of GIST have mutations in c-KIT and PDGFRA genes. Herein we demonstrate the case of successful treatment of patient with giant omental GIST with c-KIT exon 11 mutation. 64-years-old woman, was admitted to the Department of abdominal oncology with complaints of shortness of breath and abdominal enlargement in volume. CT-scan revealed a large tumor in the abdominal cavity with tumor size of 54×34×22 cm. The patient underwent left thoraco-abdominal approach. It was found that the tumor was originated from the greater omentum with several metastases located on the peritoneum of the left lateral channel. Resection of the large omentum, splenectomy, liver resection and was done. Postoperative immunohistochemical study showed the expression of CD117, CD34 in tumor cells. Ki-67 index was 12–15%. Genetic study revealed c-KIT exon 11 mutation. Treatment with imatinib 400 mg per day was started. Patient has been treated with imatinib for 12 years. On control examination we have found a metastasis in the anterior abdominal wall 3,5×3×2,5 cm in diameter. Afterwards we performed resection of anterior abdominal wall with metastasis on 9 November 2017. Immunohistochemical study confirmed metastasis of GIST. The index of tumor proliferation activity (Ki-67) was 45%. Patient prolonged imatinib treatment at the dose of 400 mg per day after operation. No signs of progression have been revealed on control examination 72 months after the operation. 12-year progression-free survival during imatinib treatment is unique in our practice. Moreover, in the case of further progression, we have second and third-line targeted therapy (sunitinib and regorafenib) and surgery treatment in local progression.

5. Publisher Organizing agency, location LLC Obyedinennaya Redaktsiya
6. Contributor Sponsor(s)
7. Date (DD-MM-YYYY) 15.12.2021
8. Type Status & genre Peer-reviewed Article
8. Type Type Research Article
9. Format File format
10. Identifier Uniform Resource Identifier https://modernonco.orscience.ru/1815-1434/article/view/76385
10. Identifier Digital Object Identifier (DOI) 10.26442/18151434.2021.4.201222
11. Source Title; vol., no. (year) Journal of Modern Oncology; Vol 23, No 4 (2021)
12. Language English=en ru
13. Relation Supp. Files Fig. 1. Gastrointestinal stromal tumor of the large omentum. The loops of the intestine and the liver are shifted to the right. (76KB)
Fig. 2. Gastrointestinal stromal tumor of the large omentum. The tumor shifts the diaphragm upwards with compression of the left lung. (89KB)
Fig. 3. Removed gastrointestinal stromal tumor of the large omentum with a resected section of the left lobe of the liver and the spleen. (324KB)
Fig. 4. Primary EGIST. Spindle cells with hyperchromic nuclei with high mitotic rate. Cells form regular structures like "intertwining" bundles. Hematoxylin-eosin staining, ×100. (244KB)
Fig. 5. Primary EGIST. Immunohistochemical study. Expression of CD117, ×100. (264KB)
Fig. 6. Metastasis of a gastrointestinal stromal tumor of the large omentum in the anterior abdominal wall 12 years after surgery. (79KB)
Fig. 7. Metastatic EGIST. High mitotic index. Staining with hematoxylin-eosin, ×200. (221KB)
Fig. 8. Metastatic GIST. Immunohistochemical study. Ki67 proliferation index is 45%, ×100. (177KB)
14. Coverage Geo-spatial location, chronological period, research sample (gender, age, etc.)
15. Rights Copyright and permissions Copyright (c) 2021 Consilium Medicum
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