Persistent Lymph Node Metastasis Post Imatinib Treatment in Low Grade Gastrointestinal Stromal Tumor with PDGFRA Mutation

Persistent Lymph Node Metastasis Post Imatinib Treatment in Low Grade Gastrointestinal Stromal Tumor with PDGFRA Mutation

Author Info

Corresponding Author
Belinda Sun
Department of Pathology, Banner-University Medical Center Tucson, University of Arizona Health Sciences, University of Arizona, Tucson, Arizona, USA

A B S T R A C T

Background/Aims: Lymph node metastasis has been considered very rare in gastrointestinal stromal tumors (GIST), especially in low grade GIST. Thus, lymphadenectomy is not required routinely as standard of care during surgery for GIST unless there is suspicion for lymph node metastasis. However, herein we present a low grade PDGFRA mutated GIST status post imatinib chemotherapy with nearly complete response in the primary tumor but a persistent lymph node metastasis which significantly affected the management of the patient. Case Report: A 38-year-old male presented with a 11.5 cm epigastric GIST status post imatinib (Gleevec) treatment who underwent partial gastrectomy with tumor excision. The initial biopsy showed epithelioid type GIST with a low mitotic rate and PDGFRA gene mutation detected by genetic analysis. The original tumor had nearly complete response to imatinib with a few possible residual tumor cells identified; however, one lymph node was found to be positive for metastatic GIST with minimal treatment effect present. The patient was managed with continuous imatinib treatment and life-long follow up. Conclusion: This case raises the awareness of the possibility of lymph node metastasis in low grade conventional GIST with PDGFRA mutation. Lymph node examination may need to be considered as standard of care for better management of patients with GIST.

Article Info

Article Type
Case Report
Publication history
Received: Sat 04, Jul 2020
Accepted: Wed 15, Jul 2020
Published: Sat 25, Jul 2020
Copyright
© 2019 Belinda Sun. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Hosting by Science Repository. All rights reserved.
DOI: 10.31487/j.AJSCR.2020.03.10