46year old woman who underwent open resection of Fundus for GIST 4years ago with recurrence at the site and two peritoneal nodules near the spleen.Ever since surgery she is being followed by a medical oncologist.Pet scan one year ago was normal.
Have you had taken a biopsy specimen from the local recurrence node in the stomach, and if yes, what is its histological etc.conclusion? What are the nodes' sizes? Do you tailor to repeat PET, once the three nodes have been found?
PET shows only mass at the previous operated site and and small peritonial nodules near the spleen.Biopsy was not done.Awaiting for surgery.Thankyou
Diagnostic and if possible therapeutic laparoscopy seems a good option. Even for metastases is the treatment of choice resection with a clear margin.
Thanks you for presenting this interesting case. I assume that the diagnostic workup has involved more than just a PET, e.g. upper GI endoscopy, a good CT (in case the PET was not a PET-CT). My opinion is that, size of the lesions, a decision should be made regarding pre-operative downstaging with imatinib or proceeding to surgery, followed by imatinib. Though an increasing number of tumours with intraperitoneal spread are being treated with cytoreductive surgery and HIPEC, there is no evidence of this being of any benefit in case of GIST.
By the way, did any tumour spill occur during the initial operation?
Thanks Akash,I had some technical difficulty as it was at the fundus with narrow coastal angle but cannot recollect any spill ,she was operated 4 years ago and pet in 2014 no recurrence.
As far as I understood from the topic, Dr.Reddy does suppose a recurrence of the previous GIST and no other alternative. However, four years is not a charasteric time for recurrency to occur.
Have you had a routine gastroscopy? If yes, what has been found on the mucosal lining at the place of the previous operation? So, that could not be a 'usual' carcinoma?
Thanks Andrey,
upper GI endoscopy is normal,pt has beensent to the oncologist to down grade the tumour prior to surgery
If the radiology is convincing for metastatic recurrence of the GIST then a TKI would seem sensible in the first instance. Was the tumour high risk. Did profiling suggest it to be tki sensitive ?
