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Indian Journal of Cancer, Vol. 48, No. 3, July-September, 2011, pp. 383-384 Letter to Editor Mesentric gastrointestinal stromal tumor with bone metastases A Jain, B Dubashi, Mangaladevi, SS Chandra, D Halanaik Department of Medical Oncology, Surgery, Nuclear Medicine, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry - 6, India Code Number: cn11108 PMID: 21921354 DOI: 10.4103/0019-509X.84934 Sir, Gastrointestinal stromal tumors (GIST) are the most common (80%) mesenchymal tumor of the gastrointestinal tract. Fifteen to 47% of patient present with overt metastatic disease. [1] Common sites of metastases include liver, peritoneum, and omentum. In contrast to other sarcomas, lung and bone metastases are unusual and appear late in the course of disease. [2] A 55-year-old male presented to our hospital with multiple scalp swellings and generalized bony pains in previous 1 year. His past history was significant as he underwent ileojejunostomy and sigmoid colectomy for an intra-abdominal mass of 25×20 cm which was arising from mesentery of small and large intestine 3 years back in 2007. On examination there were multiple small 1×1 cm palpable lesions over the scalp and massive hepatomegaly. The review slides and block of initial surgery at our center were suggestive of epithelioid gastrointestinal stromal tumor with round to oval spindle cells with 2-3/10 hpf visible mitoses and cells were positive for CD117 and SMA. The skull X-ray showed multiple osteolytic lesions all over the skull [Figure - 1]. Bone scan was suggestive of multiple bony metastases [Figure - 2]. The USG abdomen was suggestive of multiple hepatic metastases. FNAC from liver metastases was morphologically suggestive of metastatic GIST. The bone marrow aspiration and biopsy was normal. Patient was started on 400 mg/day of imatinib and he is on regular follow up with stable disease since 6 months. In various series of metastatic GIST the incidences of bone metastases is approximately 5%. [1],[3],[4] Few of the largest series with bony metastases are discussed in [Table - 1]. The most common sites for bony metastases are spine and pelvis. Skull metastases are reported in one of the case reports of rectal GIST. [5] In our case report, in addition to vertebral metastases, skull metastases were present. Development of bony metastases heralds the downhill course of metastatic GIST. Schuler et al in their largest series of 307 patients of GIST reported that median survival for patients from the time of diagnosis is 325 weeks, from diagnosis to distant metastases 252 weeks, and 135 weeks from the time of occurrence of bony metastases. [5] These data suggest that development of bony metastases is a poor prognostic feature in patients with metastatic GIST. They also commented that the incidences of bone metastases are underestimated due to the fact that bone lesions of the extremities were mainly found due to clinical symptoms. Isolated bone metastases are a rare presentation and most of the time bone metastases occur with hepatic or peritoneal metastases. In our case also hepatic metastases were present. Another differential diagnosis of GIST with bone metastases is imatinib-induced bone marrow necrosis as reported by Vanel. [6] In addition to imatinib, various modalities like radiation and bisphosphonates are used for the management of bony metastases. The likelihood of finding these unusual sites of metastases are more due to prolonged survival in GIST patients after the introduction of imatinib therapy. [3],[5],[6] All physicians involved in care of GIST patients should be aware of these unusual sites of metastases during the prolonged natural history of GIST in the imatinib era. References
Copyright 2011 - Indian Journal of Cancer The following images related to this document are available:Photo images[cn11108t1.jpg] [cn11108f1.jpg] [cn11108f2.jpg] |
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