Case Report
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 7, 2017; 23(9): 1720-1724
Published online Mar 7, 2017. doi: 10.3748/wjg.v23.i9.1720
Gastrointestinal stromal tumor of the stomach with axillary lymph node metastasis: A case report
Naoki Kubo, Nobumichi Takeuchi
Naoki Kubo, Nobumichi Takeuchi, Department of Surgery, Ina central Hospital, Inashi, Nagano 396-8555, Japan
Author contributions: Kubo N and Takeuchi N participated in the surgery of this case; Takeuchi N treated the patient after surgery; Kubo N drafted the manuscript and all authors read and approved the final manuscript.
Institutional review board statement: This case report was exempt from the Institutional Review Board standard at the Ina Central Hospital.
Informed consent statement: The patient has died no consent obtained.
Conflict-of-interest statement: The authors have no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Naoki Kubo, MD, Department of Surgery, Ina central Hospital, 1313-1, koshiroukubo, Inashi, Nagano 396-8555, Japan. nkazumihp@yahoo.co.jp
Telephone: +81-265-723121 Fax: +81-265-782248
Received: October 31, 2016
Peer-review started: November 1, 2016
First decision: December 2, 2016
Revised: January 5, 2017
Accepted: January 17, 2017
Article in press: January 18, 2017
Published online: March 7, 2017
Abstract

Gastrointestinal stromal tumors (GISTs) are the most common type of gastrointestinal mesenchymal tumors, although metastasis to the perigastric lymph nodes is relatively rare, compared with liver or peritoneal metastasis. In this report, we describe a case of stomach GIST with a solitary simultaneous metastasis in the left axillary lymph node. A 68-year-old man was diagnosed with a large upper-stomach GIST, and computed tomography and positron emission tomography revealed masses in the left axilla and right mediastinum. We did not detect evidence of metastases to the liver, or other sites including the perigastric lymph nodes, although findings from the surgically resected axillary lymph nodes were compatible with GIST metastasis. Treatment using imatinib markedly reduced the gastric and mediastinal lesions, and this response persisted for 3 years. The patient subsequently experienced rapid growth of the gastric lesion without mediastinal or axilla recurrence, which required palliative surgery. Despite continuing medical treatment (sunitinib and regorafenib), the patient died of liver metastases 23 mo after the surgery. Based on our findings, it appears that the axillary lymph nodes can be a potential metastatic site for GIST metastasis.

Keywords: Gastrointestinal stromal tumor, Axillary, Lymph node, Metastasis, Imatinib

Core tip: Gastrointestinal stromal tumors (GISTs) are the most common type of gastrointestinal mesenchymal tumors, although metastasis to the perigastric lymph nodes is relatively rare, compared to liver or peritoneal metastasis. In this report, we describe a case of stomach GIST with a solitary simultaneous metastasis in the left axillary lymph node. Based on our findings, it appears the axillary lymph nodes can be a potential metastatic site of GIST metastasis.