Published online Feb 26, 2021. doi: 10.12998/wjcc.v9.i6.1490
Peer-review started: November 23, 2020
First decision: November 29, 2020
Revised: December 13, 2020
Accepted: December 28, 2020
Article in press: December 28, 2020
Published online: February 26, 2021
Gastrointestinal stromal tumor (GIST) usually originates in the stomach, followed by the small intestine, rectum, and other parts of the gastrointestinal tract. The most common sites of metastasis are the liver and peritoneum, whereas spinal metastases from GIST are extremely rare.
We found a case of GIST with the first presentation of multilevel spinal metastases involving the thoracic and lumbar vertebrae. A 61-year-old Chinese man presented to our clinic because of pain in his lower back and hip for 10 d without cause. Subsequently, computed tomography (CT) and magnetic resonance imaging (MRI) revealed abnormal signals in the vertebral appendages of T12 and L4 accompanied by spinal canal stenosis, which was considered as tumor metastasis. As there were no metastases to vital organs, posterior thoracic and lumbar spinal decompression + adnexal mass resection + pedicle internal fixation was adopted to achieve local cure and prevent nerve compression. The results of histopathological studies were consistent with the metastasis of GIST. No local recurrence or new metastases were found at the 6-mo follow-up at the surgical site. The patient has no neurological symptoms at present. It is worth mentioning that a rectal mass was found and surgically removed 1 mo after the patient was discharged from hospital, and the pathological diagnosis of the mass was GIST.
By reviewing 26 previously reported cases of spinal metastasis in GIST, it was found that spinal metastasis of GIST has become more common in recent years, so the possibility of early spinal metastasis should be recognized. CT and MRI are of great value in the diagnosis of spinal metastatic tumors, and pathological biopsy is the gold standard for the diagnosis of metastatic tumors. It is safe and feasible to treat isolated spinal metastasis in GIST by excising metastatic masses, decompressing the spinal canal, and stabilizing the spine.
Core Tip: Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor in the digestive tract and originates from Cajal stromal cells or related stem cells. GIST metastasis usually occurs in the liver (28%), mesentery and omentum (30%), and less often in the lungs (7%), subcutaneous tissue (4.7%), and lymph nodes (4.7%), whereas GIST bone metastasis is very rare (only 0.47%). We report a case of GIST in a 61-year-old man with multisegmental spinal metastasis as the first presentation and review the literature. As far as we know, this is the first report of a GIST with the first presentation of multisegmental spinal metastases from the thoracolumbar spine. This case highlights the importance of resection of metastatic tumors of the spine as an effective treatment for GIST.