Digestive and Liver Disease 45 (2013) e8 Contents lists available at SciVerse ScienceDirect Digestive and Liver Disease jou rn al h om epage: www.elsevier.com/locate/dld Image of the Month A liver metastasis 19 years after primary surgery discloses the correct diagnosis Kensuke Adachi a,∗ , Takuya Hashimoto a , Kazuaki Enatsu b a Department of Surgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan b Department of Pathology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan a r t i c l e i n f o Article history: Received 4 November 2012 Accepted 29 November 2012 Available online 5 January 2013 Fig. 1. A 74-year-old man visited our hospital with a huge, palpable liver tumor. A T1-weighted axial MRI demonstrated a heteroge- neous tumor in the right hepatic lobe (Fig. 1). 19 years ago the patient had undergone a total gastrectomy for the bulky gastric submucosal tumor (SMT) > 10 cm in size. The pathologic diagnosis was labeled as leiomyosarcoma. A hepatectomy was performed, and the patient regained his health with no indication of recurrence 14 months. The lesional hepatic tissue showed spindle cells arranged in an interlacing fascicular growth-pattern reminiscent of the fea- tures observed in the prior gastric LMS. Further examination of c-kit yielded positive immune staining in both tumors (Fig. 2). Genetic analysis in each lesion revealed the same in-flame dele- tions involving exon 11 of c-kit at codon 558–559. This case was diagnosed unequivocally as a “true” liver metastasis from gastrointestinal stromal tumor (GIST), made remarkable by the fact that it ∗ Corresponding author at: 2-8-29, Musashidai, Fuchu, Tokyo 183-8524, Japan. Tel.: +81 42 323 5111; fax: +81 42 323 9209. E-mail address: kensuke [email protected] (K. Adachi). Fig. 2. occurred 19 years after primary surgery although the mitotic rate of the primary tumor showed <1 mitosis/50 high-power fields. Prior to the advent of c-kit, gastrointestinal SMTs covered the broad spectrum of benign or malignant mesenchymal tumors. Risk factors of recurrence have been well-established; however, the natural course of GIST is very unpredictable. Importantly, GISTs sometimes show ‘delayed metastases’ even though there may be no evidence for tumor necrosis, aneuploidy, or pleomorphic cellularity [1]. Conflict of interest statement The authors have neither potential conflicts of interest nor financial arrangements. Reference [1] Joensuu H, Vehtari A, Riihimaki J, et al. Risk of recurrence of gastrointestinal stromal tumour after surgery: an analysis of pooled population-based cohorts. Lancet Oncology 2012;13:265–74. 1590-8658/$36.00 © 2012 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.dld.2012.11.016

A liver metastasis 19 years after primary surgery discloses the correct diagnosis

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Page 1: A liver metastasis 19 years after primary surgery discloses the correct diagnosis

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Digestive and Liver Disease 45 (2013) e8

Contents lists available at SciVerse ScienceDirect

Digestive and Liver Disease

jou rn al h om epage: www.elsev ier .com/ locate /d ld

mage of the Month

liver metastasis 19 years after primary surgery discloses the correct diagnosis

ensuke Adachia,∗, Takuya Hashimotoa, Kazuaki Enatsub

Department of Surgery, Tokyo Metropolitan Tama Medical Center, Tokyo, JapanDepartment of Pathology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan

r t i c l e i n f o

rticle history:eceived 4 November 2012ccepted 29 November 2012vailable online 5 January 2013

Fig. 1.

A 74-year-old man visited our hospital with a huge, palpableiver tumor. A T1-weighted axial MRI demonstrated a heteroge-eous tumor in the right hepatic lobe (Fig. 1). 19 years ago theatient had undergone a total gastrectomy for the bulky gastricubmucosal tumor (SMT) > 10 cm in size. The pathologic diagnosisas labeled as leiomyosarcoma. A hepatectomy was performed,

nd the patient regained his health with no indication of recurrence4 months.

The lesional hepatic tissue showed spindle cells arranged inn interlacing fascicular growth-pattern reminiscent of the fea-ures observed in the prior gastric LMS. Further examination of-kit yielded positive immune staining in both tumors (Fig. 2).enetic analysis in each lesion revealed the same in-flame dele-

ions involving exon 11 of c-kit at codon 558–559. This case wasiagnosed unequivocally as a “true” liver metastasis from gastroin-estinal stromal tumor (GIST), made remarkable by the fact that it

∗ Corresponding author at: 2-8-29, Musashidai, Fuchu, Tokyo 183-8524, Japan.el.: +81 42 323 5111; fax: +81 42 323 9209.

E-mail address: kensuke [email protected] (K. Adachi).

[

Fig. 2.

occurred 19 years after primary surgery although the mitotic rateof the primary tumor showed <1 mitosis/50 high-power fields.

Prior to the advent of c-kit, gastrointestinal SMTs covered thebroad spectrum of benign or malignant mesenchymal tumors. Riskfactors of recurrence have been well-established; however, thenatural course of GIST is very unpredictable. Importantly, GISTssometimes show ‘delayed metastases’ even though there may be noevidence for tumor necrosis, aneuploidy, or pleomorphic cellularity[1].

Conflict of interest statementThe authors have neither potential conflicts of interest nor financialarrangements.

Reference

1] Joensuu H, Vehtari A, Riihimaki J, et al. Risk of recurrence of gastrointestinalstromal tumour after surgery: an analysis of pooled population-based cohorts.Lancet Oncology 2012;13:265–74.

dx.doi.org/10.1016/j.dld.2012.11.016

http://www.sciencedirect.com/science/journal/15908658

http://www.elsevier.com/locate/dld

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dx.doi.org/10.1016/j.dld.2012.11.016