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 2013Fig. 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 in

    n 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 558559. 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 adachi@tmhp.jp (K. Adachi).

    [

    590-8658/$36.00 2012 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevierttp://dx.doi.org/10.1016/j.dld.2012.11.016Fig. 2.

    occurred 19 years after primary surgery although the mitotic rateof the primary tumor showed

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