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