病例報告-罕見直腸腸胃道基質瘤併攝護腺侵犯以下泌尿道症狀表現
蔡禮賢、蕭博任、張兆祥、楊啟瑞
中國醫藥大學附設醫院 泌尿部
Rare rectal gastrointestinal stromal tumor presented as prostate mass: Case report and review of the literature
Li-Hsien Tsai, Po-Jen Hsiao, Chao-Hsiang Chang, Chi-Rei Yang
Department of Urology, China Medical University Hospital, Taichung, Taiwan
Purpose: Gastrointestinal stromal tumor (GIST) is a rare disease that accounts for less than 1% of gastrointestinal tumors. Rectal GIST only accounts for 5% of GIST population. Progression of the tumor sometimes causes lower urinary tract symptoms such as frequency or urine retention that mimic prostate enlargement. Surgical resection remains the cornerstone of GIST treatment. Imatinib is a tyrosine kinase enzyme and has been widely used to treat GIST. We reported one unusual rectal GIST presented as prostate mass which treated by imatinib and robotic assisted tumor resection
Materials and Methods: A 63-year-old male patient presented with progressive obstructive lower urinary tract symptoms for months. Digital rectal exam showed one firm, non-tenderness mass. PSA was only 0.63 ng/ml. Transrectal ultrasound biopsy confirmed diagnosis of GIST. Magnetic resonance imaging showed protruding rectal mass with prostate invasion and size about 76x66x76mm. The patient then received imatinib 400mg per day. MRI after six months showed partial response with tumor size decreased to 62x59x54mm. Due to limited response to imatinib, we arranged surgery.
Results: We used approach method as robotic radical prostatectomy. After fully dissected prostate, we performed anterior rectal tumor resection. Frozen sections of the rectal wall were sent due to the blurred margin between normal tissue and tumor. 3-0 V-loc suture was used for rectum repair and vesicourethral anastomosis. Enterostomy was created for protection purpose. Surgery time was about 400 minutes. Blood lost around 150ml. The stoma was closed 2 months later. Pathology report showed GIST with low cellularity, possibly post-treatment effect and all margins were negative.
Conclusions: There were only 26 published cases previously. In our case, pathological report showed the majority of the GIST tissues are spindle-shaped and showed low cellularity, possibly from post-treatment effect. There is still no golden treatment for rectal GIST. National Comprehensive Cancer Network published the multiple disciplinary teams was important for the treatment of GIST. We utilized robotic surgery with the wristed instrumentation and three-dimensional vision which has proven advantages compared to conventional laparoscopy, especially in confined spaces such as pelvis. Rectal GISTs can be treated with safe surgical procedure with promising oncological results.