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Gastrointestinal stromal tumor with intracranial metastasis: case presentation and systematic review of literature

BACKGROUND: Intracranial metastasis of Gastrointestinal Stromal Tumors (GISTs) is rare but presents unique treatment challenges. We present a case of intracranial metastasis of GIST with a systematic review of the literature. A literature search using key terms “‘gastrointestinal stromal tumor’ AND...

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Autores principales: Prablek, Marc, Srinivasan, Visish M., Srivatsan, Aditya, Holdener, Stephanie, Oneissi, Mazen, Heck, Kent A., Jalali, Ali, Mandel, Jacob, Viswanathan, Ashwin, Patel, Akash J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6858695/
https://www.ncbi.nlm.nih.gov/pubmed/31730471
http://dx.doi.org/10.1186/s12885-019-6316-7
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author Prablek, Marc
Srinivasan, Visish M.
Srivatsan, Aditya
Holdener, Stephanie
Oneissi, Mazen
Heck, Kent A.
Jalali, Ali
Mandel, Jacob
Viswanathan, Ashwin
Patel, Akash J.
author_facet Prablek, Marc
Srinivasan, Visish M.
Srivatsan, Aditya
Holdener, Stephanie
Oneissi, Mazen
Heck, Kent A.
Jalali, Ali
Mandel, Jacob
Viswanathan, Ashwin
Patel, Akash J.
author_sort Prablek, Marc
collection PubMed
description BACKGROUND: Intracranial metastasis of Gastrointestinal Stromal Tumors (GISTs) is rare but presents unique treatment challenges. We present a case of intracranial metastasis of GIST with a systematic review of the literature. A literature search using key terms “‘gastrointestinal stromal tumor’ AND brain AND metastasis”” was conducted through May 2019 via Embase and Pubmed according to PRISMA guidelines. Only cases describing intradural metastases rather than calvarial or intraorbital metastases were included. CASE PRESENTATION: A 57-year-old woman with history of GIST metastatic to the liver presented with a six-week history of left facial weakness, left hearing loss, and left facial numbness, and a one-week history of headaches, gait disturbance, and dizziness. MRI revealed a contrast-enhancing dural-based left middle cranial fossa mass measuring 2.9 cm × 3.1 cm × 3.4 cm with extension into the internal auditory canal and cerebral edema. A left temporal craniotomy was performed to excise the lesion, and the patient was discharged to a rehabilitation facility at her preoperative baseline. Intraoperative pathology revealed a spindle cell neoplasm, postoperative MRI demonstrated gross total resection of the lesion, and microscopic analysis demonstrated sheets of spindled tumor cells with short ovoid, irregular, hyperchromatic nuclei and scattered large atypical nuclei without extensive necrosis. Immunohistochemical staining was positive for KIT proto-oncogene (CD117, c-KIT), and the patient was put on imatinib (400 mg/day). CONCLUSIONS: Of the 18 cases analyzed and our present case, metastasis typically involved the cerebrum with only one in infratentorial elements. The tumors in seven of the cases involved the dura, and one case metastasized to the pituitary. Eight patients died following treatment. Surgery remains the mainstay of intracranial metastatic GIST, however there are many reports of good responses to radiation or chemotherapy alone. More investigation is required to determine the best treatment course for these patients.
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spelling pubmed-68586952019-11-29 Gastrointestinal stromal tumor with intracranial metastasis: case presentation and systematic review of literature Prablek, Marc Srinivasan, Visish M. Srivatsan, Aditya Holdener, Stephanie Oneissi, Mazen Heck, Kent A. Jalali, Ali Mandel, Jacob Viswanathan, Ashwin Patel, Akash J. BMC Cancer Case Report BACKGROUND: Intracranial metastasis of Gastrointestinal Stromal Tumors (GISTs) is rare but presents unique treatment challenges. We present a case of intracranial metastasis of GIST with a systematic review of the literature. A literature search using key terms “‘gastrointestinal stromal tumor’ AND brain AND metastasis”” was conducted through May 2019 via Embase and Pubmed according to PRISMA guidelines. Only cases describing intradural metastases rather than calvarial or intraorbital metastases were included. CASE PRESENTATION: A 57-year-old woman with history of GIST metastatic to the liver presented with a six-week history of left facial weakness, left hearing loss, and left facial numbness, and a one-week history of headaches, gait disturbance, and dizziness. MRI revealed a contrast-enhancing dural-based left middle cranial fossa mass measuring 2.9 cm × 3.1 cm × 3.4 cm with extension into the internal auditory canal and cerebral edema. A left temporal craniotomy was performed to excise the lesion, and the patient was discharged to a rehabilitation facility at her preoperative baseline. Intraoperative pathology revealed a spindle cell neoplasm, postoperative MRI demonstrated gross total resection of the lesion, and microscopic analysis demonstrated sheets of spindled tumor cells with short ovoid, irregular, hyperchromatic nuclei and scattered large atypical nuclei without extensive necrosis. Immunohistochemical staining was positive for KIT proto-oncogene (CD117, c-KIT), and the patient was put on imatinib (400 mg/day). CONCLUSIONS: Of the 18 cases analyzed and our present case, metastasis typically involved the cerebrum with only one in infratentorial elements. The tumors in seven of the cases involved the dura, and one case metastasized to the pituitary. Eight patients died following treatment. Surgery remains the mainstay of intracranial metastatic GIST, however there are many reports of good responses to radiation or chemotherapy alone. More investigation is required to determine the best treatment course for these patients. BioMed Central 2019-11-15 /pmc/articles/PMC6858695/ /pubmed/31730471 http://dx.doi.org/10.1186/s12885-019-6316-7 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Case Report
Prablek, Marc
Srinivasan, Visish M.
Srivatsan, Aditya
Holdener, Stephanie
Oneissi, Mazen
Heck, Kent A.
Jalali, Ali
Mandel, Jacob
Viswanathan, Ashwin
Patel, Akash J.
Gastrointestinal stromal tumor with intracranial metastasis: case presentation and systematic review of literature
title Gastrointestinal stromal tumor with intracranial metastasis: case presentation and systematic review of literature
title_full Gastrointestinal stromal tumor with intracranial metastasis: case presentation and systematic review of literature
title_fullStr Gastrointestinal stromal tumor with intracranial metastasis: case presentation and systematic review of literature
title_full_unstemmed Gastrointestinal stromal tumor with intracranial metastasis: case presentation and systematic review of literature
title_short Gastrointestinal stromal tumor with intracranial metastasis: case presentation and systematic review of literature
title_sort gastrointestinal stromal tumor with intracranial metastasis: case presentation and systematic review of literature
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6858695/
https://www.ncbi.nlm.nih.gov/pubmed/31730471
http://dx.doi.org/10.1186/s12885-019-6316-7
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