Small intestinal perforation due to a huge gastrointestinal stromal tumor in a kidney transplant recipient: a case report and literature review.
Antineoplastic Agents
/ administration & dosage
Digestive System Surgical Procedures
/ methods
Dose-Response Relationship, Drug
Gastrointestinal Neoplasms
/ complications
Gastrointestinal Stromal Tumors
/ complications
Humans
Imatinib Mesylate
/ administration & dosage
Immunocompromised Host
Intestinal Perforation
/ diagnosis
Intestine, Small
/ diagnostic imaging
Kidney Transplantation
/ adverse effects
Male
Middle Aged
Mutation
Proto-Oncogene Proteins c-kit
/ genetics
Treatment Outcome
Tumor Burden
And imatinib mesylate
Gastrointestinal stromal tumor
Kidney transplant recipient
Spontaneous rupture
Journal
BMC nephrology
ISSN: 1471-2369
Titre abrégé: BMC Nephrol
Pays: England
ID NLM: 100967793
Informations de publication
Date de publication:
03 04 2019
03 04 2019
Historique:
received:
11
01
2019
accepted:
21
03
2019
entrez:
5
4
2019
pubmed:
5
4
2019
medline:
10
5
2020
Statut:
epublish
Résumé
Gastrointestinal stromal tumors (GISTs) in transplant recipients are very rare and only a handful of cases have been reported to date. Here we present the first known case of a huge GIST in a kidney transplant recipient with perforation of small intestine. A 64-year-old male presented at our hospital with right colic pain; he had received an ABO incompatible kidney transplant 6 years earlier and was treated with cyclosporine, mycophenolate mofetil, and methylprednisolone. Radiological evaluation revealed a huge (11 cm in diameter) solitary tumor at the small intestine without distant metastasis. The small intestinal wall at the tumor location was perforated one week after diagnosis and the patient underwent emergency surgery. The pathological findings were compatible with GIST and the tumor consisted of spindle cells with positive staining for KIT, CD34, and DOG1 and negative or weak staining for desmin and S-100 protein. A mutation in exon 11 of the c-kit gene was also detected. Cyclosporine was withdrawn and imatinib mesylate (400 mg daily) was introduced. However, thereafter, we needed to decrease the dose at 300 mg daily due to severe hyponatremia. Reduced imatinib treatment was well tolerated and recurrence was not observed for 18 months after surgery. The occurrence of GISTs in transplant patients is rare, and huge GISTs should be resected immediately after diagnosis because gastrointestinal tract at the tumor site could be perforated. Imatinib treatment is feasible in transplant recipients under immunosuppression, although immunosuppressive drugs metabolized by CYP3A4 should be used at a reduced dosage or withdrawn.
Sections du résumé
BACKGROUND
Gastrointestinal stromal tumors (GISTs) in transplant recipients are very rare and only a handful of cases have been reported to date. Here we present the first known case of a huge GIST in a kidney transplant recipient with perforation of small intestine.
CASE PRESENTATION
A 64-year-old male presented at our hospital with right colic pain; he had received an ABO incompatible kidney transplant 6 years earlier and was treated with cyclosporine, mycophenolate mofetil, and methylprednisolone. Radiological evaluation revealed a huge (11 cm in diameter) solitary tumor at the small intestine without distant metastasis. The small intestinal wall at the tumor location was perforated one week after diagnosis and the patient underwent emergency surgery. The pathological findings were compatible with GIST and the tumor consisted of spindle cells with positive staining for KIT, CD34, and DOG1 and negative or weak staining for desmin and S-100 protein. A mutation in exon 11 of the c-kit gene was also detected. Cyclosporine was withdrawn and imatinib mesylate (400 mg daily) was introduced. However, thereafter, we needed to decrease the dose at 300 mg daily due to severe hyponatremia. Reduced imatinib treatment was well tolerated and recurrence was not observed for 18 months after surgery.
CONCLUSIONS
The occurrence of GISTs in transplant patients is rare, and huge GISTs should be resected immediately after diagnosis because gastrointestinal tract at the tumor site could be perforated. Imatinib treatment is feasible in transplant recipients under immunosuppression, although immunosuppressive drugs metabolized by CYP3A4 should be used at a reduced dosage or withdrawn.
Identifiants
pubmed: 30943904
doi: 10.1186/s12882-019-1310-5
pii: 10.1186/s12882-019-1310-5
pmc: PMC6448240
doi:
Substances chimiques
Antineoplastic Agents
0
Imatinib Mesylate
8A1O1M485B
KIT protein, human
EC 2.7.10.1
Proto-Oncogene Proteins c-kit
EC 2.7.10.1
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
120Références
Transplantation. 2008 May 15;85(9):1363
pubmed: 18475199
Asia Pac J Clin Oncol. 2017 Feb;13(1):104-106
pubmed: 27461055
Nephrol Dial Transplant. 2007 May;22(5):1489-90
pubmed: 17277341
Transplant Proc. 2008 Dec;40(10):3781-3
pubmed: 19100489
Clin Pharmacokinet. 2005;44(9):879-94
pubmed: 16122278
Case Rep Oncol. 2013 Mar 23;6(1):163-8
pubmed: 23626555
Cancer Res. 2013 Jun 15;73(12):3499-510
pubmed: 23592754
Clin Cancer Res. 2012 Oct 15;18(20):5780-7
pubmed: 22850565
Science. 1998 Jan 23;279(5350):577-80
pubmed: 9438854
Mol Cancer Ther. 2003 Aug;2(8):699-709
pubmed: 12939459
JAMA. 2012 Mar 28;307(12):1265-72
pubmed: 22453568
Clin Exp Nephrol. 2012 Apr;16(2):350-3
pubmed: 22009637
Mod Pathol. 2000 Oct;13(10):1134-42
pubmed: 11048809
BMJ Case Rep. 2015 Jun 01;2015:
pubmed: 26032701
Ann Oncol. 2010 Oct;21(10):1990-8
pubmed: 20507881
Am J Pathol. 2004 Jul;165(1):107-13
pubmed: 15215166
Invest New Drugs. 2012 Dec;30(6):2400-2
pubmed: 22116657
Hum Pathol. 2002 May;33(5):459-65
pubmed: 12094370
Cancer Metastasis Rev. 2007 Dec;26(3-4):611-21
pubmed: 17713840
Proc Natl Acad Sci U S A. 1999 Aug 31;96(18):10391-6
pubmed: 10468618
Lancet Oncol. 2012 Mar;13(3):265-74
pubmed: 22153892