Case of oesophageal gastrointestinal stromal tumour

Gastrointestinal stromal tumours (GIST) are tumours of the mesenchymal origin most often found in the stomach (60–70% of cases), in the small intestine (20–25%), and colon (5%). The oesophagus constitutes the rarest location of GIST (2–3%), and with uncommon clinical symptoms it is possible for the tumour to grow large [1, 2]. In this letter, we would like to share our own insights in the treatment of oesophageal GIST.
A male, 63 years old, was admitted to the department due to a smooth pathological mass located in the lower thoracic part of the oesophagus. For 2 years the patient had complained of difficulties in swallowing, which had intensified in recent months. X-ray examination of the oesophagus with contrast showed the modelling of the oesophagus at a level of 33 cm from the incisors (Figure 1 A). Computed tomography scan of the chest revealed a smooth pathological mass with the dimensions of 30 × 30 mm located at the level of the lower pulmonary vein, without mediastinal lymph node enlargement (Figure 1 B). The patient underwent a biopsy with the EUS technique with the diagnosis of GIST. The patient was subjected to surgical treatment using the Ivory-Lewis technique and side-to-side anastomosis. Postoperative care was uncomplicated and the patient was discharged on day 9 after the surgery. Histopathological examination confirmed the earlier diagnosis of GIST, and an immunohistochemical examination showed positive reactions for CD 117 and CD 34, negative for S100 and actins of smooth muscles. The mitotic index was 0/50 HPF (Figure 2). The patient did not receive adjuvant treatment after surgery (0/50 HPF). Four-year follow-up did not show any recurrence.
In 1983 Mazur and Clark were the first ones to use the term GIST for mesenchymal tumours. The definition is general and defines GIST as the group of non-epithelial gastrointestinal tumours composed of spindle cells derived from interstitial cells of Cajal [3].
This tumour is usually found in men aged 40–50 years, and its main symptom is gradually increasing dysphagia, the severity of which depends on the location and size of the tumour [4, 5].
Diagnosis is based on the gastrofibroscopy, transoesophageal ultrasound, and computed tomography (CT) of the chest [5]. It is controversial to perform the biopsy of the tumour using the EUS technique. It is believed that GIST has a brittle consistency, and the biopsy can increase the risk of bleeding and spreading the cancer. At the same...


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