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Case Reports
. 2022 Jan 25:25:101353.
doi: 10.1016/j.ajoc.2022.101353. eCollection 2022 Mar.

Surgical resection of intraorbital metastasis of a gastrointestinal stromal tumor resistant to chemotherapy

Affiliations
Case Reports

Surgical resection of intraorbital metastasis of a gastrointestinal stromal tumor resistant to chemotherapy

Masanori Mikuni et al. Am J Ophthalmol Case Rep. .

Abstract (VSports手机版)

Purpose: We present a case of a gastrointestinal stromal tumor (GIST) metastasis of the rectal primary resisting chemotherapy to the right orbit 15 years after excision of the primary lesion. VSports手机版.

Observations: A 79-year-old man was diagnosed with rectal GIST at the age of 65 years and underwent rectal amputation. He underwent hepatectomy for GIST liver metastases at the age of 69 years and pericardiectomy for GIST pericardial metastases at 72 years of age. At the age of 79 years, positron emission tomography-computed tomography revealed the possibility of liver metastasis and metastasis to the right orbit of 10 mm in size. Magnetic resonance imaging revealed a well-circumscribed mass of 10 mm × 12 mm in the deep medial rectus muscle of the right orbit, which was referred to our department for ophthalmic examination. The latter revealed only mild abduction disorder in the right eye. Although chemotherapy was initiated, the tumor gradually increased, causing exophthalmos in the right eye, visual field impairment due to optic nerve exclusion, and decreased visual acuity V体育安卓版. Due to repeated multiple metastases, the patient underwent right orbital exenteration and free flap reconstruction at the age of 83 years for radical cure. Pathological examination revealed c-Kit positive, CD34 positive, S100 protein minority positive, MIB-1 positive rate of 10% or more, and α-SMA negative, and the diagnosis was intraorbital metastasis of GIST. .

Conclusions and importance: Orbital metastases in GISTs are extremely rare, and there is no established standard treatment. Therefore, a comprehensive decision must be made based on the final treatment goal and the patient's background when selecting treatment V体育ios版. .

Keywords: Gastrointestinal stromal tumor; Intraorbital metastasis; Orbital exenteration; Orbital tumor VSports最新版本. .

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Conflict of interest statement

No conflict of interest exists.

Figures

Fig. 1
Fig. 1
Magnetic resonance imaging (MRI) image of a tumor in the right orbit (upper) T1-weighted image (contrast), (Lower) T2-weighted image, (right column) Coronal section, (left column) Maxillary section. Inside the right orbit, a 10 mm × 12 mm-sized well-circumscribed circular nodule is observed in close contact with the medial rectus muscle. This tumor shows a contrast effect almost similar to that of the extraocular muscles (a, b), and at T2, it shows a signal similar to that of the muscle (c, d).
Fig. 2
Fig. 2
a: The infraorbital wall, maxilla, and ethmoid bone are excised to secure the surgical field (arrow), b: facial artery (arrow) and facial vein (arrowhead), c: radial artery and cephalic vein (arrow), d: A 7 cm square free-flap from the left forearm is used for eye suck reconstruction, e: Photograph at the end of surgery. Weber-Fergusson incision line (arrow).
Fig. 3
Fig. 3
Histopathological examination of the tumor in the right orbit Hematoxylin-eosin (HE) staining shows spindle-shaped cells with nuclear swelling and bundled to complex proliferation (a). No obvious necrosis or vascular invasion is observed; however, infiltration is observed in the surrounding striated muscle. The margin is negative, and no infiltration into the optic nerve is observed. The number of fission images is 10 or more per 50 HPF (b). Immunostaining shows that spindle-shaped cells are diffusely positive for c-Kit (c) and CD34 (d). The MIB-1 positivity rate is ≥ 10% (e).

References

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