Posted on Authorea 11 Jun 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.159189855.51317167 — This a preprint and has not been peer reviewed. Data may be preliminary. Kajiwara Inoue Masashi duodenal low-risk a of tumor resection stromal after gastrointestinal years 7 metastasis liver A auioToyota Kazuhiro hwdsideclswt ioe ih6mtss5 PsadaK6 au f7.Immunohistochemical metastasis 7%. liver a of as value diagnosed was Ki67 tumor a The 7). and (Fig. HPFs CD34 and mitoses/50 c-Kit hepatectomy. 6 for partial staining with underwent positive mitoses patient revealed analysis the with (Fig. and cells 3.8 3.9 tumor, accumulation spindle of liver a showed showed (SUVmax) metastatic showed value (PET) a uptake findings tomography as standardized diagnosed mm emission Macroscopic maximum was 39 as Positron a tumor a with 5a). known The based revealed tumor (Fig. 5b). (also dGIST CT the 4 low-risk later, in classification segment 7years 18F-fluorodeoxyglucose as Fletcher liver of and diagnosed modified continued, in was was cells and tumor tumor follow-up tumor enhanced The classification Postoperative the 4). classification). Miettien that (Fig. Joensuu classification, the expression indicated Fletcher CD34 evaluation the and Immunohistochemical mitotic on c-Kit submucosal 5 (HPFs). including for was fields cells positive 20 diagnosis high-power spindle-shaped were gastrectomy, a of 50 preoperative comprised distal contained tumor per with The specimen a bulb figures revealed resected duodenal evaluation 2). The the Histopathological 30- the 3). of a in (Fig. reconstruction. resection (Fig. revealed partial originating Roux-en-Y bulb underwent (CT) by mass patient tomography followed duodenal the hypoechoic computed and the a tumor, bowel abdominal in showed duodenal A Contrast-enhanced tumor (EUS) 1a). hyper-vascular 1b). ultrasound (Fig. mm Endoscopic erosion (Fig. partial mucosa during diagnostic. with muscularis anemia tumor not Upper have duodenal to ranges. was normal submucosal found biopsy within a was were values revealed who laboratory endoscopy disease and Graves-Basedow gastrointestinal unremarkable, was with examination woman Physical 45-year-old follow-up. a years was 7 patient metastasis The liver of case a presentation: report Case we people. Herein dGIST. million low-risk dGISTs. to per of of resection tumors 11-19.6 recurrent after rare. mesenchymal for in extremely are primary particularly occurs and treatment of GISTs, GIST optimal all type of 4-5% common tract. only represent most gastrointestinal (dGISTs) the the are from (GISTs) originate tumors stromal Gastrointestinal recurrence. Introduction: metastases liver for observation, therapy long-term imatinib require and and resection combining metastasize by may achieved dGIST be manage- low-risk may therapeutic even their prognosis present regarding long-term We exists a consensus disease. and of lack recurrent a for and particularly rare, ment are (dGISTs) tumors stromal gastrointestinal Duodenal Abstract 2020 11, June 1 ainlHsia raiainHgsiHrsiaMdclCenter Medical Hiroshima Higashi Organization Hospital National 1 iouiSawada Hiroyuki , 1 aauiShishida Masayuki , 1 ej Sadamoto Seiji , 1 cioOmori Ichiro , × 3.0 1 × n aaeuTakahashi Tadateru and , 1 . mtnadge oi uo Fg ) itlgclanalysis Histological 6). (Fig. tumor solid grey and tan cm 3.5 tuioWatanabe Atsuhiro , 1 auk Miyamoto Kazuaki , 1 3,4) 1 yjr Kajikawa Ryujiro , o hr slc fcnessregarding consensus of lack is there So, 1 1 aaioIkeda Masahiro , × 2m umcsltumor submucosal 12-mm 1,2) udnlGISTs Duodenal 1 Ryotaro , 1 , Posted on Authorea 11 Jun 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.159189855.51317167 — This a preprint and has not been peer reviewed. Data may be preliminary. h rtcoc o ramn frscal rmr ITi opeesria resection. al. et surgical Fletcher by complete proposed is those as GIST such categories, primary al. risk resectable recurrence et years on of based 4 treatment be disease should for follow-up of choice free first remains The and daily mg 400 imatinib Discussion: oral received surgery. has last patient the after The dGIST. the from uMdsac sn h e em doea IT n lvrmtsai’rvae ae reports cases 9 revealed metastasis’ ‘liver be and has GIST’ dGIST risk, ‘duodenal low terms even after key case, years the this case 5 our in using for including as search months But PubMed 12 surgery. A after to years 6 or 10 every low-risk, clas- recur. to recommended intermediate-risk, Fletcher to up is with the able annually patients to CT then In according abdominal and tumors. risk by surgery, low-risk low such follow-up chemotherapy be for adjuvant GIST, to today, recommended ultra-low-risk deemed Even not was classification. is Fletcher duodenum imatinib modified the with and groups in classification, high-risk tumor Miettinen only the sification, selects and case, present for duodenum, further the useful the that for In be classification in groups to high-risk Fletcher 8.3% as reported groups Modified intestine, destruction risk been a capsule small other has tumor reported from of each the classification al. cases Fletcher GIST in considered et risk Modified and 4.3% Joensuu groups low recurrence. stomach, 3 mitotic 2008, in into the inconspicuous In mitosis metastases intestine. or each in of stratified large size 3.6% rate the tumor is be the small in classification) classification, to a 8.5% Miettinen Joensuu reported with the GIST the is In though as location metastases. Even known show occurrence. may (also of figures classification site by Fletcher divided modified further and classification Miettinen eal ob civdb obnn opeerscinadiaii hrp nptet o ie metastases liver for patients in therapy imatinib and resection may complete prognosis combining long-term by excellent achieved recurrence. an be However, surgery. to after able long be relatively metastasize can if dGIST Low-risk recurrence, dGIST experience who patients possible. in Conclusion: is appropriate therapy. therapy and is imatinib imatinib surgery resected with and that completely resection resection suggests R0 R0 was report combining and resection, case by liver surgery this obtained after years Thus, after be 4 can years for prognosis recurrence 7 without good alive appeared a remained to metastasis has suggesting therapy. few patient liver responsive imatinib The were administered. with the disease outcomes has combination case, imatinib long-term or resection present liver the disease after the although years stable In reports, 10 with have survived metastasis have patients may liver case resection for dGIST one R0/R1 therapy included, previous and imatinib In GISTs therapy. with been recurrent/metastatic imatinib has combined with GIST when patients metastatic benefits of imatinib for improvement combining (RFA) treatment prognostic therapy within multidisciplinary the ablation occur of radiofrequency most usefulness or and the reported resection peritoneum 90% hand, surgical to and other and 80% the liver treatment is On the recurrence. resection are GIST after for GIST recurrence al. of in years frequency et metastasis 2 the DeMatteo or tumors, by recurrence liver low-risk report metastatic of with a patients sites to in common According even after years most necessary 29 is the appeared follow-up Generally, metastasis low-risk liver long-term one the that Only case, years. suggests that 29 This in to dGIST. reported; dGIST. months been 3 the has from of case ranged resection present metastasis the liver than of other appearance case to time The metastasis. 7) 19) n osue al et Joesuu and 20)-24) hs ITi icl ocr ihsreyaoe n mtnbteteti h rtchoice first the is treatment imatinib and alone, surgery with cure to difficult is GIST Thus, . aoe al et Sato . 10)-17) 9) . he ae a ycrnu ie eatssadsxcsshdmtcrnu liver metachronous had cases six and metastasis liver synchronous had cases Three . 8) 25) h lthr lsicto sbsdo uo ieadmttcrt,wiethe while rate, mitotic and size tumor on based is classification Fletcher’ The . eotdcniuu mtnbteayapast eipratpiaiyfor primarily important be to appears therapy imatinib continuous reported 18) 3 frcrecsocri h ie.Ee o resectable for Even liver. the in occur recurrences of 63% , 2 5) Postoperative 6) Miettinen , 6) . Posted on Authorea 11 Jun 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.159189855.51317167 — This a preprint and has not been peer reviewed. Data may be preliminary. 6 taoolsC onwlaZ ii ,e l eaoacetdoeetm o eattcduodenal metastatic for Hepatopancreatoduodenectomy 2006;5(1):147-150. al. Int. et Dis elevated Pancreat J, systemic Hepatobiliary 2015;15:788. Piris by tumor. caused Z, Cancer. stromal vein GIST Soonawalla BMC gastrointestinal metastatic C, literature. portal in the Stratopoulos and Hypercalcemia of review 16. partition al. and et liver report T, ablation case Harslof a microwave CN, Wulff calcitriol: Percutaneous K, Hygum report. case al. 15. A et metastases: tumor D, stromal 2017;96(42):e8271. in gastrointestinal Hong Day (Baltimore). large to per C, Medicine due Imatinib hepatectomy Zhang mg planned 2011;4(3):505-511. 400 for J, embolization with Oncol. Liu Treatment Rep of Case Years Tumor. Ten 14. Stromal al. Gastrointestinal et Advanced H, of Schwoerer Case IM, a Schaefer from S, metastases Cameron liver multiple 13. with hepatectomy. case and a 2006;12(17):2793-2797. Rep. imatinib of with survival Case Gastroenterol. treatment Long-term the J Med by World reduced al. J drastically et tumor K, stromal Soga gastrointestinal report. duodenal A, case Hagiwara receiving C, a progression Sakakura after disease 12. no tumour: GIST with stromal imatinib recurrent on gastrointestinal survival with years duodenal Six patients metastatic 2008;2:110. al. Long-surviving of et after S, diagnosis Ravi tumour al. after AK, Choudhury stromal et 2009;50(3):437-440. S, gastrointestinal Bhattacharya J. WJ, Med 11. of Yonsei Hyung reccurence therapy. S, imatinib of Kim with Risk surgery WH, cytoreductive Oncol.2012;13(3):265-274. al: Choi Lancet et cohorts. population-based J, 10. pooled Pathol Riihimali of Hum A, analysis tumor. Vehtari an stromal H, surgery: gastrointestinal Joesuu with diagnosed 9. patients 1411-1419. of : stratification 39 Risk ; : 2008 Semin H consensus sites. different Joensuu A at 8. prognosis tumors: and stromal pathology tumors: gastrointestinal stromal Pathol.2006;23(2):70-83. of Gastrointestinal Diag J. Diagnosis Lasota al. M, Miettinen et 7. C, follow-up Corless and Pathol.2003;33:459-465. JJ, treatment, Hum diagnosis, Berman approach. standard CD, Cancer.2016;19:3-14. The Gastric Fletcher YK. guidelines. 6. Kang on Y, based stromal Kitagawa tumors gastrointestinal S, stromal Hirota of gastrointestinal JY, management of Blay and T, Presentation Nishida 2006;72:719-722. al. 5. Surg. et Am SB, duodenum. but Vogel the propria, SN, of muscularis Hochwald tumors 391(4):322-329. the RD, 2006; in Surg. Winfield origin Arch 4. regular Langenbecks a presentation. tumors: gross stromal diverse Cancer.2005;103: Gastrointestinal extremely Sweden. PH. an Wunsch western progno- A, in and Agaimy study course, 3. clinical population-based prevalence, era–a incidence, mesylate the preimatinib tumors: 821–829. stromal the Gastrointestinal in nation- al. a stication et of B, results underestimated: Nilsson is 2868–2872. 2. tumours 41: stromal Cancer.2005; gastrointestinal J of Eur Incidence study. al. wide et G, W. Goettsch 1. K.M.,M.I.,K.T., I.O., H.S., R.K., R.K., References: A.W., study. the manuscript. designed the M.S. proofread and S.S.,T.T., M.I. manuscript. the wrote M.I. contributions Author 3 Posted on Authorea 11 Jun 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.159189855.51317167 — This a preprint and has not been peer reviewed. Data may be preliminary. hr r optnilcnit fitrs odisclose. to this interest of of Editor-in-Chief conflicts potential the ac- no by any are review and There for series available case is this interests: consent of Competing written publication the for of patients copy the journal. A from obtained images. was companying consent Immuno- informed 7%. Written of value Ki67 CD34. a and and HPFs c-Kit of Consent: mitoses/50 for accumulation 6 staining with showed positive tumor. cells PET revealed spindle solid analysis showed b) grey histochemical analysis and Histological S4. tan 7. 3.9x3.0x3.5-mm segment a Fig. liver showed in findings tumor Macroscopic 3.8. of enhanced 6. SUVmax 39-mm Fig. a a with revealed tumor the CT c-Kit in for a) 18F-fluorodeoxyglucose positive were 5. cells mitotic tumor 5 Fig. the including that cells indicated spindle-shaped expression. evaluation of CD34 Immunohistochemical comprised and HPF. tumor 50 a per revealed tumor. evaluation figures submucosal Histopathological bulb. 20x12-mm duodenal 4. a the contained Fig. in specimen tumor resected hyper-vascular The 30-mm 3. a revealed b) Fig. CT erosion. abdominal mucosa. partial Contrast-enhanced muscularis with the 2. tumor in Fig. duodenal originating submucosal mass a hypoechoic revealed a endoscopy showed 58-64. gastrointestinal EUS 47: a)Upper 2017; 1. Today. Surg Fig. registry. GIST Kinki the gastrointestinal legends: recurrent/metastatic of for Figure analysis metastasectomy of an Role on al. based et tumors T, Masuzawa stromal T, Tsujinaka Stromal S, Gastrointestinal Sato of 531-539 Metastases 25. Liver 14: of 2015; Management Hepatol. al. et Ann Metastases W, (GIST). Hepatic Using Hohenberger Tumors Managing A, Therapy Agaimy in 132-139 N, Systemic RFA Vassos Adjuvant Targeted 37: 24. for 2014; With Role Treatment Radiol. A Gas- Intervent After Cardiovasc Metastatic al. (GIST) Inhibitors of et Kinase Tumors Treatment F, Stromal in Deschamps Therapy Gastrointestinal AL, From Cesne Operative 248-254 A, of 177(2): Hakime Role 2012; 23. Res. al. Surg FG,et J Que Tumors. SH, 341-346 Stromal Therapy Okuno 245: trointestinal Molecular-Targeted Following V, 2007; Disease Zaydfudim Surg. Residual Ann of 22. Surgery GIST. Advanced/Metastatic al. in et Mesylate F, Miselli Imatinib Oncol. M, With Surg With Fiore Ann Patients A, to (GEIS) Gronchi in Sarcoma Sensitive on 21. Surgery Tumors Research of for Stromal Group Role 2948-2957 Spanish Gastrointestinal the 22: Advanced of al. 2015; Analysis et Locally Retrospective A G, Unresectable Imatinib: Garcia-Albeniz or J, Metastatic, Martinez-Trufero Recurrent, J, recurrence Rubio-Casadevall tumors: stromal 33(5):466-477,2002. tumors: gastrointestinal Pathol 20. of stromal Hum management Clinical gastrointestinal STI-571. al: hundred after Pathol. et and WM, Two Surg El-Rifai before MC, 2000;231(1):51-58. J Heinrich al. RP, Surg. Int Dematteo et Ann 19. literature. D, survival. for the Leung factors gastrointestinal of JJ, prognostic duodenal review Lewis and a and RP, patterns from case DeMatteo metastasis a hepatic of 18. Late report al. surgery): et after S, years 2015;23(4):317-321. Marsili (29 F, tumor Scaramuzzino stromal A, Ginori 17. 4 Posted on Authorea 11 Jun 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.159189855.51317167 — This a preprint and has not been peer reviewed. Data may be preliminary. after-resection-of-a-low-risk-duodenal-gastrointestinal-stromal-tumor at available \begin{CJK}{UTF8}{gbsn}\end{CJK}\selectlanguage{english}risuku\begin{CJK}{UTF8}{gbsn}\end{CJK}\selectlanguage{english}Fig.7.pptx dGIST file Hosted after-resection-of-a-low-risk-duodenal-gastrointestinal-stromal-tumor at available \begin{CJK}{UTF8}{gbsn}\end{CJK}\selectlanguage{english}risuku\begin{CJK}{UTF8}{gbsn}\end{CJK}\selectlanguage{english}Fig.6.pptx dGIST file Hosted after-resection-of-a-low-risk-duodenal-gastrointestinal-stromal-tumor at available \begin{CJK}{UTF8}{gbsn}\end{CJK}\selectlanguage{english}risuku\begin{CJK}{UTF8}{gbsn}\end{CJK}\selectlanguage{english}Fig.5.pptx dGIST file Hosted after-resection-of-a-low-risk-duodenal-gastrointestinal-stromal-tumor at available \end{CJK}\selectlanguage{english}Fig.4.pptx \begin{CJK}{UTF8}{gbsn}\end{CJK}\selectlanguage{english}risuku\begin{CJK}{UTF8}{gbsn} dGIST file Hosted after-resection-of-a-low-risk-duodenal-gastrointestinal-stromal-tumor at available 3.pptx \begin{CJK}{UTF8}{gbsn}\end{CJK}\selectlanguage{english}risuku\begin{CJK}{UTF8}{gbsn}\end{CJK}\selectlanguage{english}Fig dGIST file Hosted after-resection-of-a-low-risk-duodenal-gastrointestinal-stromal-tumor at available dGIST\begin{CJK}{UTF8}{gbsn}\end{CJK}\selectlanguage{english}risuku\begin{CJK}{UTF8}{gbsn}\end{CJK}\selectlanguage{english}FIg2.pptx file Hosted after-resection-of-a-low-risk-duodenal-gastrointestinal-stromal-tumor at available dGIST\begin{CJK}{UTF8}{gbsn}\end{CJK}\selectlanguage{english}risuku\begin{CJK}{UTF8}{gbsn}\end{CJK}\selectlanguage{english}FIg1.pptx file Hosted https://authorea.com/users/332527/articles/458940-a-liver-metastasis-7-years- https://authorea.com/users/332527/articles/458940-a-liver-metastasis-7-years- https://authorea.com/users/332527/articles/458940-a-liver-metastasis-7-years- https://authorea.com/users/332527/articles/458940-a-liver-metastasis-7-years- https://authorea.com/users/332527/articles/458940-a-liver-metastasis-7-years- https://authorea.com/users/332527/articles/458940-a-liver-metastasis-7-years- https://authorea.com/users/332527/articles/458940-a-liver-metastasis-7-years- 5