In this article, we reviewed the case of a patient who was object, in 1999, of a published case report of schwannoma of the jejunal wall. Recently, the patient has been referred to our institution for a mass of the stomach identified by upper gastrointestinal endoscopy. The patient underwent a wedge resection of the stomach and a histopathological diagnosis of GIST of the stomach, based on a positive immunohistochemical staining of c-kit and CD34, was made. In consideration of these findings, we performed immunohistochemistry for c-kit and for CD34 on the previous lesion of the jejunal wall, which resulted strongly positive for CD117 and negative for CD34. A new diagnosis of gastrointestinal stromal tumour (GIST) of jejunal wall with moderate risk of progression was made. The lesion was also classified, according to the AJCC Seventh Edition, as a pT3, pN0, Stage II, GIST. This case shows the importance of a reassessment of the diagnosis of mesenchymal neoplasm of the small intestine made before the development of anti-CD117 antibody for a correct prognostic stratification, a better therapeutic management and a close follow-up, if necessary.
Key words: Adjuvant therapy, c-kit, GIST Imatinib.
L’articolo proposto descrive un caso clinico di GIST della parete gastrica in un paziente già sottoposto nel 1999 a resezione intestinale per neoformazione mesenchima del digiuno. Gli autori pongono l’attenzione sulla necessità di rivalutare immunoistochimicamente le lesioni mesenchimali diagnosticate prima dell’avvento di c-kit al fine di ottenere un migliore inquadramento diagnostico e prognostico. Infatti, la diagnosi differenziale tra GIST e le altre neoplasie mesenchimali del tratto gastro-intestinale, quali leiomiomi, schwannomi, neurofibromi e ganglineuromi, era praticamente impossibile prima dell’avvento del c-kit. Identificare i GIST tra quelle che un tempo venivano classificate come neoplasie mesenchimali consentirebbe di offrire ai pazienti la possibilità di beneficiare, qualora fosse indicato, del trattamento neoadiuvante con Imatinib o, alternativamente, di più stretti schemi di follow-up al fine di diagnosticare in maniera precoce eventuali recidive di malattia.