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DOI: 10.1055/a-2466-9742
Submucosal tunnel endoscopic resection for removal of deep-seated rectal gastrointestinal stromal tumor in the muscularis propria
Treatment of rectal gastrointestinal stromal tumors (GISTs) is complex, and surgical resection is recommended regardless of tumor size [1]. No definitive method has yet been established.
A 41-year-old woman underwent a colonoscopy at our hospital during a routine health screening, revealing a hemispherical protrusion approximately 1.2 cm in diameter located just above the dentate line of the distal rectum ([Fig. 1]). Endoscopic ultrasound showed the lesion measuring approximately 12.3 mm by 9.4 mm, and originating from the muscularis propria ([Fig. 2]). The patient underwent submucosal tunnel endoscopic resection (STER) under propofol anesthesia ([Video 1]). Initially, submucosal injection of methylene blue was performed for lifting, and a golden knife (Nanwei Medical Technology, Nanjing, China) was employed to incise the external mucosa and establish the tunnel entry ([Fig. 3]). Since the tumor was not detected in the superficial layer of the muscularis propria, the layer was incised to expose the tumor. The deep white tumor in the muscularis propria was completely resected using the golden knife ([Fig. 4]). The procedure was completed within 45 minutes. Pathological results indicated a rectal GIST, with a risk of recurrence classified as intermediate. Immunohistochemistry showed: CD117 (+), CD34 (+), DOG-1 (+), SMA (–), desmin (–), S100 (–), SOX10 (–), ALK (–), SDHB (+), Ki67 (Li: 5%) ([Fig. 5]). The patient experienced no postoperative complications, and adjuvant therapy with imatinib will be considered based on the results of genetic testing (KIT and FDGRRA genes).
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Conflict of Interest
The authors declare that they have no conflict of interest.
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Reference
- 1 Judson I, Jones RL, Wong NACS. et al. Gastrointestinal stromal tumour (GIST): British Sarcoma Group clinical practice guidelines. Br J Cancer 2024;
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Publication History
Article published online:
04 December 2024
© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
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Reference
- 1 Judson I, Jones RL, Wong NACS. et al. Gastrointestinal stromal tumour (GIST): British Sarcoma Group clinical practice guidelines. Br J Cancer 2024;