A case of cecal gastrointestinal stromal tumor with lymph node metastasis

A 65-year-old woman presented with dull pain in her lower right abdomen. CT examination revealed intussusception in the ileocecal region and emergency surgery was performed. Intussusception extending to the center of the transverse colon was found, and manual repositioning revealed a tumor in the cecum. A diagnosis of cecum cancer with lymph node metastasis was made, and right hemicolectomy with D3 lymphadenectomy was performed. The resected specimen showed a type 2 4.5 by 3.8 cm tumor in the cecum. On histological examination, desmin, S-100 and CD34 were negative and c-kit was strongly positive. A diagnosis of cecal gastrointestinal stromal tumor (GIST) with lymph node metastasis was made. Treatment with imatinib was started 8 weeks after the operation, but CT performed one month later showed multiple hepatic metastases and celiac lymph node metastasis. Treatment was changed to sunitinib and some improvement was seen, but the patient died 5 months and 2 weeks after surgery. Cecal GIST with lymph node metastasis is very rare and no cases have so far been reported in Japan.