Peter  Wanes,Sarah K.  Daley,Belinda Sun,
Persistent Lymph Node Metastasis Post Imatinib Treatment in Low Grade Gastrointestinal Stromal Tumor with PDGFRA Mutation
American Journal of Surgical Case Reports
2020
2674-5046
http://dx.doi.org/10.31487/j.AJSCR.2020.03.10
https://www.sciencerepository.org/persistent-lymph-node-metastasis-post-imatinib-treatment-in-low-grade_AJSCR-2020-3-110 
Abstract: Background/Aims: Lymph node metastasis has been considered very rare in gastrointestinal stromal
tumors (GIST), especially in low grade GIST. Thus, lymphadenectomy is not required routinely as standard
of care during surgery for GIST unless there is suspicion for lymph node metastasis. However, herein we
present a low grade PDGFRA mutated GIST status post imatinib chemotherapy with nearly complete
response in the primary tumor but a persistent lymph node metastasis which significantly affected the
management of the patient.
Case Report: A 38-year-old male presented with a 11.5 cm epigastric GIST status post imatinib (Gleevec)
treatment who underwent partial gastrectomy with tumor excision. The initial biopsy showed epithelioid
type GIST with a low mitotic rate and PDGFRA gene mutation detected by genetic analysis. The original
tumor had nearly complete response to imatinib with a few possible residual tumor cells identified; however,
one lymph node was found to be positive for metastatic GIST with minimal treatment effect present. The
patient was managed with continuous imatinib treatment and life-long follow up.
Conclusion: This case raises the awareness of the possibility of lymph node metastasis in low grade
conventional GIST with PDGFRA mutation. Lymph node examination may need to be considered as
standard of care for better management of patients with GIST.Keywords: Gastrointestinal stromal tumors, lymph node, metastasis, PDGFRA mutation