Small intestinal perforation due to a huge gastrointestinal stromal tumor in a kidney transplant recipient: A case report and literature review

Ryohei Takahashi, Kazunobu Shinoda, Takashi Ishida, Yasuo Hamamoto, Shinya Morita, Hirotaka Akita, Sotaro Kitaoka, Satoshi Tamaki, Hiroshi Asanuma, Tadashi Yoshida, Masahiro Jinzaki, Kaori Kameyama, Mototsugu Oya

Research output: Contribution to journalReview article

Abstract

Background: Gastrointestinal stromal tumors (GISTs) in transplant recipients are very rare and only a handful of cases have been reported to date. Here we present the first known case of a huge GIST in a kidney transplant recipient with perforation of small intestine. Case presentation: A 64-year-old male presented at our hospital with right colic pain; he had received an ABO incompatible kidney transplant 6 years earlier and was treated with cyclosporine, mycophenolate mofetil, and methylprednisolone. Radiological evaluation revealed a huge (11 cm in diameter) solitary tumor at the small intestine without distant metastasis. The small intestinal wall at the tumor location was perforated one week after diagnosis and the patient underwent emergency surgery. The pathological findings were compatible with GIST and the tumor consisted of spindle cells with positive staining for KIT, CD34, and DOG1 and negative or weak staining for desmin and S-100 protein. A mutation in exon 11 of the c-kit gene was also detected. Cyclosporine was withdrawn and imatinib mesylate (400 mg daily) was introduced. However, thereafter, we needed to decrease the dose at 300 mg daily due to severe hyponatremia. Reduced imatinib treatment was well tolerated and recurrence was not observed for 18 months after surgery. Conclusions: The occurrence of GISTs in transplant patients is rare, and huge GISTs should be resected immediately after diagnosis because gastrointestinal tract at the tumor site could be perforated. Imatinib treatment is feasible in transplant recipients under immunosuppression, although immunosuppressive drugs metabolized by CYP3A4 should be used at a reduced dosage or withdrawn.

Original languageEnglish
Article number120
JournalBMC Nephrology
Volume20
Issue number1
DOIs
Publication statusPublished - 2019 Apr 3

Keywords

  • And imatinib mesylate
  • Gastrointestinal stromal tumor
  • Kidney transplant recipient
  • Spontaneous rupture

ASJC Scopus subject areas

  • Nephrology

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