Six years survival on imatinib with no disease progression after diagnosis of metastatic duodenal gastrointestinal stromal tumour: A case report

A 68 year old female was diagnosed with unresectable GIST in the duodenum with metastasis to liver, pancreas and omentum in November 2001. She was commenced on imatinib mesylate (Glivec) chemotherapy. This case report was prepared from the medical records and radiology reports. She had good tolerance with stable disease. After six years her CT scan showed no disease progression and her WHO performance status was zero.This report supports the view that imatinib is a safe and effective drug in controlling disease progression in advanced metastatic GIST and plays an important role in improving the patient's quality of life.A duodenal tumour, especially a gastrointestinal stromal tumour (GIST), is a rare finding and until recently advanced disease had a poor prognosis. A PubMed search revealed only a few reports of prolongation of the lives of patients with advanced duodenal GIST by treatment with imatinib. The maximum length of follow up was 29 months [1] from diagnosis. A recent study suggested that the prognosis for unresectable and/or metastatic GIST is poor with few if any patients surviving more than five years [2].A previously fit and well, 68-year-old female presented in November 2001 with recent onset of epigastric discomfort, significant loss of appetite and melaena. She had also lost 5 kilos in weight over a three-week period. Over the previous few weeks, she was mostly confined to bed, as she was extremely lethargic.Upper gastrointestinal endoscopy (Figure 1c) revealed a pre-ampullary tumour in the second part of the duodenum. Histology confirmed the tumour to be a GIST with more than 10 mitotic activities per 50 high power fields (HPF) (Figure 1a). The tumour was found to be positive for a deletion mutation in exon-11 (of the c-KIT exon) (Figure 1b). Computerised tomography (CT) of the abdomen showed multiple metastatic deposits in the liver (Figure 2a). At laparotomy the tumour was found to involve the liver, pancreas and omentum. A hard lump in the right