[Gastrointestinal stromal tumor: individualized treatment for a special class of tumors]

Case 1: A 36-year-old woman was admitted because of dizziness and weakness. Her skin and mucosae were pale. There was rather dark stool on the gloved finger at rectal examination, but the patient had not noticed any tarry stools. Case 2: An 89-year-old man in excellent general condition presented with dyspepsia. Physical examination was unremarkable except for a small epigastric hernia.

Endoscopy in Case 1 revealed, at the lesser curvature of the gastric antrum, a submucous tumour covered by a slightly haemorrhagic mucosal erosion. In Case 2 endoscopy similarly revealed an antral submucous tumour. There was no evidence of metastasis in either case.

Exploratory laparotomy was performed in both patients. A subtotal gastric resection with gastrojejunostomy was undertaken in Case 1, a submucous excision via an anterior gastrostomy in Case 2. In both cases histology showed a gastrointestinal stromal tumour, but its benignity could not be firmly established even after detailed immunohistological examination.

Gastrointestinal tumours are rare. Although they have particular immunohistological characteristics their benignity cannot usually be definitively established even on the excised specimen. Because more extensive resection does not increase survival time, a resection margin of 1-2 cm is considered adequate. Neither radio- nor chemotherapy are successful. Life-long follow-up is indicated because the tumor's uncertain benignity.