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INTERESTING IMAGE
Year : 2020  |  Volume : 35  |  Issue : 4  |  Page : 350-352  

Response assessment of recurrent extragastrointestinal stromal tumor of the urinary bladder to imatinib: Findings on serial 18F-fluorodeoxyglucose positron emission tomography–computed tomography scans


Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India

Date of Submission10-Apr-2020
Date of Decision20-Apr-2020
Date of Acceptance22-Apr-2020
Date of Web Publication21-Oct-2020

Correspondence Address:
Dr. Shamim Ahmed Shamim
Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijnm.IJNM_68_20

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   Abstract 


Extragastrointestinal stromal tumors (EGISTs) are rare mesenchymal tumors occurring outside the gastrointestinal tracts that have similar histological and immunohistochemical characteristics similar to those of gastrointestinal stromal tumors. EGISTs involving the urinary bladder are extremely rare tumors with very few reports mentioned in the literature. We present a case of a 48-year-old man, known case of biopsy-proven EGIST of the urinary bladder that presented with recurrence after partial cystectomy and 18F-fluorodeoxyglucose positron emission tomography–computed tomography scans documenting the response assessment of the recurrent tumor to imatinib.

Keywords: Extragastrointestinal stromal tumor, fluorodeoxyglucose, positron emission tomography–computed tomography, urinary bladder


How to cite this article:
Tripathy S, Arun Raj ST, Prakash S, Thanaignathan T, Shamim SA. Response assessment of recurrent extragastrointestinal stromal tumor of the urinary bladder to imatinib: Findings on serial 18F-fluorodeoxyglucose positron emission tomography–computed tomography scans. Indian J Nucl Med 2020;35:350-2

How to cite this URL:
Tripathy S, Arun Raj ST, Prakash S, Thanaignathan T, Shamim SA. Response assessment of recurrent extragastrointestinal stromal tumor of the urinary bladder to imatinib: Findings on serial 18F-fluorodeoxyglucose positron emission tomography–computed tomography scans. Indian J Nucl Med [serial online] 2020 [cited 2020 Dec 5];35:350-2. Available from: https://www.ijnm.in/text.asp?2020/35/4/350/298751



A 48-year-old man underwent partial cystectomy with loop ileostomy surgery for urinary bladder mass. Surgical pathology from the mass was suggestive of extragastrointestinal stromal tumor (EGIST) of the urinary bladder. The patient came to the surgery outpatient department after 1 year with chief complaints of intermittent abdominal pain. Cystoscopy and biopsy were done, which were suggestive of recurrent disease in the urinary bladder.18 F-fluorodeoxyglucose positron emission tomography–computed tomography (FDG PET-CT) was advised by the referring surgeon for accurate delineation of the extent of recurrent disease. PET-CT scan revealed focal wall thickenings along the superolateral wall of the urinary bladder showing increased FDG uptake [Figure 1]a, [Figure 1]b, [Figure 1]c, [Figure 1]d, [Figure 1]e. Suspecting recurrence of the primary tumor, the patient was started on 400 mg bd imatinib, and a follow-up PET-CT scan was done after 1 year. PET-CT scan findings revealed no significant residual disease in the urinary bladder or elsewhere in the body [Figure 2]a, [Figure 2]b, [Figure 2]c, [Figure 2]d, [Figure 2]e, suggesting complete response to imatinib therapy. EGISTs are mesenchymal tumors occurring outside the gastrointestinal tract, with morphological, immunophenotypic, and molecular biological characteristics very similar to those of gastrointestinal stromal tumors.[1] EGISTs are a rare clinical entity, accounting for <5% of the soft-tissue tumors.[2],[3],[4] There have been very few reports in the literature regarding EGIST of the urinary bladder.[5],[6],[7],[8],[9] The authors through this case want to describe this very rare tumor which has limited description in the literature and underscore the importance of 18 F-FDG PET-CT over conventional imaging modalities such as CT in the evaluation of response assessment to the chemotherapeutic agents.
Figure 1: (a) Maximum intensity projection image of fluorodeoxyglucose positron emission tomography–computed tomography scan showing focal area of radiotracer uptake in the pelvic region (black arrow). (b) Axial computed tomography section of the pelvis showing abnormal focal wall thickening in the superolateral aspect of the urinary bladder showing increased fluorodeoxyglucose uptake in the fused positron emission tomography–computed tomography image (c, white arrow). (d) Sagittal section of the abdomen showing abnormal focal wall thickening in the superolateral aspect of the urinary bladder showing increased fluorodeoxyglucose uptake in the fused positron emission tomography–computed tomography image (e, white arrow)

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Figure 2: (a) Maximum intensity projection image of the follow-up fluorodeoxyglucose positron emission tomography–computed tomography scan showing no abnormal focal radiotracer uptake in the pelvic region with physiologic radiotracer uptake in the urinary bladder. (b) Axial computed tomography section of the abdomen showing no abnormal wall thickening or abnormal fluorodeoxyglucose uptake in the fused positron emission tomography–computed tomography image (c). (d) Sagittal computed tomography section of the abdomen showing no abnormal wall thickening or abnormal fluorodeoxyglucose uptake in the fused positron emission tomography–computed tomography image (e)

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Llenas-García J, Guerra-Vales JM, Moreno A, Ibarrola C, Castelbon FJ, Fernández-Ruiz M, et al. Primary extragastrointestinal stromal tumors in the omentum and mesentery: A clinicopathological and immunohistochemical study. Hepatogastroenterology 2008;55:1002-5.  Back to cited text no. 1
    
2.
Miettinen M, Monihan JM, Sarlomo-Rikala M, Kovatich AJ, Carr NJ, Emory TS, et al. Gastrointestinal stromal tumors/smooth muscle tumors (GISTs) primary in the omentum and mesentery: Clinicopathologic and immunohistochemical study of 26 cases. Am J Surg Pathol 1999;23:1109-18.  Back to cited text no. 2
    
3.
Reith JD, Goldblum JR, Lyles RH, Weiss SW. Extragastrointestinal (soft tissue) stromal tumors: An analysis of 48 cases with emphasis on histologic predictors of outcome. Mod Pathol 2000;13:577-85.  Back to cited text no. 3
    
4.
Fletcher CD, Berman JJ, Corless C, Gorstein F, Lasota J, Longley BJ, et al. Diagnosis of gastrointestinal stromal tumors: A consensus approach. Hum Pathol 2002;33:459-65.  Back to cited text no. 4
    
5.
Lasota J, Carlson JA, Miettinen M. Spindle cell tumor of urinary bladder serosa with phenotypic and genotypic features of gastrointestinal stromal tumor. Arch Pathol Lab Med 2000;124:894-7.  Back to cited text no. 5
    
6.
Krokowski M, Jocham D, Choi H, Feller AC, Horny HP. Malignant extragastrointestinal stromal tumor of bladder. J Urol 2003;169:1790-1.  Back to cited text no. 6
    
7.
Mekni A, Chelly I, Azzouz H, Ben Ghorbel I, Bellil S, Haouet S, et al. Extragastrointestinal stromal tumor of the urinary wall bladder: Case report and review of the literature. Pathologica 2008;100:173-5.  Back to cited text no. 7
    
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García-Segui A, Gascón M. Gastrointestinal stromal tumour in the urinary bladder. Actas Urol Esp 2011;35:124-5.  Back to cited text no. 8
    
9.
Shin HS, Cho CH, Kum YS. Extragastrointestinal stromal tumor of the urinary bladder: A case report. Urol J 2011;8:165-7.  Back to cited text no. 9
    


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  [Figure 1], [Figure 2]



 

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