Could imatinib replace surgery in esophageal gastrointestinal stromal tumor

Gastrointestinal stromal tumors (GISTs) are cellular spindle, or epithelioid tumors that occur in the stomach, intestine, and rarely in the esophagus. A 61-year-old man was complaining of resistant dry cough with dysphagia for one month duration. Upper gastrointestinal tract endoscopic examination showed a polypoid mass 30 cm from the incisors obstructing 50% of the lumen, where multiple biopsies were taken. Magnetic resonance imaging (MRI) showed a mass in the wall of the esophagus extending into the thoracic cavity. Histologically, the stained sections with the routine hematoxylin and eosin as well as the immunohistochemical stains for CD117, CD34, S100, vimentin, and smooth muscle actin confirmed the diagnosis of esophageal GIST. The patient was treated with imatinib, 400 mg/day. There was a dramatic reduction in the size of the tumor with successful improvement of his symptoms after 2 months of treatment, which was confirmed by repeated upper GIT endoscopy, and MRI.