Efficacy of Imatinib Mesylate Neoadjuvant Treatment for a Locally Advanced Rectal Gastrointestinal Stromal Tumor

Surgery is the standard treatment for a primary gastrointestinal stromal tumor (GIST); however, surgical resection is often not curative, particularly for large GISTs. In the past decade, with imatinib mesylate (IM), management strategies for GISTs have evolved significantly, and now IM is the standard care for patients with locally advanced, recurrent or metastatic GISTs. Adjuvant therapy with imatinib was recently approved for use, and preoperative imatinib is an emerging treatment option for patients who require cytoreductive therapy. IM neoadjuvant therapy for primary GISTs has been reported, but there is no consensus on the dose of the drug, the duration of treatment and the optimal time of surgery. These are critical because drug resistance or tumor progression can develop with a prolonged treatment. This report describes two cases of large rectal malignant GISTs, for which a abdominoperineal resection was initially anticipated. The two patients received IM preoperative treatment; we followed-up with CT or magnetic resonance imaging to access the response. After 9 months of treatment, a multi-disciplinary consensus that maximal benefit from imatinib had been achieved was reached. We determined the best time for surgical intervention and successfully performed sphincter-preserving surgery before resistance to imatinib or tumor progression occurred. We believe that a multidisciplinary team approach, considerating the optimal duration of therapy and the timing of surgery, is required to optimize treatment outcome.

Kaposi's Sarcoma on Mediastinum after Renal Retransplantation

Kaposi's sarcoma occurs in higher rates in the setting of immunosuppression, especially in patients with acquired immunodeficiency syndrome (AIDS), immunosuppressive therapy or posttransplantation, commonly involving the skin, visceral, oral cavity or respiratory tract. Of the de novo malignancies in transplantation patients, the incidence of Kaposi's sarcoma is increasing steadily. We report a case of a 37-year-old male patient who was diagnosed with Kaposi's sarcoma 16 years after his first renal transplantation and 5 months after his second transplantation. He presented with lymphoproliferative lesions in the mediastinum and supraclavicular area without showing any typical cutaneous lesions. Diagnosis was confirmed by gun biopsy of the enlarged axillary lymph nodes. Tacrolimus, the initial immunosuppressive drug, was tapered while sirolimus therapy and chemotherapy with vincristine was initiated. The enlarged lymph nodes decreased in size and the patient has been treated with vincristin and conversion of tacrolimus to sirolimus.

Comparison of New Onset Diabetes according to the Time of Onset in Kidney Transplant Recipients / 대한이식학회지

BACKGROUND: New onset diabetes is a common complication after kidney transplantation. However, the clinical course of post-transplant diabetes mellitus (PTDM) remains unclear. The aim of the present study is to analyze the natural courses and risk factors of PTDM according to the time of onset. METHODS: A total of 216 consecutive kidney transplant recipients were enrolled and patient medical records were investigated retrospectively. PTDM was defined as glucose > or =126mg without previous diabetic history. Patients were classified according to the onset (12 months): early PTDM (E-PTDM) and late PTDM (L-PTDM). RESULTS: PTDM was observed in 34 (17.4%) patients. The number of E-PTDM and L-PTDM patients was 17 and 17. Compared with normoglycemic patients, the PTDM group was older and showed higher pre-transplant HbA1c level. The use of tacrolimus was associated with the development of E-PTDM (OR=4.87, 1.71~13.8 in 95% CI) but not L-PTDM (OR=0.34, 0.04~2.70 in 95% CI) CONCLUSIONS: The development of E-PTDM and L-PTDM may have different risk factors. It will be important to choose different therapeutic strategy according to the onset of PTDM.