Late hepatic metastasis in the evolution of gastrointestinal stromal tumors

Gastro-intestinal stromal tumours develop in the digestive tract wall, in the undifferentiated mesenchymal cells with a starting point at the level of the interstitial cells of Cajal. Gastro-intestinal stromal tumours often lead to peritoneal and hepatic metastasis. Assessment of aggressive behavior of GIST is difficult. A special attention should be paid to localization, serosal invasion, mucous ulceration, size of the tumor and mitotic index, in order to set the prognosis of the patient. We here by present two cases of gastro-intestinal stromal tumours one with gastric location and one jejunal tumor with ulceration and hemorrhage, of small sizes, initially diagnosed as benign but developing in the late evolution liver metastases. Right lobectomy was performed in both cases, in one case being associated with segment II resection. The patients have been followed-up at oncology and they received Imatinib, and when the metastasis reappeared was reintroduced, increasing the dose.