Consultation report, Dr. Ester Tahover
- Information of a confidential nature -
Assuta Medical Center
Rama-A-Khayal
Department of Oncology
A-Barzel 20, Tel Aviv 69710, Israel
Tel.: +973 – 7645177
Fax: +973 – 7645119
Email: cimo@assuta.co.il
Patient: Anastasia Zherlitsina
ID No: ME923960-9
Date of birth: 25/04/1976
Age: 47
Sex: Female
Address: A-Barzel 20, Tel Aviv-Jaffa
Phone: 03-7645177
Date of consultation: 07/06/2023
"Confidential Health Information": The information contained in this document is protected by privacy law. Disclosure of this information is against the law.
Expert opinion - oncology department
Telemedicine consultation via Zoom
Clinical diagnosis:
| Diagnosis | Code | Side | Date | S/P | M/P | Rec |
|---|---|---|---|---|---|---|
| Gastrointestinal stromal tumor (GIST) | H89363 |
Discussion and conclusion
Date and time of the last examination: 07/06/2023 at 12:57.
Report / Discussion:
A Zoom consultation was held with the patient's brother Egor.
In September 2022, the patient was diagnosed with liver metastases, abdominal lesions, and a stomach tumor.
The results of pathomorphological examination of a tissue sample taken from the liver: revealed leiomyosarcoma.
The patient started treatment with Gemzar, Taxotere and Pazopanib, resulting in mostly neurological side effects. The revision revealed a gastrointestinal stromal tumor. The same result was obtained in laboratory analyzes carried out in Israel using cKIT gene staining and SDH hormone deficiency.
One month ago, the patient started taking Imatinib at a dosage of 400 mg per day, without any side effects.
Genomic testing results: KIT Q556_V559DelinsHis mutation detected. According to the cBioPortal portal, only three cases of such a mutation have been described in GIST and not a single case in uterine leiomyosarcoma.
Recommendations:
- Continue taking Imatinib. We discussed possible side effects of the treatment.
- After three months of treatment, undergo a second PET-CT examination to evaluate the response to treatment.
- Consider endoscopic ultrasound to detect a primary tumor in the stomach.
- If there is no response to treatment, it may be worthwhile to take a second biopsy to assess for SDH hormone deficiency and cKIT gene mutation, which, according to the literature, are mutually exclusive. If SDH deficiency is identified, Imatinib is not recommended.
- Genetic testing for germline mutation - the entire panel of analyzes. Consider using the Tempus test in both assays, which is specific to the hormone SDH.
- It is necessary to monitor the results of the study of the uterus: the detected masses are considered benign, but they require subsequent medical observation.
Best regards,
