A 62-year-old man underwent enucleation of a submucosal tumor of the stomach. Histological evaluation revealed an intermediate-risk GIST. He developed an abdominal recurrence 7 years later. After neoadjuvant IM treatment (400 mg/day) for 8 months, resection of the stomach antrum, gallbladder and atypical resection of the liver (segment III) was performed. One month later, a subcarinal lymph node with increased FDG uptake on PET-CT was detected and suggested metastatic disease. Mediastinoscopy was performed and lymph node biopsy showed granulomatous disease with focal necrosis suggestive of sarcoidosis or tuberculosis (fig. 1, fig. 2). During IM treatment, new lung lesions appeared leading to surgical removal of the lesions. Histological examination showed near totally regressing lung metastasis from GIST, but no evidence of granulomatous disease. He has since remained in continuous complete remission on IM for more than 38 months. The lymph nodes showed decreasing FDG uptake on follow-up FDG-PET-CT. Periodic CT scans did not show any new lymphadenopathy.