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Yoshinami Y, Nishimura E, Hosokai T, Yamamoto S, Matsuda S, Nomura M, Kawakubo H, Kato K, Kitagawa Y. Rare malignant neoplasm of the esophagus: current status and future perspectives. Jpn J Clin Oncol 2024; 54:111-120. [PMID: 37861097 PMCID: PMC10849183 DOI: 10.1093/jjco/hyad144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 09/29/2023] [Indexed: 10/21/2023] Open
Abstract
Esophageal cancer is common worldwide, including in Japan, and its major histological subtype is squamous cell carcinoma. However, there are some rare esophageal cancers, including neuroendocrine neoplasm, gastrointestinal stromal tumor, carcinosarcoma and malignant melanoma. The biological and clinical features of these cancers differ from those of esophageal squamous cell carcinoma. Therefore, different treatment strategies are needed for these cancers but are based on limited evidence. Neuroendocrine neoplasm is mainly divided into neuroendocrine tumor and neuroendocrine carcinoma by differentiation and the Ki-67 proliferation index or mitotic index. Epidemiologically, the majority of esophageal neuroendocrine neoplasms are neuroendocrine carcinoma. The treatment of neuroendocrine carcinoma is similar to that of small cell lung cancer, which has similar morphological and biological features. Gastrointestinal stromal tumor is known to be associated with alterations in the c-KIT and platelet-derived growth factor receptor genes and, if resectable, is treated in accordance with the modified Fletcher classification. Carcinosarcoma is generally resistant to both chemotherapy and radiotherapy and requires multimodal treatments such as surgery plus chemotherapy to achieve cure. Primary malignant melanoma is resistant to cytotoxic chemotherapy, but immune checkpoint inhibitors have recently demonstrated efficacy for malignant melanoma of the esophagus. This review focuses on the current status and future perspectives for rare cancer of the esophagus.
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Affiliation(s)
- Yuri Yoshinami
- Department of Head and Neck, Esophageal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Erica Nishimura
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Taisuke Hosokai
- Department of Clinical Oncology, Kyoto University Hospital, Kyoto, Japan
| | - Shun Yamamoto
- Department of Head and Neck, Esophageal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Satoru Matsuda
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Motoo Nomura
- Department of Clinical Oncology, Kyoto University Hospital, Kyoto, Japan
| | - Hirofumi Kawakubo
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Ken Kato
- Department of Head and Neck, Esophageal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
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Du C, He Z, Li L, Ning B, Zhang B, Zhai Y, Ma Y, Han K, Wang H, Tang P, Chai N, Linghu E. Endoscopic resection for the treatment of non-gastric gastrointestinal stromal tumors: A retrospective study from a large tertiary hospital in China. Clin Res Hepatol Gastroenterol 2023; 47:102152. [PMID: 37257690 DOI: 10.1016/j.clinre.2023.102152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/14/2023] [Accepted: 05/29/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND AND AIMS Few studies on endoscopic resection (ER) for the treatment of non-gastric gastrointestinal (GI) stromal tumors (GISTs) have been conducted, and most have been case reports or case series. The aim of this study was to evaluate the effectiveness and safety of ER for non-gastric GISTs. METHODS From January 2010 to December 2022, 329 patients who were diagnosed with GISTs underwent ER. After excluding 302 patients with gastric GISTs, we retrospectively assessed the data of 27 patients with non-gastric GISTs. The main outcome measures were en bloc resection, complete resection, residual disease, recurrence, and complications. RESULTS A total of 15(55.6%) females and 12(44.4%) males with a mean age of 53.8 ± 11.0 years were assessed. There were 19 (70.4%) GISTs in the esophagus, 2 (7.4%) in the duodenum, 3 (11.1%) in the colon and 3 (11.1%) in the rectum. The median tumor size was 12.0 mm (range 4.0-35.0 mm). Most of the GISTs (20, 74.1%) were very low risk, and the remaining 7(25.9%) were low risk. Both en bloc resection and complete resection were achieved in 25(92.6%) patients. Piecemeal resection mainly resulted from a larger tumor size, an irregular shape, and an extraluminal growth pattern. No residual disease or recurrence was noted during the follow-up period. The median operation time was 23 min (range 2-125 min). After excluding the operation time of EER, the operation time was prolonged to 37 min (range 12-125 min). Only one patient experienced mild abdominal pain, leading to a complication rate of 3.7%. No severe complications requiring for surgical interventions occurred. CONCLUSION ER was an effective and safe method for non-gastric GISTs in selected cases. GISTs of a small size and regular shape with an intraluminal growth pattern require complete resection.
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Affiliation(s)
- Chen Du
- Senior Department of Gastroenterology, the First Medical Center of PLA General Hospital, Fuxing Road 28. Haidian District, Beijing 100853, China
| | - Zhengting He
- Senior Department of Gastroenterology, the First Medical Center of PLA General Hospital, Fuxing Road 28. Haidian District, Beijing 100853, China
| | - Longsong Li
- Senior Department of Gastroenterology, the First Medical Center of PLA General Hospital, Fuxing Road 28. Haidian District, Beijing 100853, China
| | - Bo Ning
- Senior Department of Gastroenterology, the First Medical Center of PLA General Hospital, Fuxing Road 28. Haidian District, Beijing 100853, China
| | - Bo Zhang
- Senior Department of Gastroenterology, the First Medical Center of PLA General Hospital, Fuxing Road 28. Haidian District, Beijing 100853, China
| | - Yaqi Zhai
- Senior Department of Gastroenterology, the First Medical Center of PLA General Hospital, Fuxing Road 28. Haidian District, Beijing 100853, China
| | - Yan Ma
- Senior Department of Gastroenterology, the First Medical Center of PLA General Hospital, Fuxing Road 28. Haidian District, Beijing 100853, China
| | - Ke Han
- Senior Department of Gastroenterology, the First Medical Center of PLA General Hospital, Fuxing Road 28. Haidian District, Beijing 100853, China
| | - Hongbin Wang
- Senior Department of Gastroenterology, the First Medical Center of PLA General Hospital, Fuxing Road 28. Haidian District, Beijing 100853, China
| | - Ping Tang
- Senior Department of Gastroenterology, the First Medical Center of PLA General Hospital, Fuxing Road 28. Haidian District, Beijing 100853, China
| | - Ningli Chai
- Senior Department of Gastroenterology, the First Medical Center of PLA General Hospital, Fuxing Road 28. Haidian District, Beijing 100853, China.
| | - Enqiang Linghu
- Senior Department of Gastroenterology, the First Medical Center of PLA General Hospital, Fuxing Road 28. Haidian District, Beijing 100853, China.
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Large esophageal gastrointestinal stromal tumors resected thoracoscopically after oral imatinib therapy: a report of two cases. Clin J Gastroenterol 2022; 16:136-141. [PMID: 36547850 PMCID: PMC10063499 DOI: 10.1007/s12328-022-01743-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022]
Abstract
AbstractEsophageal gastrointestinal stromal tumors (GISTs) are very rare, accounting for 2–5% of all GISTs. As with other GISTs, the principle of surgical treatment is complete resection with negative margins. In addition to biological grades of GISTs itselves, local recurrence due to capsular damage is a known risk. We describe two cases of massive esophageal GISTs that were successfully resected thoracoscopically after 2 months administration of 400 mg imatinib, with some discussion of the literature. Case 1, the patient was a 51-years-old man. After treated with 400 mg of imatinib as preoperative chemotherapy for 2 months, we performed surgery that included right thoracoscopic subtotal esophagectomy, gastric tube reconstruction, and jejunostomy. The resection specimen and histopathology were esophageal GIST-LtMtAeG, 110 × 95 mm. The postoperative course was uneventful, and was discharged on postoperative day 14. The patient has been recurrence free for 11 months postoperatively. Case 2, the patient was a 70-years-old man. After treated with 400 mg of imatinib as preoperative chemotherapy for 2 months, we performed surgery that included right thoracoscopic subtotal esophagectomy, gastric tube reconstruction, and jejunostomy. The resection specimen and histopathology were esophageal GIST-LtAeG, 90 × 52 mm. The postoperative course was uneventful, and was discharged on postoperative day 14. The patient has been recurrence free for 9 months postoperatively.
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Luo Y, Wu Y, Chang X, Huang B, Luo D, Zhang J, Zhang P, Shi H, Fan J, Nie X. Identification of a novel FGFR2-KIAA1217 fusion in esophageal gastrointestinal stromal tumours: A case report. Front Oncol 2022; 12:884814. [PMID: 35978808 PMCID: PMC9377458 DOI: 10.3389/fonc.2022.884814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 07/12/2022] [Indexed: 12/02/2022] Open
Abstract
Background Gastrointestinal stromal tumours (GISTs) rarely arise in the esophagus. The clinical course and treatment options for esophageal GISTs are poorly understood because of their rarity. In general, the mutation spectrum of esophageal GISTs resembles that of gastric GISTs. Wild-type (WT) GISTs lacking KIT and PDGFRA gene mutations occasionally occur in adults; primary esophageal GISTs are commonly WT. Case presentation Herein, we report the case of a 41-year-old female patient who presented with a 1-week history of anterior upper chest pain. Chest computed tomography revealed a 3.7 cm × 2.8 cm × 6.7 cm soft tissue mass in the right posterior mediastinum adjacent to the esophagus. The patient underwent thoracoscopic mediastinal tumor resection and was subsequently diagnosed with an esophageal GIST. Neither KIT nor PDGFRA mutations were detected by Sanger sequencing; however, next-generation sequencing (NGS) identified an FGFR2-KIAA1217 gene fusion in the tumor tissue. No relapse was observed in this patient during the 8-month treatment-free follow-up period. Conclusion To the best of our knowledge, this report is the first to describe an FGFR2-KIAA1217 fusion in a patient with a quadruple WT esophageal GIST. When WT KIT/PDGFRA GISTS are suspected, intensive genetic analysis is recommended, and obtaining a better molecular characterization of these tumours might reveal novel therapeutic avenues.
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Affiliation(s)
- Yuehao Luo
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ying Wu
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaona Chang
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bo Huang
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Danju Luo
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiwei Zhang
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Peng Zhang
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Heshui Shi
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jun Fan
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Xiu Nie, ; Jun Fan,
| | - Xiu Nie
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Xiu Nie, ; Jun Fan,
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Du H, Ning L, Chen H, Hu F, Shan G, Chen W, Xu G. Endoscopic treatment can be a viable therapeutic option for esophageal gastrointestinal stromal tumors. Scand J Gastroenterol 2022; 57:371-376. [PMID: 34839764 DOI: 10.1080/00365521.2021.2009024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Esophageal gastrointestinal stromal tumors(GISTs) are extremely rare. We sought to determine whether endoscopic treatment can be a viable therapeutic option for esophageal GISTs. METHODS A total of 20 cases with histological diagnosis of esophageal GISTs were obtained from our center between 2008 and 2020. Data on the clinicopathological features and treatment were recorded. RESULTS There were 9 males (45%) and 11 females (55%) in this study, with a median age of 56 years. The tumors preferentially occurred in the middle and lower parts of the thoracic esophagus (45 and 40%, respectively). The mean size of the tumors was 2.27 cm and mitotic index was no more than 5/50 high power field (HPF) in all patients. In this study, 11 patients received endoscopic treatment and nine patients underwent surgical resection. Tumors ranged from 0.6 to 4 cm in the endoscopic treatment patients and 0.5 to 7 cm in the surgical patients. There were no significant differences in gender, age, symptoms, tumor location, tumor size, mitotic index, and adjuvant imatinib therapy between the endoscopic treatment group and the surgery group (all p > .05). The Kaplan-Meier curve suggested that there was also no significant difference in disease-free survival between the two groups (p = .264). CONCLUSIONS Endoscopic treatment may be an option for the treatment of esophageal GISTs smaller than 5 cm with a mitotic index no more than 5/50 HPF.
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Affiliation(s)
- Haojie Du
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Longgui Ning
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hongtan Chen
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Fengling Hu
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Guodong Shan
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wenguo Chen
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Guoqiang Xu
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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A nationwide survey on esophageal gastrointestinal stromal tumors at accredited institutions by the Japan Esophageal Society. Esophagus 2021; 18:451-460. [PMID: 33928490 DOI: 10.1007/s10388-021-00847-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 04/18/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND As esophageal gastrointestinal stromal tumors (GISTs) are very rare, their clinicopathological features remain obscure. We conducted a nationwide survey to clarify the characteristics of these tumors and to establish a consensus on their diagnosis and treatment. METHODS The clinicopathological information of patients with esophageal GISTs who underwent treatment between January 2010 and June 2016 at the accredited institutions by the Japan Esophageal Society was collected via a questionnaire method and analyzed statistically. RESULTS Fifty-one patients (29 men and 22 women; median age, 68 years) were recruited from 31 institutions. Diagnosis was triggered most frequently during screening and other disease scrutiny. Symptoms were seen only in 17 patients: highest in 11 patients with dysphagia. Thirty-five patients underwent surgery alone; 15 patients, surgery with imatinib therapy; and one patient, endoscopic resection. The tumors preferentially occurred in the lower and middle parts of the thoracic esophagus, with a median size of 36.5 mm. Neoadjuvant and adjuvant imatinib therapies were performed in seven and eight patients, respectively. Administration of imatinib 400 mg/day was the standard regimen. Postoperative follow-up observations were conducted mostly via computed tomography (CT) scans every 3 or 6 months until 5 years after surgery. The tumors recurred in ten patients within 5 years postoperatively (high risk, 38.5%; intermediate risk, 20%; low risk, 0%; very low risk, 0%; three cases of relapse with an unknown risk assessment). A patient with a high-risk GIST died from the tumor 54 months after surgery. CONCLUSIONS This nationwide survey revealed the current status of esophageal GISTs in Japan and provided important information for making a consensus on the treatment and follow-up method.
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Costa F, Casaca R, Monteiro C, Ramos P. Oesophageal GIST. BMJ Case Rep 2020; 13:13/10/e238058. [PMID: 33130586 DOI: 10.1136/bcr-2020-238058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Gastrointestinal stromal tumours (GISTs) are the most common mesenchymal tumours of the gastrointestinal tract. Oesophageal GISTs are extremely uncommon, accounting for 0.7% of all GISTs, and their management is surrounded by some debate. We report a case of a 70-year-old man who was incidentally diagnosed with an oesophageal lesion on a 18F-fluorodeoxyglucose positron emission tomography. An endoscopic study revealed a non-obstructing 40 mm oesophageal lesion. Endoscopic ultrasound showed a well-circumscribed submucosal tumour on the middle oesophagus. Fine-needle aspiration was positive for CD117 and the overall features were of a GIST. After an initial thoracoscopic approach, the tumour was completely enucleated through a thoracotomy incision. The patient experienced no surgical complications and was discharged on day 4. Histopathology and immunohistochemical staining confirmed a low-risk GIST.
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Affiliation(s)
| | - Rui Casaca
- Instituto Portugues de Oncologia de Lisboa Francisco Gentil EPE, Lisboa, Portugal
| | - Cecilia Monteiro
- Instituto Portugues de Oncologia de Lisboa Francisco Gentil EPE, Lisboa, Portugal
| | - Paulo Ramos
- Instituto Portugues de Oncologia de Lisboa Francisco Gentil EPE, Lisboa, Portugal
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Hihara J, Mukaida H, Hirabayashi N. Gastrointestinal stromal tumor of the esophagus: current issues of diagnosis, surgery and drug therapy. Transl Gastroenterol Hepatol 2018; 3:6. [PMID: 29441371 DOI: 10.21037/tgh.2018.01.06] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 01/09/2018] [Indexed: 12/14/2022] Open
Abstract
Gastrointestinal stromal tumors (GISTs) often arise in the stomach and small intestine, while esophageal GISTs are rare. Due to their rarity, clinicopathological data on esophageal GISTs are extremely limited, and this results in a lack of clear recommendations concerning optimal surgical management for esophageal GISTs. It is difficult to distinguish esophageal GIST from leiomyoma, the most frequent esophageal mesenchymal tumor, prior to resection, because the two types of tumors appear similar on computed tomography (CT), endoscopic ultrasound (EUS), and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET). Fine-needle aspiration biopsy (FNAB) under EUS enables definitive diagnosis, but it is often avoided because scarring could make enucleation more difficult and increase the risk of tumor dissemination by capsule destruction. Esophageal segmental and wedge resections are not usually performed due to the anatomical peculiarity of the esophagus, and the surgical options are limited to the highly invasive esophagectomy or the much less invasive surgical tumor enucleation. The decision as to which surgical procedure should be performed for esophageal GISTs is still under debate. Tumor enucleation may be permitted for smaller tumors, and esophagectomy may be recommended for larger GISTs or high-risk tumors with a high mitotic rate. The purpose of neoadjuvant imatinib administration is downsizing of the GIST to reduce the extent of resection and to reduce the risk of intraoperative complications, including tumor rupture. The efficacy of neoadjuvant/adjuvant imatinib therapy for esophageal GISTs is poorly understood, because the reports are limited to case reports or case series with small numbers. More clinicopathological data and clinical trials for esophageal GIST are expected.
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Affiliation(s)
- Jun Hihara
- Department of Surgery, Hiroshima City Asa Citizens Hospital, Asakita-ku, Hiroshima, Japan
| | - Hidenori Mukaida
- Department of Surgery, Hiroshima City Asa Citizens Hospital, Asakita-ku, Hiroshima, Japan
| | - Naoki Hirabayashi
- Department of Surgery, Hiroshima City Asa Citizens Hospital, Asakita-ku, Hiroshima, Japan
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Pence K, Correa AM, Chan E, Khaitan P, Hofstetter W, Kim MP. Management of esophageal gastrointestinal stromal tumor: review of one hundred seven patients. Dis Esophagus 2017; 30:1-5. [PMID: 28881878 DOI: 10.1093/dote/dox064] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 05/17/2017] [Indexed: 12/11/2022]
Abstract
Gastrointestinal stromal tumors (GIST) are the most common type of gastrointestinal mesenchymal tumor, but are rarely found in the thoracic esophagus. There is no clear consensus about the optimal treatment of this rare disease. A systematic search of the literature was performed for localized esophageal GIST that was resected between 2000 and 2015, and individual patients were included from two major academic institutions. We obtained information on demographics, tumor size and location, mitotic rate, treatment method, and time to recurrence or death. We performed univariate and multivariate Cox regression analyses to evaluate the factors associated with recurrence or death. A total of 28 studies met our inclusion and exclusion criteria, and with two patients from two academic institutions, we had a total of 107 patients in the study. Due to lack of uniformity among studies, there were several missing data for different variables. The average patient age was 56 (n = 98) with mostly males (60%, n = 91). The average tumor size on the CT scan was 7.9 ± 5.4 cm (n = 91), located mostly in the distal esophagus (81%, n = 74). A similar number of patients underwent enucleation (n = 47) compared to esophagectomy (n = 42). Approximately half of the patients had a mitotic rate of 0-4 mitosis per 50 high-powered field (48%, n = 80). The median survival time was 73 months with a 5-year disease free survival of 57% (n = 97). Univariate Cox regression analyses showed that a large tumor, undergoing esophagectomy, and a high mitotic rate were associated with poor survival or recurrence control. We found that patients with a lesion smaller than or equal to 5 cm on the CT scan had a better disease-free survival rate than those with a size greater than 5 cm (HR = 12.41, p = 0.014) and had a 5-year survival rate of 92% with 90% of those patients undergoing enucleation (n = 29). Esophageal GIST is a very rare malignancy. The tumor size and mitotic rate of the tumor are associated with poor survival. However, patients with esophageal GIST measuring 5 cm or smaller may be safely treated with esophageal enucleation.
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Affiliation(s)
- K Pence
- Department of Surgery, Houston Methodist Hospital
| | - A M Correa
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center
| | - E Chan
- Department of Surgery, Houston Methodist Hospital
| | - P Khaitan
- Department of Surgery, Houston Methodist Hospital.,Weill Cornell Medical College, Houston Methodist Hospital, Houston, Texas, USA
| | - W Hofstetter
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center
| | - M P Kim
- Department of Surgery, Houston Methodist Hospital.,Weill Cornell Medical College, Houston Methodist Hospital, Houston, Texas, USA
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Feng F, Tian Y, Liu Z, Xu G, Liu S, Guo M, Lian X, Fan D, Zhang H. Clinicopathologic Features and Clinical Outcomes of Esophageal Gastrointestinal Stromal Tumor: Evaluation of a Pooled Case Series. Medicine (Baltimore) 2016; 95:e2446. [PMID: 26765432 PMCID: PMC4718258 DOI: 10.1097/md.0000000000002446] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Clinicopathologic features and clinical outcomes of gastrointestinal stromal tumors (GISTs) in esophagus are limited, because of the relatively rare incidence of esophageal GISTs. Therefore, the aim of the current study was to investigate the clinicopathologic features and clinical outcomes of esophageal GISTs, and to investigate the potential factors that may predict prognosis.Esophageal GIST cases were obtained from our center and from case reports and clinical studies extracted from MEDLINE. Clinicopathologic features and survivals were analyzed and compared with gastric GISTs from our center.The most common location was lower esophagus (86.84%), followed by middle and upper esophagus (11.40% and 1.76%). The majority of esophageal GISTs were classified as high-risk category (70.83%). Mitotic index was correlated with histologic type, mutational status, and tumor size. The 5-year disease-free survival and disease-specific survival were 65.1% and 65.9%, respectively. Tumor size, mitotic index, and National Institutes of Health risk classification were associated with prognosis of esophageal GISTs. Only tumor size, however, was the independent risk factor for the prognosis of esophageal GISTs. In comparison to gastric GISTs, the distribution of tumor size, histologic type, and National Institutes of Health risk classification were significantly different between esophageal GISTs and gastric GISTs. The disease-free survival and disease-specific survival of esophageal GISTs were significantly lower than that of gastric GISTs.The most common location for esophageal GISTs was lower esophagus, and most of the esophageal GISTs are high-risk category. Tumor size was the independent risk factor for the prognosis of esophageal GISTs. Esophageal GISTs differ significantly from gastric GISTs in respect to clinicopathologic features. The prognosis of esophageal GISTs was worse than that of gastric GISTs.
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Affiliation(s)
- Fan Feng
- From the Department of Digestive Surgery, Xijing Hospital, Fourth Military Medical University (FF, ZL, GX, SL, MG, XL, DF, HZ) and Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, China (YT)
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Koyuncuer A, Gönlüşen L, Kutsal AV. A rare case of giant gastrointestinal stromal tumor of the stomach involving the serosal surface. Int J Surg Case Rep 2015; 12:90-4. [PMID: 26036460 PMCID: PMC4485691 DOI: 10.1016/j.ijscr.2015.04.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 04/16/2015] [Accepted: 04/30/2015] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Although rare, gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors affecting the gastrointestinal tract. PRESENTATION OF CASE Here we report the case of a 43-year-old man complaining of abdominal pain along with a painless and palpable mass, which was confirmed on magnetic resonance and multislice computed tomography. Laparotomy revealed a nodular grayish-white firm noninfiltrative mass (39×27×14cm, 6109g) that was well localized within the extramuscular and peritoneal surface of the anterior wall of the stomach; complete tumor resection was performed. Histopathological examination revealed features typical of GIST, including increased cellularity, increased mitotic activity, and spindle shaped cells as well as positive immunoreactivity for KIT, CD34, and vimentin. DISCUSSION A review of literature revealed that GISTs of the size and weight similar to the present case has been rarely reported. GIST most frequently involves the stomach. Although the etiopathogenesis of this disease remains unclear, few well-documented familial cases have been associated with GIST syndromes. CONCLUSION The primary treatment preferred is complete surgical excision of the tumor.
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Affiliation(s)
- Ali Koyuncuer
- Department of Pathology, Antakya State Hospital, Hatay, Turkey.
| | - Levent Gönlüşen
- Department of Surgery, Antakya State Hospital, Hatay, Turkey.
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