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Hatai S, Nagai S, Yoshida T, Matsuoka M, Shinkawa T, Oyama Y, Tanabe Y, Kitahara D, Tamiya S, Amada S, Nishihara K, Nakano T. Transvaginal resection of a gastrointestinal stromal tumor of the rectum: a case report. Surg Case Rep 2024; 10:150. [PMID: 38886293 PMCID: PMC11183011 DOI: 10.1186/s40792-024-01949-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 06/11/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND The most common curative treatment for gastrointestinal stromal tumors (GISTs) is local excision. For rectal GISTs, however, local excision is difficult because of the anatomical features of the rectum. The optimal surgical approach is still under debate, and less invasive methods are desired. We herein report a case of transvaginal resection of a rectal GIST in a young woman. CASE PRESENTATION A 21-year-old woman was diagnosed with a resectable GIST in the anterior rectal wall and underwent transvaginal tumor resection. The posterior vaginal wall was incised, revealing the tumor fully covered by the rectal mucosa. The rectal adventitia and muscular layer were incised, and the tumor was resected en bloc without rupture. The postoperative course was favorable, and the patient was discharged on postoperative day 12. No findings consistent with recurrence were present 6 months postoperatively. CONCLUSION Transvaginal tumor resection is a treatment option as a minimally invasive procedure for GISTs in the anterior rectal wall in female patients.
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Affiliation(s)
- Sanshiro Hatai
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Basyaku, Kokurakita-Ku, Kitakyushu, Fukuoka, 802-0077, Japan
| | - Shuntaro Nagai
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Basyaku, Kokurakita-Ku, Kitakyushu, Fukuoka, 802-0077, Japan.
| | - Taiki Yoshida
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Basyaku, Kokurakita-Ku, Kitakyushu, Fukuoka, 802-0077, Japan
| | - Masaru Matsuoka
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Basyaku, Kokurakita-Ku, Kitakyushu, Fukuoka, 802-0077, Japan
| | - Tomohiko Shinkawa
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Basyaku, Kokurakita-Ku, Kitakyushu, Fukuoka, 802-0077, Japan
| | - Yasuhiro Oyama
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Basyaku, Kokurakita-Ku, Kitakyushu, Fukuoka, 802-0077, Japan
| | - Yoshitaka Tanabe
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Basyaku, Kokurakita-Ku, Kitakyushu, Fukuoka, 802-0077, Japan
| | - Daichi Kitahara
- Department of Pathology, Kitakyushu Municipal Medical Center, Fukuoka, Japan
| | - Sadafumi Tamiya
- Department of Pathology, Kitakyushu Municipal Medical Center, Fukuoka, Japan
| | - Satoshi Amada
- Department of Obstetrics and Gynecology, Kitakyushu Municipal Medical Center, Fukuoka, Japan
| | - Kazuyoshi Nishihara
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Basyaku, Kokurakita-Ku, Kitakyushu, Fukuoka, 802-0077, Japan
| | - Toru Nakano
- Department of Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Basyaku, Kokurakita-Ku, Kitakyushu, Fukuoka, 802-0077, Japan
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Hasnaoui A, Trigui R, Khedhiri N, Helal I, Zaafouri H, Ben Maamer A. Surgical management of a locally advanced jejunal stromal tumor: A case report of a challenging condition. Int J Surg Case Rep 2024; 114:109155. [PMID: 38086132 PMCID: PMC10758957 DOI: 10.1016/j.ijscr.2023.109155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/28/2023] [Accepted: 12/03/2023] [Indexed: 01/05/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Locally advanced jejunal stromal tumors stand as a captivating and relatively rare entity, garnering attention for several reasons. Their inaccessible location by conventional endoscopy poses a diagnostic challenge. Further, treatment decisions necessitate a multidisciplinary approach, compounded by the absence of high-level evidence studies. CASE PRESENTATION A 54-year-old patient was admitted to our surgical department with abdominal pain and chronic anemia. Abdominal CT imaging confirmed the presence of a non-metastatic sizable jejunal tumor. The patient underwent laparotomy, revealing a locally advanced jejunal tumor contracting the ileum and the ascending colon. A monobloc oncological resection was performed, followed by the restoration of digestive continuity. Anatomopathological analysis delineated a locally advanced Stromal Tumor with a high risk of recurrence. The patient underwent a course of tyrosine kinase inhibitors for 3 years, with no reported recurrence during the subsequent 3-year follow-up. DISCUSSION Locally advanced jejunal stromal tumors are rare. Most patients present with unspecific symptoms. Diagnosis remains challenging due to their intricate anatomical location. Decisions regarding management must be deliberated within a multidisciplinary framework, tailored to each patient's unique characteristics. While combined therapeutic modalities have demonstrated efficacy in recent studies, prudence is advised given the heightened incidence of both short and long-term complications. CONCLUSION In the absence of randomized controlled trials, the management of locally advanced jejunal stromal tumors underscores the imperative of multidisciplinary collaboration in treatment deliberations. A wide, sometimes mutilating excision is only permissible if it is complete.
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Affiliation(s)
- Anis Hasnaoui
- Faculty of Medicine of Tunis, Tunis El Manar University, Rue Djebal Lakhdar, 1006 Tunis, Tunisia; Department of General Surgery, Menzel Bourguiba Hospital, Tunisia.
| | - Racem Trigui
- Faculty of Medicine of Tunis, Tunis El Manar University, Rue Djebal Lakhdar, 1006 Tunis, Tunisia; Department of General Surgery, Menzel Bourguiba Hospital, Tunisia
| | - Nizar Khedhiri
- Faculty of Medicine of Tunis, Tunis El Manar University, Rue Djebal Lakhdar, 1006 Tunis, Tunisia; Department of General Surgery, Habib Thameur Hospital, Tunisia.
| | - Imen Helal
- Faculty of Medicine of Tunis, Tunis El Manar University, Rue Djebal Lakhdar, 1006 Tunis, Tunisia; Department of Pathology, Habib Thameur hospital, Tunisia
| | - Haithem Zaafouri
- Faculty of Medicine of Tunis, Tunis El Manar University, Rue Djebal Lakhdar, 1006 Tunis, Tunisia; Department of General Surgery, Habib Thameur Hospital, Tunisia
| | - Anis Ben Maamer
- Faculty of Medicine of Tunis, Tunis El Manar University, Rue Djebal Lakhdar, 1006 Tunis, Tunisia; Department of General Surgery, Habib Thameur Hospital, Tunisia
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Sathyamoorthy H, Mahmood H, Zubir AZA, Hankinson P, Khurram SA. Prognostic importance of mitosis quantification and PHH3 expression in oral epithelial dysplasia. Virchows Arch 2024; 484:47-59. [PMID: 37882821 PMCID: PMC10791886 DOI: 10.1007/s00428-023-03668-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 10/27/2023]
Abstract
Oral epithelial dysplasia (OED) is diagnosed and graded using a range of histological features, making grading subjective and challenging. Mitotic counting and phosphohistone-H3 (PHH3) staining have been used for the prognostication of various malignancies; however, their importance in OED remains unexplored. This study conducts a quantitative analysis of mitotic activity in OED using both haematoxylin and eosin (H&E)-stained slides and immunohistochemical (IHC) staining for PHH3. Specifically, the diagnostic and prognostic importance of mitotic number, mitotic type and intra-epithelial location is evaluated. Whole slide images (WSI) of OED (n = 60) and non-dysplastic tissue (n = 8) were prepared for analysis. Five-year follow-up data was collected. The total number of mitosis (TNOM), mitosis type and intra-epithelial location was manually evaluated on H&E images and a digital mitotic count performed on PHH3-stained WSI. Statistical associations between these features and OED grade, malignant transformation and OED recurrence were determined. Mitosis count increased with grade severity (H&E: p < 0.005; IHC: p < 0.05), and grade-based differences were seen for mitosis type and location (p < 0.05). The ratio of normal-to-abnormal mitoses was higher in OED (1.61) than control (1.25) and reduced with grade severity. TNOM, type and location were better predictors when combined with histological grading, with the most prognostic models demonstrating an AUROC of 0.81 for transformation and 0.78 for recurrence, exceeding conventional grading. Mitosis quantification and PHH3 staining can be an adjunct to conventional H&E assessment and grading for the prediction of OED prognosis. Validation on larger multicentre cohorts is needed to establish these findings.
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Affiliation(s)
- Hrishikesh Sathyamoorthy
- Unit of Oral and Maxillofacial Pathology, School of Clinical Dentistry, University of Sheffield, 19 Claremont Crescent, Sheffield, S10 2TA, UK
| | - Hanya Mahmood
- Academic Unit of Oral & Maxillofacial Surgery, School of Clinical Dentistry, University of Sheffield, 19 Claremont Crescent, Sheffield, S10 2TA, UK
| | - Amir Zaki Abdullah Zubir
- Unit of Oral and Maxillofacial Pathology, School of Clinical Dentistry, University of Sheffield, 19 Claremont Crescent, Sheffield, S10 2TA, UK
| | - Paul Hankinson
- Unit of Oral and Maxillofacial Pathology, School of Clinical Dentistry, University of Sheffield, 19 Claremont Crescent, Sheffield, S10 2TA, UK
| | - Syed Ali Khurram
- Unit of Oral and Maxillofacial Pathology, School of Clinical Dentistry, University of Sheffield, 19 Claremont Crescent, Sheffield, S10 2TA, UK.
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Althoubaity F, Wazira LA, Ahmad HMY, Aljuhani RT. Concurrence of Adenomyoepithelioma of the Breast and Gastrointestinal Stromal Tumor of the Stomach: A Case Report and Review of the Literature. Med Sci (Basel) 2023; 11:57. [PMID: 37755162 PMCID: PMC10537318 DOI: 10.3390/medsci11030057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 08/25/2023] [Accepted: 09/06/2023] [Indexed: 09/28/2023] Open
Abstract
Adenomyoepithelioma (AME) of the breast and gastrointestinal stromal tumors (GISTs) are rare benign (primarily) tumors observed in the breast and gastrointestinal tract, respectively. The coexistence of both of these rare tumors is extremely rare; therefore, the author describes the clinical presentation and pathophysiological findings of such a unique case in this study. A 56-year-old female patient with no medical history presented with a substantial right breast lump, severe nausea, and vomiting, and suffered from iron deficiency anemia. Radiological observation and a right breast excisional biopsy diagnosed the patient with AME associated with ductal carcinoma in situ (DCIS). Endoscopy and a CT scan of the stomach revealed the existence of GIST. This is the first reported case of concurrence of a huge mass of AME and GIST in a patient. Histological and immunohistochemistry tests using p63, SMA, calponin, and Ki67 markers for the breast tumor and DOG-1, CD34, and CD117 markers for the gastric tumor revealed the non-invasive benign state. The patient had a right breast mastectomy with a negative resection margin. AME of the breast and GIST pose diagnostic challenges due to their erratic morphological characteristics and can cause misinterpretation drawn solely from radiological tests. Effective and accurate diagnostics require assessing the histological and immunohistochemistry findings of the tumor to identify the invasiveness of the neoplasm and the associated risk levels. This report, thus, creates awareness among clinicians and pathologists for the consideration of such possibilities and, therefore, conducts the necessary diagnostics and prophylactic treatments.
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Affiliation(s)
- Fatma Althoubaity
- Department of Surgery, King Abdulaziz University Hospital, Jeddah 21589, Saudi Arabia
| | - Lamar A Wazira
- Department of Surgery, Collage of medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Hanin M Y Ahmad
- Department of Surgery, Collage of medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Reyof T Aljuhani
- Department of Surgery, Collage of medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia
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Seo JW, Park KB, Chin HM, Jun KH. Is single incision laparoscopic surgery (SILS) for gastric gastrointestinal stromal tumor (GIST) dependent on the location of the tumor? BMC Surg 2023; 23:247. [PMID: 37605202 PMCID: PMC10441706 DOI: 10.1186/s12893-023-02141-0] [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: 05/20/2023] [Accepted: 08/05/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND We compared the surgical outcomes of single-incision laparoscopic surgery (SILS) and conventional laparoscopic surgery (CLS) for gastric gastrointestinal stromal tumor (GIST). METHODS We performed single-incision gastric wedge resection on prospectively-enrolled 15 consecutive patients with gastric GIST between November 2020 and April 2022 in a single tertiary center. The early perioperative outcomes of these patients were compared to those of patients who underwent CLS. The indications did not differ from those for conventional laparoscopic procedures for gastric GIST. RESULTS In total, 30 patients were assigned to the SILS (n = 15) and CLS (n = 15) groups. There were no significant differences in the estimated blood loss and intraoperative blood transfusion between the SILS and CLS groups. There were no intraoperative complications or conversions to multiple-port or open surgery in the SILS group. Proximally located tumors were more commonly treated with CLS than with SILS (P = 0.045). GISTs located in the greater curvature were more commonly treated with SILS than with CLS, although the difference was not statistically significant (P = 0.08). The mean incision length in the SILS group was 4.1 cm shorter than that in the CLS group (3.2 ± 0.7 and 7.3 ± 5.2 cm, respectively, P = 0.01). The postoperative analgesic dose was significantly lower in the SILS than in the CLS group (0.4 ± 1.4 and 2.1 ± 2.3, respectively P = 0.01). Also, the duration of postoperative use of analgesic was shorter in SILS than in CLS (0.4 ± 0.7 and 2.0 ± 1.8, respectively, P = 0.01). There were no significant differences in the early postoperative complications between the groups. CONCLUSIONS SILS is as safe, feasible, and effective for the treatment of gastric GIST as CLS with comparable postoperative complications, pain, and cosmesis. Moreover, SILS can be considered without being affected by the type or location of the tumor.
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Affiliation(s)
- Ji Won Seo
- Department of Surgery, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ki Bum Park
- Department of Surgery, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyung Min Chin
- Department of Surgery, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyong-Hwa Jun
- Department of Surgery, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
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6
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Syamprasad NP, Madje N, Bachannagari J, Jannu AK, Jain S, Tene K, Shantanu PA, Naidu V, Chella N. Niclosamide nanocrystal for enhanced in-vivo efficacy against gastrointestinal stromal tumor via regulating EGFR/STAT-3/DR-4 axis. J Drug Deliv Sci Technol 2023. [DOI: 10.1016/j.jddst.2023.104221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Colapkulu-Akgul N, Gunel H, Beyazadam D, Ozsoy MS, Alimoglu O. Gastrointestinal Stromal Tumors: Recurrence and Survival Analysis of 49 Patients. Middle East J Dig Dis 2023; 15:19-25. [PMID: 37547161 PMCID: PMC10404080 DOI: 10.34172/mejdd.2023.315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 09/20/2022] [Indexed: 08/08/2023] Open
Abstract
Background: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumor originating from the gastrointestinal tract and have a broad spectrum of clinicopathological features affecting disease management regarding the treatment modalities. Methods: A retrospective study of 49 patients who underwent surgery for gastrointestinal tumors between 2008 and 2016 was conducted. Clinical, pathological, and immunohistochemical features of patients with and without recurrence were statistically analyzed. Results: Twenty-nine (59.1%) patients had gastric; 16 (32.6%) had small intestinal; 3 (6.1%) had mesenteric; and 1 (2.2%) had rectal GISTs. Microscopic tumor necrosis and tumor ulceration were also significant for disease recurrence (P = 0.005, P = 0.049). High-risk patients according to Miettinen's risk classification were more likely to develop a recurrence (P < 0.001). Additionally, high-grade tumors were also a risk factor for recurrence (P < 0.001). Ki-67 levels were available in 40 patients and the mean Ki-67 level was 16.8 in patients with recurrence, which was a significant risk factor in regression analysis (HR: 1.24, 95%, CI: 1.08-1-43). Five-year disease-free survival rates of non-gastric and gastric GISTs were 62.3% and 90%, respectively (P = 0.044). Conclusion: Larger tumors and higher mitotic rates are more likely to develop recurrence. High Ki-67 levels were also associated with recurrence.
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Affiliation(s)
| | - Humeyra Gunel
- Department of Pathology, Istanbul Medeniyet University, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey
| | - Damla Beyazadam
- Department of General Surgery, Istanbul Medeniyet University, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey
| | - Mehmet S Ozsoy
- Department of General Surgery, Istanbul Medeniyet University, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey
| | - Orhan Alimoglu
- Department of General Surgery, Istanbul Medeniyet University, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey
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Hariswamy S, Alhayo S, Farooque Y. Splenic capsulitis associated with gastric
GIST. ANZ J Surg 2022; 93:1104-1105. [PMID: 36398382 DOI: 10.1111/ans.18139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/23/2022] [Accepted: 10/25/2022] [Indexed: 11/21/2022]
Affiliation(s)
- Soumya Hariswamy
- Upper Gastrointestinal Surgery Department Liverpool Hospital, SWSLHD Sydney New South Wales Australia
| | - Sam Alhayo
- Upper Gastrointestinal Surgery Department Liverpool Hospital, SWSLHD Sydney New South Wales Australia
| | - Yasser Farooque
- Upper Gastrointestinal Surgery Department Liverpool Hospital, SWSLHD Sydney New South Wales Australia
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9
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Yang Y, Sun D, Tang K. Primary extragastrointestinal stromal tumors of the prostate: A case report and literature review. Front Oncol 2022; 12:1038853. [DOI: 10.3389/fonc.2022.1038853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 10/12/2022] [Indexed: 11/10/2022] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are the main stromal tumors of the digestive tract. Extragastrointestinal stromal tumors (EGISTs) typically originate outside the gastrointestinal tract; are not associated with the stomach or intestinal walls; and are mainly derived from the mesentery, peritoneum, posterior peritoneum, bladder, and scrotum. However, EGISTs from the prostate are rare. Here, we present a case of EGIST that passed off in the prostate of a 62-year-old man. The patient undergoes transrectal guided trans-perineal prostate puncture, and pathological reports suggest a GIST. Tumor cells are spindle-shaped, and no obvious neoplastic necrosis is seen in the sections. Immunohistochemical results are robustly positive for CD117, DOG-1, and CD34 expression. The patient had a good prognosis after treatment with imatinib, no recurrence and no metastases after six months of follow-up, and the prognosis was good. This article also provides a literature review and discussion of the treatment of EGISTs.
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Qu H, Xu Z, Ren Y, Gong Z, Ju RH, Zhang F, Shao S, Chen X, Chen X. The analysis of prognostic factors of primary small intestinal gastrointestinal stromal tumors with R0 resection: A single-center retrospective study. Medicine (Baltimore) 2022; 101:e29487. [PMID: 35758385 PMCID: PMC9276149 DOI: 10.1097/md.0000000000029487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 05/05/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE We aim to assess factors that affect overall survival in patients with primary small intestinal gastrointestinal stromal tumors (GISTs) who had undergone R0 resection. METHOD A retrospective analysis reviewed the data of 82 consecutive confirmed GIST patients at a single medical center in China from January 2012 to June 2020. The survival curve was estimated using the Kaplan-Meier method, and independent prognostic factors were confirmed using the Cox regression model. RESULTS A total of 82 patients were included in the study: 42 men and 40 women, the mean age was 59 years old (23-83 years old). Tumors were commonly found in the jejunum (46.3%), ileum (20.7%), and duodenum (32.9%). The median tumor size was 6.0 cm (range: 1.0-15.0 cm). The number of mitoses per one 50 high-power field was used to define the mitotic rates. In our present study, 56 patients presented a mitotic rate ≤5 (68.3%) and 26 patients showed a rate >5 (31.7%) at the time of diagnosis. All patients accepted tumor resection without lymph node resection. The positivity rate was 97.6% for CD117, 96.3% for delay of germination 1, 65.9% for CD34, 6.1% for S-100, and 59.8% for smooth muscle actin using immunohistochemistry. Tumor size, tumor rupture, Ki67 index, mitotic index, and postoperative imatinib were independent prognostic factors for small intestinal GISTs. CONCLUSIONS In this study, larger tumor size, high Ki67 index, high mitotic index, the occurrence of tumor rupture, and use of imatinib were independent unfavorable prognostic indicators.
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Affiliation(s)
- Hui Qu
- Department of Hernia and Colorectal Surgery, The Second Hospital of Dalian Medical University, Dalian, People's Republic of China
- Dalian Medical University, Dalian, People's Republic of China
| | - ZhaoHui Xu
- Department of Hernia and Colorectal Surgery, The Second Hospital of Dalian Medical University, Dalian, People's Republic of China
- Dalian Medical University, Dalian, People's Republic of China
| | - YanYing Ren
- Department of Hernia and Colorectal Surgery, The Second Hospital of Dalian Medical University, Dalian, People's Republic of China
| | - ZeZhong Gong
- Department of Hernia and Colorectal Surgery, The Second Hospital of Dalian Medical University, Dalian, People's Republic of China
- Dalian Medical University, Dalian, People's Republic of China
| | - Ri Hyok Ju
- Department of Hernia and Colorectal Surgery, The Second Hospital of Dalian Medical University, Dalian, People's Republic of China
- Dalian Medical University, Dalian, People's Republic of China
| | - Fan Zhang
- Department of Hernia and Colorectal Surgery, The Second Hospital of Dalian Medical University, Dalian, People's Republic of China
| | - Shuai Shao
- Department of Hernia and Colorectal Surgery, The Second Hospital of Dalian Medical University, Dalian, People's Republic of China
| | - XiaoLiang Chen
- Department of Hernia and Colorectal Surgery, The Second Hospital of Dalian Medical University, Dalian, People's Republic of China
| | - Xin Chen
- Department of Hernia and Colorectal Surgery, The Second Hospital of Dalian Medical University, Dalian, People's Republic of China
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Chen TY, Xu JX, Chen WF, Li QL, Cai MY, Hu JW, Qin WZ, Ji Y, Xu XY, Zhang YQ, Zhou PH. Long-term prognosis of small gastric gastrointestinal stromal tumors with high histological grade: a longitudinal nested cohort study. Surg Endosc 2022; 36:4042-4049. [PMID: 35137258 DOI: 10.1007/s00464-021-08725-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 08/30/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND AND AIMS Gastrointestinal stromal tumors (GIST) are mostly seen in the stomach. Clinical data on GISTs ≤ 2 cm with > 5 mitosis/50 HPFs are limited. This study aimed to analyze small GISTs with high histological grades to gain a more comprehensive understanding of their clinical characteristics with long-term follow-up. METHODS This was a nested cohort study of patients with gastric GISTs ≤ 2 cm and > 5 mitosis/50 HPFs. Individuals with endoscopically resected gastric specimens diagnosed as GISTs between January 2008 and July 2019 were enrolled. We analyzed baseline clinicopathological characteristics, perioperative characteristics, risk of recurrence, and metastasis during follow-up. RESULTS A total of 55 patients diagnosed with gastric GISTs ≤ 2 cm and > 5 mitosis/50 HPFs were enrolled. The mean tumor size was 1.6 ± 0.4 cm (median 1.7 cm, range 0.8-2.0 cm). ESD was performed in 33 patients (60.0%) and EFTR in 22 patients (40.0%). Mean mitotic figures were 8.9/50 HPFs. Postoperative bleeding in one patient (1.8%) was the only severe adverse event. The mean follow-up period was 61.2 ± 33.9 months (median 53 months, range 13-133 months). Five patients (5/55, 9.1%) received additional therapies, including partial gastrectomy and adjuvant Imatinib. Only two patients (2/55, 3.6%) showed signs of recurrence. We observed no significant difference regarding baseline clinical characteristics and recurrence among GISTs with mitosis < 10/50 HPF and ≥ 10/50 HPF. No patient had signs of metastasis during follow-up. CONCLUSION Endoscopic resection of gastric GISTs ≤ 2 cm with > 5 mitosis/50 HPFs has a low risk of recurrence and metastasis in the long term. Endoscopic resection of GISTs is safe and feasible.
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Affiliation(s)
- Tian-Yin Chen
- Endoscopy Centre and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Jia-Xin Xu
- Endoscopy Centre and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Wei-Feng Chen
- Endoscopy Centre and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Quan-Lin Li
- Endoscopy Centre and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Ming-Yan Cai
- Endoscopy Centre and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Jian-Wei Hu
- Endoscopy Centre and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Wen-Zheng Qin
- Endoscopy Centre and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Yuan Ji
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiao-Yue Xu
- Endoscopy Centre and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Yi-Qun Zhang
- Endoscopy Centre and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
| | - Ping-Hong Zhou
- Endoscopy Centre and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
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Harhar M, Harouachi A, Akouh N, Atmani A, Aabdi H, Bouhout T, Bennani A, Serji B, EL Harroudi T. Gastrointestinal stromal tumor in the fourth portion of the duodenum does not express the CD117: A case report. Ann Med Surg (Lond) 2022; 77:103560. [PMID: 35637997 PMCID: PMC9142376 DOI: 10.1016/j.amsu.2022.103560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/27/2022] [Accepted: 03/27/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the digestive tract. Presentation of case 54-year-old woman with a history of phyllodes tumor of the left breast he patient was admitted to our hospital for management of retroperitoneal soft tissue tumor, attached to the fourth portion of the duodenum, opposite the head of the pancreas. The patient underwent a large excision of the tumor, the duodenojejunal flexure, and the third and fourth portions of the duodenum along with the head of the pancreas. The histopathological examination confirmed the presence of a spindlecell mesenchymal proliferation. These cells do not express CD117, but they express DOG1. A PDGFRA mutation was identified later. The final diagnosis was duodenal GIST. Discussion few cases of GIST in the fourth portion of the duodenum had been reported in the literature. PDGFRA mutation is identified as GISTs tumorigenesis to 15% of cases, and the diagnosis of GISTs is not based solely on the expression of the protein Kit. Conclusion the molecular biology examinations are very helpful in the direction of the correct diagnosis in case of negative staining for CD117.
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Affiliation(s)
- Marouane Harhar
- Surgical Oncology Department, Regional Oncology Center, Mohammed VI University Hospital, Oujda, Morocco
- Mohammed First University Oujda, Faculty of Medicine and Pharmacy Oujda, Oujda, Morocco
| | - Abdelhakim Harouachi
- Surgical Oncology Department, Regional Oncology Center, Mohammed VI University Hospital, Oujda, Morocco
- Mohammed First University Oujda, Faculty of Medicine and Pharmacy Oujda, Oujda, Morocco
| | - Nada Akouh
- Mohammed First University Oujda, Faculty of Medicine and Pharmacy Oujda, Oujda, Morocco
- Department of Pathology, Mohammed VI University Hospital, Oujda, Morocco
| | - Abderrahmane Atmani
- Surgical Oncology Department, Regional Oncology Center, Mohammed VI University Hospital, Oujda, Morocco
- Mohammed First University Oujda, Faculty of Medicine and Pharmacy Oujda, Oujda, Morocco
| | - Houssam Aabdi
- Surgical Oncology Department, Regional Oncology Center, Mohammed VI University Hospital, Oujda, Morocco
- Mohammed First University Oujda, Faculty of Medicine and Pharmacy Oujda, Oujda, Morocco
| | - Tariq Bouhout
- Surgical Oncology Department, Regional Oncology Center, Mohammed VI University Hospital, Oujda, Morocco
- Mohammed First University Oujda, Faculty of Medicine and Pharmacy Oujda, Oujda, Morocco
| | - Amal Bennani
- Mohammed First University Oujda, Faculty of Medicine and Pharmacy Oujda, Oujda, Morocco
- Department of Pathology, Mohammed VI University Hospital, Oujda, Morocco
| | - Badr Serji
- Surgical Oncology Department, Regional Oncology Center, Mohammed VI University Hospital, Oujda, Morocco
- Mohammed First University Oujda, Faculty of Medicine and Pharmacy Oujda, Oujda, Morocco
| | - Tijani EL Harroudi
- Surgical Oncology Department, Regional Oncology Center, Mohammed VI University Hospital, Oujda, Morocco
- Mohammed First University Oujda, Faculty of Medicine and Pharmacy Oujda, Oujda, Morocco
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Saito H, Kotake M, Ogawa J, Hashimoto M, Sawada K, Oshima M, Hada M, Kato Y, Oyama K, Hara T, Inaki N. Laparoscopic resection of a gastrointestinal stromal tumor that recurred more than 15 years after surgery using lighted ureteral catheters: A case report. Asian J Endosc Surg 2022; 15:397-400. [PMID: 34874113 DOI: 10.1111/ases.13018] [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] [Received: 08/11/2021] [Revised: 10/29/2021] [Accepted: 11/15/2021] [Indexed: 11/29/2022]
Abstract
A 69-year-old woman underwent abdominoperineal resection for a gastrointestinal stromal tumor (GIST) of the rectum 15 years ago. She received adjuvant chemotherapy for 8 years. Seven years later, abdominal computed tomography revealed a soft-tissue shadow in the left lower abdomen, and fluorodeoxyglucose uptake was observed at the same site on positron emission tomography. The recurrence of GIST was suspected, and laparoscopic resection was performed. Laparoscopy showed that the tumor was located at the retroperitoneum near to the descending colon and invaded the left ovarian vessels. It also made contact with the left ureter; however, lighted ureteral catheters enabled us to identify and preserve the left ureter. An immunohistochemical examination revealed the recurrence of GIST. Recurrence may become apparent 15 years or more after GIST surgery, and, thus, a long-term follow-up is required. Lighted ureteral catheters were useful for identifying the ureter and preventing ureteral injury in a recurrent case suspected of invading the ureter.
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Affiliation(s)
- Hiroshi Saito
- Department of Surgery, Koseiren Takaoka Hospital, Takaoka, Japan
| | - Masanori Kotake
- Department of Surgery, Koseiren Takaoka Hospital, Takaoka, Japan
| | - Jyunichi Ogawa
- Department of Surgery, Koseiren Takaoka Hospital, Takaoka, Japan
| | | | - Koichiro Sawada
- Department of Surgery, Koseiren Takaoka Hospital, Takaoka, Japan
| | - Masahiro Oshima
- Department of Surgery, Koseiren Takaoka Hospital, Takaoka, Japan
| | - Masahiro Hada
- Department of Surgery, Koseiren Takaoka Hospital, Takaoka, Japan
| | - Yosuke Kato
- Department of Surgery, Koseiren Takaoka Hospital, Takaoka, Japan
| | - Kaeko Oyama
- Department of Surgery, Koseiren Takaoka Hospital, Takaoka, Japan
| | - Takuo Hara
- Department of Surgery, Koseiren Takaoka Hospital, Takaoka, Japan
| | - Noriyuki Inaki
- Department of Gastrointestinal Surgery/Breast Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
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14
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The Diagnosis of Small Gastrointestinal Subepithelial Lesions by Endoscopic Ultrasound-Guided Fine Needle Aspiration and Biopsy. Diagnostics (Basel) 2022; 12:diagnostics12040810. [PMID: 35453857 PMCID: PMC9027519 DOI: 10.3390/diagnostics12040810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/21/2022] [Accepted: 03/23/2022] [Indexed: 12/02/2022] Open
Abstract
Endoscopic ultrasonography (EUS) has been widely accepted in the diagnosis of all types of tumors, especially pancreatic tumors, lymph nodes, and subepithelial lesions (SELs). One reason is that the examination can provide a detailed observation, with tissue samples being immediately obtained by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). Many SELs are detected incidentally during endoscopic examinations without symptoms. Most SELs are mesenchymal tumors originating from the fourth layer, such as gastrointestinal stromal tumors (GISTs), leiomyomas, and schwannomas. GISTs are potentially malignant. Surgical treatment is recommended for localized GISTs of ≥20 mm. However, the indications for the diagnosis and follow-up of GISTs of <20 mm in size are controversial. There are several reports on the rapid progression or metastasis of small GISTs. Therefore, it is important to determine whether a SEL is a GIST or not. The main diagnostic method is EUS-FNA. Recently, endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) using a new biopsy needle has been reported to obtain larger tissue samples. Additionally, various biopsy methods have been reported to have a high diagnostic rate for small GISTs. In local gastric SELs, regardless of the tumor size, EUS can be performed first; then, EUS-FNA/B or various biopsy methods can be used to obtain tissue samples for decision-making in relation to therapy and the follow-up period.
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15
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Extra gastrointestinal stromal tumor in the recto-vesical pouch: A case report and literature review. Ann Med Surg (Lond) 2022; 74:103283. [PMID: 35127068 PMCID: PMC8807970 DOI: 10.1016/j.amsu.2022.103283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 01/21/2022] [Accepted: 01/22/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Extra-gastrointestinal stromal tumors (EGISTs) are rare mesenchymal tumors located outside the gastrointestinal tract, and exhibit the same phenotypic and morphological profile of gastrointestinal stromal tumors (GISTs). Case report We report the case of a 20-year-old male patient consulted for chronic discomfort in the hypogastric region. Abdominal ultrasound and abdomino-pelvic CT scan identified a retro-vesical mass measuring 16 × 9 cm. He underwent an exploratory laparotomy and a total resection of the mass R0. The histopathological panel of the surgical specimen confirmed the diagnosis of EGIST. Clinical discussion The primary localization in the recto-vesical pouch of EGIST is a very rare entity. Their clinical and radiological presentations are unusual, and their definitive diagnosis is largely based on immunohistochemistry staining. Conclusion the origin of extra gastrointestinal stromal tumors EGIST can remain unclear. Extra gastrointestinal stromal tumors (EGISTs) are very rare primary entities that develop outside the digestive tract. Their primary localization in the recto-vesical pouch is a very rare entity. Their definitive diagnosis is largely based on immunohistochemistry staining. The only accepted treatment for non-metastatic EGISTs is a complete surgical resection.
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16
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Fujinaga A, Ohta M, Masuda T, Itai Y, Nakanuma H, Kawasaki T, Kawano Y, Hirashita T, Endo Y, Inomata M. Recurrence of gastric gastrointestinal stromal tumor 12 years after repeat hepatectomies for liver metastases: report of a case. Clin J Gastroenterol 2021; 14:1637-1641. [PMID: 34486081 DOI: 10.1007/s12328-021-01513-4] [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] [Received: 06/09/2021] [Accepted: 08/31/2021] [Indexed: 10/20/2022]
Abstract
No consensus has been reached on the postoperative treatment and follow-up duration for high-risk malignant gastrointestinal stromal tumor (GIST). We herein report a case of recurrent liver metastasis from gastric GIST in a patient who had been receiving adjuvant chemotherapy with imatinib mesylate for 10 years. A 78-year-old woman underwent local gastrectomy for a 20-cm gastric GIST with a mitotic index of 25/50 high-power fields (HPF) 17 years before. Partial hepatectomy for recurrent liver metastases was repeatedly performed 14 and 12 years before. After the second hepatectomy, postoperative adjuvant chemotherapy with imatinib mesylate was given for 10 years, during which no recurrence was observed. Two years after the completion of adjuvant chemotherapy, computed tomography revealed a 2-cm hepatic tumor; thus, laparoscopic partial hepatectomy was performed. Histopathological findings revealed a liver metastasis of gastric GIST with a mitotic count of 20/50 HPF and MIB-1 labeling index of 20%. Mutation analysis of the KIT gene revealed an exon 11 mutation. The patient is currently undergoing postoperative adjuvant chemotherapy with imatinib mesylate. The combination of surgery and long-term adjuvant chemotherapy for high-risk malignant GIST and liver metastases may be effective to achieve a good prognosis.
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Affiliation(s)
- Atsuro Fujinaga
- Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Oita, 879-5593, Japan.
| | - Masayuki Ohta
- Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Oita, 879-5593, Japan.,Global Oita Medical Advanced Research Center for Health, Oita University, Oita, Japan
| | - Takashi Masuda
- Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Oita, 879-5593, Japan
| | - Yusuke Itai
- Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Oita, 879-5593, Japan.,Department of Diagnostic Pathology, Faculty of Medicine, Oita University, Oita, Japan
| | - Hiroaki Nakanuma
- Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Oita, 879-5593, Japan
| | - Takahide Kawasaki
- Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Oita, 879-5593, Japan
| | - Yoko Kawano
- Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Oita, 879-5593, Japan
| | - Teijiro Hirashita
- Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Oita, 879-5593, Japan
| | - Yuichi Endo
- Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Oita, 879-5593, Japan
| | - Masafumi Inomata
- Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Oita, 879-5593, Japan
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17
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Yamamoto H, Ebihara Y, Tanaka K, Matsui A, Nakanishi Y, Asano T, Noji T, Kurashima Y, Murakami S, Nakamura T, Tsuchikawa T, Okamura K, Shichinohe T, Hirano S. Robot-assisted thoracoscopic esophagectomy for gastrointestinal stromal tumor of the esophagus: A case report. Int J Surg Case Rep 2021; 86:106335. [PMID: 34481133 PMCID: PMC8416945 DOI: 10.1016/j.ijscr.2021.106335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/15/2021] [Accepted: 08/21/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction A gastrointestinal stromal tumor (GIST) often arises in the stomach and small intestine, while esophageal GIST is rare. The first-choice treatment is surgical resection, but there is no standard technique. Herein, we describe our experience in the treatment of esophageal GIST and discuss the usefulness of robotic esophagectomy. Presentation of case The patient was a 60-year-old woman, who was diagnosed with a 30 mm GIST in the middle thoracic esophagus. We underwent robot-assisted thoracoscopic esophagectomy in the prone position. The duration of the thoracoscopic part was 69 min and the total operation time was 319 min. Total blood loss was 135 ml. The patient's postoperative course was uneventful after surgery and the patient was discharged home in good condition on the 18th postoperative day. Discussion The prognosis of esophageal GIST was less favorable compared with gastric GIST, and due to the anatomical peculiarities of the esophagus, which surgical procedure should be performed is still under debate. Robotic surgery has several technological advantages as it provides a three-dimensional view, ten times magnification, tremor control, and ambidexterity. Therefore, Robotic-assisted minimally invasive esophagectomy (RAMIE) allows achieving for safe R0 resection of esophageal GIST. Conclusion RAMIE may be useful for esophageal GIST because it facilitates safe and minimally invasive surgery in a limited space of the thoracic cavity. There is no standard technique due to the anatomical peculiarities of the esophagus. We think McKeown's procedure in the prone position has some advantages from others. Robot surgery has a three-dimensional view, tremor control, and ambidexterity. RAMIE would be useful techniques in a limited space of the thoracic cavity.
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Affiliation(s)
- Hiroyuki Yamamoto
- Department of Gastroenterological Surgery II, Hokkaido University Faculty School of Medicine, North 15 West 7, Kita-ku, Sapporo 0608638, Hokkaido, Japan.
| | - Yuma Ebihara
- Department of Gastroenterological Surgery II, Hokkaido University Faculty School of Medicine, North 15 West 7, Kita-ku, Sapporo 0608638, Hokkaido, Japan.
| | - Kimitaka Tanaka
- Department of Gastroenterological Surgery II, Hokkaido University Faculty School of Medicine, North 15 West 7, Kita-ku, Sapporo 0608638, Hokkaido, Japan
| | - Aya Matsui
- Department of Gastroenterological Surgery II, Hokkaido University Faculty School of Medicine, North 15 West 7, Kita-ku, Sapporo 0608638, Hokkaido, Japan
| | - Yoshitsugu Nakanishi
- Department of Gastroenterological Surgery II, Hokkaido University Faculty School of Medicine, North 15 West 7, Kita-ku, Sapporo 0608638, Hokkaido, Japan
| | - Toshimichi Asano
- Department of Gastroenterological Surgery II, Hokkaido University Faculty School of Medicine, North 15 West 7, Kita-ku, Sapporo 0608638, Hokkaido, Japan
| | - Takehiro Noji
- Department of Gastroenterological Surgery II, Hokkaido University Faculty School of Medicine, North 15 West 7, Kita-ku, Sapporo 0608638, Hokkaido, Japan.
| | - Yo Kurashima
- Department of Gastroenterological Surgery II, Hokkaido University Faculty School of Medicine, North 15 West 7, Kita-ku, Sapporo 0608638, Hokkaido, Japan
| | - Soichi Murakami
- Department of Gastroenterological Surgery II, Hokkaido University Faculty School of Medicine, North 15 West 7, Kita-ku, Sapporo 0608638, Hokkaido, Japan
| | - Toru Nakamura
- Department of Gastroenterological Surgery II, Hokkaido University Faculty School of Medicine, North 15 West 7, Kita-ku, Sapporo 0608638, Hokkaido, Japan
| | - Takahiro Tsuchikawa
- Department of Gastroenterological Surgery II, Hokkaido University Faculty School of Medicine, North 15 West 7, Kita-ku, Sapporo 0608638, Hokkaido, Japan
| | - Keisuke Okamura
- Department of Gastroenterological Surgery II, Hokkaido University Faculty School of Medicine, North 15 West 7, Kita-ku, Sapporo 0608638, Hokkaido, Japan
| | - Toshiaki Shichinohe
- Department of Gastroenterological Surgery II, Hokkaido University Faculty School of Medicine, North 15 West 7, Kita-ku, Sapporo 0608638, Hokkaido, Japan
| | - Satoshi Hirano
- Department of Gastroenterological Surgery II, Hokkaido University Faculty School of Medicine, North 15 West 7, Kita-ku, Sapporo 0608638, Hokkaido, Japan.
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18
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Lim J, Baeg MK, Ahn S, Ha MH, Ko SH, Kwon H, Han J. C-kit-negative Extragastrointestinal Stromal Tumor Originating in the Mesentery Misdiagnosed as an Ovarian Tumor before Surgery. THE KOREAN JOURNAL OF HELICOBACTER AND UPPER GASTROINTESTINAL RESEARCH 2021. [DOI: 10.7704/kjhugr.2020.0061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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A Case of Liver Metastasis from Small Intestinal Gastrointestinal Stromal Tumor 25 Years after Surgery including Autopsy Findings. Case Rep Gastrointest Med 2021; 2021:6642427. [PMID: 33680520 PMCID: PMC7929657 DOI: 10.1155/2021/6642427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/14/2021] [Accepted: 02/20/2021] [Indexed: 12/22/2022] Open
Abstract
Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor in the digestive tract. Recurrences may occur even after radical resection; however, recurrence later than 10 years after surgery is rare. We report a case of GIST with recurrence of liver metastasis 25 years after surgery. A 56-year-old man complained of sudden epigastric pain and was transferred to the emergency department. He had undergone partial resection of the small intestine for leiomyosarcoma 25 years previously. Abdominal computed tomography showed multiple liver tumors with massive hemorrhage. Ultrasound-guided percutaneous biopsy was performed for the 15-mm hepatic tumor in segment 2. Pathological findings revealed proliferation of spindle-shaped atypical cells, and immunostaining for c-kit and CD34 was both positive; the patient was therefore diagnosed with GIST. He then underwent chemotherapy for 7 years but died of multiple organ failure due to GIST. Autopsy revealed GIST occupying the entire liver with peritoneal dissemination, and minute lung metastases that could not be identified by CT were also detected. This case is interesting in considering the recurrence of GIST, and we will report it together with the literature review.
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20
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Diamantis A, Samara AA, Symeonidis D, Baloyiannis I, Vasdeki D, Tolia M, Volakakis G, Mavrovounis G, Tepetes K. Gastrointestinal stromal tumors (GISTs) and synchronous intra-abdominal malignancies: case series of a single institution's experience. Oncotarget 2020; 11:4813-4821. [PMID: 33447349 PMCID: PMC7779251 DOI: 10.18632/oncotarget.27853] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/08/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Gastrointestinal stromal tumors (GISTs) quite often co-exist with other primary tumors, as seen in up to 33% of cases. In the literature such occurrences have primarily been described through case reports and rarely through case series, which is not sufficient to prove if there is an association between these two entities. Materials and Methods: We conducted a retrospective study using medical and pathological records from sixty-nine patients who underwent surgical treatment for GIST in a single university surgical department between 2011 and 2019. Seven cases of GIST accompanying a synchronous primary tumor were identified and included in the study. Results: Survival analysis comparing the overall survival of patients with single GIST versus patients with concurrent GIST and another primary tumor, has shown no statistically significant difference between these two groups (p = 0.19). However, when comparing the recurrence rate, patients with synchronous GISTs and another primary tumor have a statistically significant increased possibility for recurrence (p = 0.02). Statistical analysis comparing the size of GISTs between the two groups has shown that patients with single GIST have larger tumors than patients with synchronous tumors (p = 0.048). Conclusions: The synchronous occurrence of GISTs and other intra-abdominal tumors is more common than previously considered, though it is not yet clear if there is a causal association for the concomitant occurrence. Further studies are required to elucidate the genetic and molecular mechanisms of carcinogenesis and progression associating GIST and synchronous tumors.
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Affiliation(s)
- Alexandros Diamantis
- Department of General Surgery, University Hospital of Larisa, Mezourlo, Larisa, Thessaly, Greece
| | - Athina A Samara
- Department of General Surgery, University Hospital of Larisa, Mezourlo, Larisa, Thessaly, Greece
| | - Dimitrios Symeonidis
- Department of General Surgery, University Hospital of Larisa, Mezourlo, Larisa, Thessaly, Greece
| | - Ioannis Baloyiannis
- Department of General Surgery, University Hospital of Larisa, Mezourlo, Larisa, Thessaly, Greece
| | - Dionysia Vasdeki
- Department of General Surgery, University Hospital of Larisa, Mezourlo, Larisa, Thessaly, Greece
| | - Maria Tolia
- Department of Radiotherapy/Radiation Oncology, Faculty of Medicine, School of Health Sciences, University of Crete, University Hospital of Heraklion, Crete, Greece
| | - Georgios Volakakis
- Department of General Surgery, University Hospital of Larisa, Mezourlo, Larisa, Thessaly, Greece
| | - Georgios Mavrovounis
- Department of General Surgery, University Hospital of Larisa, Mezourlo, Larisa, Thessaly, Greece.,Faculty of Medicine, University of Thessaly, Mezourlo, Larissa, Greece
| | - Konstantinos Tepetes
- Department of General Surgery, University Hospital of Larisa, Mezourlo, Larisa, Thessaly, Greece
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Suresh Babu MC, Chaudhuri T, Babu KG, Lakshmaiah KC, Lokanatha D, Jacob LA, Rudresha AH, Lokesh KN, Rajeev LK. Metastatic gastrointestinal stromal tumor: A regional cancer center experience of 44 cases. South Asian J Cancer 2020; 6:118-121. [PMID: 28975120 PMCID: PMC5615881 DOI: 10.4103/sajc.sajc_290_16] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract. Historically, a poor prognosis for metastatic disease has been reported with systemic chemotherapy. Significant advances have been made in the last decade, since the introduction of different tyrosine kinase inhibitors (TKIs). Unfortunately, even though the TKIs have been used for a long time, there are very few published data of the experience of TKI therapy in metastatic GIST from India. MATERIALS AND METHODS Patients diagnosed with metastatic GIST from January 2005 to October 2016 at our center, who received first-line therapy with imatinib 400 mg/day, were reviewed retrospectively. Patients' profile, response to treatment, toxicity of TKI therapy, time to progression, and survival were evaluated. RESULTS Of the 44 metastatic GIST patients, 23 (52.2%) were males. Median age at diagnosis was 48 years. The most common presenting symptom was an abdominal pain (52%), followed by weight loss (23%). Most frequently affected metastatic site was liver (57%), followed by peritoneum (16%), and lungs (4.5%). Metastases to both liver and peritoneum were found in 10 patients (22.5%). All patients were initially treated with imatinib at a dose of 400 mg/day. Disease stabilization was documented in 21 cases (48%), and 13 patients (29%) achieved a partial response. TKI therapy was well-tolerated in most cases. Median progression-free survival (PFS) was 26 months, and estimated median survival was 48 months. Patients with lung metastases have a significantly inferior median PFS and overall survival, in comparison to patients with other metastatic sites (P < 0.05). CONCLUSIONS Imatinib therapy was well tolerated and induced a sustained clinical benefit in more than half of the patients with metastatic GIST. Lung metastases seemed to be a poor prognostic factor in this patient population.
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Affiliation(s)
- M C Suresh Babu
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Tamojit Chaudhuri
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - K Govind Babu
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - K C Lakshmaiah
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - D Lokanatha
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Linu Abraham Jacob
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - A H Rudresha
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - K N Lokesh
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - L K Rajeev
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
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22
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Retrospective Comparison of Endoscopic Full-Thickness Versus Laparoscopic or Surgical Resection of Small (≤ 5 cm) Gastric Gastrointestinal Stromal Tumors. J Gastrointest Surg 2020; 24:2714-2721. [PMID: 31823317 DOI: 10.1007/s11605-019-04493-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 11/24/2019] [Indexed: 02/07/2023]
Abstract
AIM AND BACKGROUND The aim of this study was to compare the efficacy and safety between endoscopic full-thickness resection (EFR) and laparoscopic or surgical resection methods for gastric gastrointestinal stromal tumor (GIST) in size of 5.0 cm or less. Gastric GISTs are common, and resection is the most effective treatment. METHOD We retrospectively reviewed 216 resections of gastric GISTs in size of up to 5.0 cm at our center from 2009 to 2017.Eligible resection cases were divided into EFR (n = 85), laparoscopic(n = 64), and surgical (n = 67) groups. The clinical records, patient demographic, symptoms, perioperative data, pathological findings, and long-term follow-up outcomes were collected and compared statistically. RESULTS No tumor rupture or recurrence occurred in the three groups. The prevalence of complications was significantly lower in EFR (5.9%) than both laparoscopic (7.8%) and surgical group (16.4%) (P < 0.01). In EFR group, the R0 resection rate (95.3%) was significantly lower than in the laparoscopic group and surgical group (100%) (P < 0.001). The hospital cost (OR = 62.79, CI: 12.954-304.363, P < 0.0001) were significantly lower in the EFR than in the laparoscopic group. The hospital cost (OR = 39.032, CI: 8.045-189.371, P < 0.0001) and post-operative diet time (OR = 2.779, CI: 1.225-6.304, P < 0.05) were also significantly lower in the EFR than in the surgical group. CONCLUSION EFR was a feasible treatment for gastric GISTs of size of ≤ 5.0 cm with an acceptable complete resection rate. In addition, EFR had significantly fewer postoperative complications, shorter length of hospital stay, and lower cost.
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Application of A Convolutional Neural Network in The Diagnosis of Gastric Mesenchymal Tumors on Endoscopic Ultrasonography Images. J Clin Med 2020; 9:jcm9103162. [PMID: 33003602 PMCID: PMC7600226 DOI: 10.3390/jcm9103162] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/18/2020] [Accepted: 09/27/2020] [Indexed: 12/14/2022] Open
Abstract
Background and Aims: Endoscopic ultrasonography (EUS) is a useful diagnostic modality for evaluating gastric mesenchymal tumors; however, differentiating gastrointestinal stromal tumors (GISTs) from benign mesenchymal tumors such as leiomyomas and schwannomas remains challenging. For this reason, we developed a convolutional neural network computer-aided diagnosis (CNN-CAD) system that can analyze gastric mesenchymal tumors on EUS images. Methods: A total of 905 EUS images of gastric mesenchymal tumors (pathologically confirmed GIST, leiomyoma, and schwannoma) were used as a training dataset. Validation was performed using 212 EUS images of gastric mesenchymal tumors. This test dataset was interpreted by three experienced and three junior endoscopists. Results: The sensitivity, specificity, and accuracy of the CNN-CAD system for differentiating GISTs from non-GIST tumors were 83.0%, 75.5%, and 79.2%, respectively. Its diagnostic specificity and accuracy were significantly higher than those of two experienced and one junior endoscopists. In the further sequential analysis to differentiate leiomyoma from schwannoma in non-GIST tumors, the final diagnostic accuracy of the CNN-CAD system was 75.5%, which was significantly higher than that of two experienced and one junior endoscopists. Conclusions: Our CNN-CAD system showed high accuracy in diagnosing gastric mesenchymal tumors on EUS images. It may complement the current clinical practices in the EUS diagnosis of gastric mesenchymal tumors.
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Mago S, Pasumarthi A, Miller DR, Saade R, Tadros M. The Two Challenges in Management of Gastric Glomus Tumors. Cureus 2020; 12:e9251. [PMID: 32821597 PMCID: PMC7430658 DOI: 10.7759/cureus.9251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Gastric glomus tumors (GGTs) are rare gastrointestinal lesions originating from the neuromuscular arterial canal or vascular lumen which share many overlapping features with other stromal lesions. Despite most cases of GGTs being benign, there is a lack of reliable histological features predictive of tumor behavior. We present a case of a 42-year-old male who was determined to have a GGT via histological diagnosis and underwent surgical wedge resection. This case highlights the importance of establishing an accurate diagnosis and the various factors that must be taken into consideration to best determine malignant potential and management options.
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Affiliation(s)
- Sheena Mago
- Internal Medicine, University of Connecticut Health Center, Farmington, USA
| | | | | | - Rayan Saade
- Pathology, Albany Medical Center, Albany, USA
| | - Micheal Tadros
- Gastroenterology and Hepatology, Albany Medical Center, Albany, USA
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25
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Lee MW, Kim GH. Diagnosing Gastric Mesenchymal Tumors by Digital Endoscopic Ultrasonography Image Analysis. Clin Endosc 2020; 54:324-328. [PMID: 32549523 PMCID: PMC8182255 DOI: 10.5946/ce.2020.061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 04/02/2020] [Indexed: 12/13/2022] Open
Abstract
Gastric mesenchymal tumors (GMTs) are incidentally discovered in national gastric screening programs in Korea. Endoscopic ultrasonography (EUS) is the most useful diagnostic modality for evaluating GMTs. The differentiation of gastrointestinal stromal tumors from benign mesenchymal tumors, such as schwannomas or leiomyomas, is important to ensure appropriate clinical management. However, this is difficult and operator dependent because of the subjective interpretation of EUS images. Digital image analysis computes the distribution and spatial variation of pixels using texture analysis to extract useful data, enabling the objective analysis of EUS images and decreasing interobserver and intraobserver agreement in EUS image interpretation. This review aimed to summarize the usefulness and future of digital EUS image analysis for GMTs based on published reports and our experience.
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Affiliation(s)
- Moon Won Lee
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Gwang Ha Kim
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
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26
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Zheng L, Ding W, Zhou D, Lu L, Yao L. Laparoscopic versus Open Resection for Gastric Gastrointestinal Stromal Tumors: A Meta-analysis. Am Surg 2020. [DOI: 10.1177/000313481408000124] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
We conducted our meta-analysis to compare outcomes between laparoscopic resection and open resection for gastric gastrointestinal stromal tumors (GISTs) from all published comparative studies in the literature. Databases, including PubMed, Embase, Cochrane Library, Ovid, Web of Science, and CNKI, were searched to identify studies comparing outcomes after laparoscopic resection and open resection for gastric GISTs. The meta-analysis was performed by RevMan 5.1. Eleven comparative studies comprising 495 patients were identified. Patients undergoing laparoscopic resection of gastric GISTs were found to have similar operative time (weighted mean difference [WMD], 2.29; 95% confidence interval [CI], -16.01 to 11.43; P = 0.74) and complications rate (odds ratio [OR], 0.76; 95% CI, 0.36 to 1.58; P = 0.46). Less intraoperative blood loss (WMD, -55.91; 95% CI, -90.26 to -21.56; P = 0.001), earlier passing first flatus (WMD, -0.89, 95% CI, -1.60 to -0.18; P = 0.01), earlier having the first liquid diet (WMD, -1.54; 95% CI, -2.44 to -0.64; P = 0.0008), and shorter hospital stay (WMD, -4.25; 95% CI, -5.63 to -2.88; P < 0.00001) were observed in the laparoscopic resection group. The recurrence rate was higher in the group of open resection compared with the group of laparoscopic resection (OR, 0.26; 95% CI, 0.09 to 0.75; P = 0.01). Laparoscopic resection is safe and efficient in the treatment of patients with gastric GISTs as compared with open resection procedure. Laparoscopic resection may be a preferred treatment for gastric GISTs.
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Affiliation(s)
- Lijun Zheng
- Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University, Shanghai, P.R. China
| | - Weixing Ding
- Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University, Shanghai, P.R. China
| | - Donglei Zhou
- Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University, Shanghai, P.R. China
| | - Liesheng Lu
- Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University, Shanghai, P.R. China
| | - Le Yao
- Department of General Surgery, Shanghai Tenth People's Hospital, Tongji University, Shanghai, P.R. China
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Calderillo G, Muñoz-Medel M, Carbajal E, Córdova-Delgado M, Durán D, Retamal IN, Fernández P, Espinoza A, Salas R, de la Paz Mastretta M, Galindo H, Nervi B, Madrid J, Sánchez C, Ibáñez C, Peña J, Mondaca S, Acevedo F, Koch E, Pinto MP, Garrido M. Retrospective Analysis of Chilean and Mexican GI Stromal Tumor Registries: A Tale of Two Latin American Realities. JCO Glob Oncol 2020; 6:647-657. [PMID: 32324433 PMCID: PMC7193802 DOI: 10.1200/jgo.19.00410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Like other malignancies, GI stromal tumors (GIST) are highly heterogeneous. This not only applies to histologic features and malignant potential, but also to geographic incidence rates. Several studies have reported GIST incidence and prevalence in Europe and North America. In contrast, GIST incidence rates in South America are largely unknown, and only a few studies have reported GIST prevalence in Latin America. PATIENTS AND METHODS Our study was part of a collaborative effort between Chile and Mexico, called Salud con Datos. We sought to determine GIST prevalence and patients' clinical characteristics, including survival rates, through retrospective analysis. RESULTS Overall, 624 patients were included in our study. Our results found significant differences between Mexican and Chilean registries, such as stage at diagnosis, primary tumor location, CD117-positive immunohistochemistry status, mitotic index, and tumor size. Overall survival (OS) times for Chilean and Mexican patients with GIST were 134 and 156 months, respectively. No statistically significant differences in OS were detected by sex, age, stage at diagnosis, or recurrence status in both cohorts. As expected, patients categorized as being at high risk of recurrence displayed a trend toward poorer progression-free survival in both registries. CONCLUSION To the best of our knowledge, this is the largest report from Latin America assessing the prevalence, clinical characteristics, postsurgery risk of recurrence, and outcomes of patients with GIST. Our data confirm surgery as the standard treatment of localized disease and confirm a poorer prognosis in patients with regional or distant disease. Finally, observed differences between registries could be a result of registration bias.
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Affiliation(s)
- Germán Calderillo
- Gastroenterology Oncology Chief Division, National Cancer Institute, México City, México
| | - Matías Muñoz-Medel
- Department of Hematology and Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Miguel Córdova-Delgado
- Department of Hematology and Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Doris Durán
- Faculty of Medicine and Science, Universidad San Sebastián, Santiago, Chile
| | - Ignacio N Retamal
- Department of Hematology and Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.,Faculty of Dentistry, Universidad de los Andes, Santiago, Chile
| | | | - Absalón Espinoza
- Instituto Médico del Seguro Social-Unidad Médica de Alta Especialidad No. 25, Monterrey, México
| | - Rodrigo Salas
- Fundación GIST México, San Pedro Garza García, México
| | | | - Héctor Galindo
- Department of Hematology and Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Bruno Nervi
- Department of Hematology and Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jorge Madrid
- Department of Hematology and Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cesar Sánchez
- Department of Hematology and Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carolina Ibáñez
- Department of Hematology and Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - José Peña
- Department of Hematology and Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sebastián Mondaca
- Department of Hematology and Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francisco Acevedo
- Department of Hematology and Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Erica Koch
- Department of Hematology and Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Mauricio P Pinto
- Department of Hematology and Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Marcelo Garrido
- Department of Hematology and Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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Merev E, Cicin I. Effect of clinical and pathological features of gastrointestinal stromal tumors on overall survival and prognosis: Single center experience. JOURNAL OF ONCOLOGICAL SCIENCES 2019. [DOI: 10.1016/j.jons.2019.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Abstract
Extragastrointestinal stromal tumors (EGISTs) comprise a small portion of gastrointestinal stromal tumors. Metastasis normally occurs to nearby organs. However, metastasis to the lungs is uncommon in EGISTs. Furthermore, recurrence of the EGIST in a new location years later has not been documented. We present this case to highlight this behavior of EGISTs in hopes to better understand this rare type of neoplasm.
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Fujimoto G, Osada S. Duodenojejunal intussusception secondary to primary gastrointestinal stromal tumor: A case report. Int J Surg Case Rep 2019; 64:15-19. [PMID: 31590135 PMCID: PMC6796759 DOI: 10.1016/j.ijscr.2019.09.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 09/19/2019] [Accepted: 09/24/2019] [Indexed: 01/18/2023] Open
Abstract
Gastrointestinal stromal tumor (GIST) in the third portion of the duodenum is rare. Intussusception and obstruction caused by GIST are uncommon. Adult intussusception usually requires surgical resection. If the location, tumor size, and resection margin of duodenal GIST are adequate for limited resection, it seems to be better than pancreaticoduodenectomy. Elderly patients can have improved quality of life with minimally invasive surgery.
Introduction Gastrointestinal stromal tumors (GISTs) in the third portion of the duodenum are rare. Intussusception and obstruction are rarely caused by GISTs because of their tendency to grow in an extraluminal manner. Herein, we report a case involving segmental duodenectomy in a patient with duodenojejunal intussusception secondary to a primary GIST. Presentation of case A 91-year-old woman with a history of iron-deficiency anemia presented with vomiting and anorexia. Preoperative imaging suggested duodenojejunal intussusception secondary to a GIST in the third portion of the duodenum. Segmental duodenectomy with end-to-end duodenojejunostomy without reduction of the intussusception was performed. At 6 months after the surgery, the patient’s anemia had improved and she had no abdominal symptoms. Discussion Adult intussusception requires surgical resection because most of the patients have intraluminal lesions. The location in relation to the Vater papilla, tumor size, and resection margin should be considered when selecting the type of surgical resection for duodenal GIST. Limited resection appears to be better than pancreaticoduodenectomy with respect to postoperative complications. Considering the age and performance status of this patient, a less invasive maneuver was selected. Conclusion Duodenal GISTs can be a rare cause of intussusception. Thus, a limited surgical resection procedure should be considered in such cases.
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Affiliation(s)
- Goshi Fujimoto
- Department of Gastroenterological Surgery, Ofuna Chuo Hospital, Postal address: 6-2-24, Ofuna, Kamakura, Kanagawa 247-0056, Japan.
| | - Shunichi Osada
- Department of Gastroenterological Surgery, Ofuna Chuo Hospital, Postal address: 6-2-24, Ofuna, Kamakura, Kanagawa 247-0056, Japan.
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Mara D, Sylla M, Ly S, Soumana ID, Alami B, Maâroufi M, Maazaz K, Lamrani YA. [Multiple gastrointestinal stromal masses in the small bowel detected in a patient with peritonitis]. Pan Afr Med J 2019; 33:102. [PMID: 31489080 PMCID: PMC6711688 DOI: 10.11604/pamj.2019.33.102.17240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 10/07/2018] [Indexed: 11/22/2022] Open
Abstract
Nous rapportons une observation d'un cas de tumeur stromale gastro-intestinale à localisation multiple au niveau du grêle découverte dans un contexte de péritonite. La particularité de ce cas tient à la découverte en per-opératoire de masses tumorales multifocales grêliques, évoquant à la tomodensitométrie en post opératoire des tumeurs stromales gastro-intestinales. Ce tableau clinique de péritonite ne permettait en aucun cas d'évoquer une origine tumorale.
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Affiliation(s)
- Dondo Mara
- Service de Radiologie, CHU Hassan II Fès, Maroc
| | - Moussa Sylla
- Service de Chirurgie Viscérale, CHU Hassan II Fès, Maroc
| | - Seydou Ly
- Service de Radiologie, CHU Hassan II Fès, Maroc
| | | | - Badr Alami
- Service de Radiologie, CHU Hassan II Fès, Maroc
| | | | - Khalid Maazaz
- Service de Chirurgie Viscérale, CHU Hassan II Fès, Maroc
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Lee MW, Kim GH, Kim KB, Kim YH, Park DY, Choi CI, Kim DH, Jeon TY. Digital image analysis-based scoring system for endoscopic ultrasonography is useful in predicting gastrointestinal stromal tumors. Gastric Cancer 2019; 22:980-987. [PMID: 30778798 DOI: 10.1007/s10120-019-00928-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 01/18/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND When gastric mesenchymal tumors (GMTs) measuring 2-5 cm in size are found, whether to undergo further treatment or not is controversial. Endoscopic ultrasonography (EUS) is useful for the evaluation of malignant potential of GMTs, but has limitations, such as subjective interpretation of EUS images. Therefore, we aimed to develop a scoring system based on the digital image analysis of EUS images to predict gastrointestinal stromal tumors (GISTs). METHODS We included 103 patients with histopathologically proven GIST, leiomyoma or schwannoma on surgically resected specimen who underwent EUS examination between January 2007 and June 2018. After standardization of the EUS images, brightness values, including the mean (Tmean), indicative of echogenicity, and the standard deviation (TSD), indicative of heterogeneity, in the tumors were analyzed. RESULTS Age, Tmean, and TSD were significantly higher in GISTs than in non-GISTs. The sensitivity and specificity were almost optimized for differentiating GISTs from non-GISTs when the critical values of age, Tmean, and TSD were 57.5 years, 67.0, and 25.6, respectively. A GIST-predicting scoring system was created by assigning 3 points for Tmean ≥ 67, 2 points for age ≥ 58 years, and 1 point for TSD ≥ 26. When GMTs with 3 points or more were diagnosed as GISTs, the sensitivity, specificity, and accuracy of the scoring system were 86.5%, 75.9%, and 83.5%, respectively. CONCLUSIONS The scoring system based on the information of digital image analysis is useful in predicting GISTs in case of GMTs that are 2-5 cm in size.
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Affiliation(s)
- Moon Won Lee
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-ro, Seo-Gu, Busan, 49241, South Korea
| | - Gwang Ha Kim
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-ro, Seo-Gu, Busan, 49241, South Korea.
| | - Kwang Baek Kim
- Division of Computer Engineering, Silla University, Busan, South Korea
| | - Yoon Ho Kim
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-ro, Seo-Gu, Busan, 49241, South Korea
| | - Do Youn Park
- Department of Pathology, Pusan National University School of Medicine, Busan, South Korea
| | - Chang In Choi
- Department of Surgery, Pusan National University School of Medicine, Busan, South Korea
| | - Dae Hwan Kim
- Department of Surgery, Pusan National University School of Medicine, Busan, South Korea
| | - Tae Yong Jeon
- Department of Surgery, Pusan National University School of Medicine, Busan, South Korea
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Sasmal PK, Sharma R, Patra S, Mishra TS, Mishra P, Rout B. Malignant Extra-Gastrointestinal Stromal Tumor of the Mesentery. Surg J (N Y) 2019; 5:e65-e68. [PMID: 31380468 PMCID: PMC6675587 DOI: 10.1055/s-0039-1693040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 05/31/2019] [Indexed: 01/20/2023] Open
Abstract
Gastrointestinal stromal tumors (GISTs), the commonest mesenchymal tumors of gastrointestinal tract are often described to take origin from the interstitial cells of Cajal (ICC) or its precursor cells. Rarely these tumors do arise in structures other than the alimentary tract like omentum, mesentery, retroperitoneum, etc., of varying malignant potential and are known as extra-gastrointestinal stromal tumors (eGISTs). This is a case report of a 70-year-old female with multicentric malignant eGISTs arising in the mesentery of ileum. On laparotomy, a large mass of 20 × 15 cm was found in the small bowel mesentery without involvement of the adjacent ileum, with multiple other small nodules resembling lymph nodes, present adjacent to it. Histopathological study of the excised lump, confirmed the mass to be malignant eGIST without involvement of the adjacent ileum, with cluster differentiation (CD)117 positive and of high-risk stratification. The mesenteric nodule was confirmed on histopathology to be malignant eGIST, similar to that of that of the primary, without any lymphoid tissue. Adjuvant imatinib mesylate treatment was started immediately postoperation with the patient doing well at 1 year of follow-up. We report this case, due to the rare occurrence of multifocal malignant eGISTS of small bowel mesentery, which is yet to be reported. The existing literature is unclear regarding the clinicopathology and management of multifocal malignant stromal tumors of the mesentery.
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Affiliation(s)
- Prakash K Sasmal
- Department of General Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Rakesh Sharma
- Department of General Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Susama Patra
- Department of Pathology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Tushar S Mishra
- Department of General Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Pritinanda Mishra
- Department of Pathology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Bikram Rout
- Department of General Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Ihara Y, Torisu T, Moriyama T, Umeno J, Hirano A, Okamoto Y, Hori Y, Yamamoto H, Kitazono T, Esaki M. Endoscopic features of gastrointestinal stromal tumor in the small intestine. Intest Res 2019; 17:398-403. [PMID: 31352775 PMCID: PMC6667370 DOI: 10.5217/ir.2018.00161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 04/19/2019] [Indexed: 12/12/2022] Open
Abstract
Background/Aims Gastrointestinal stromal tumor (GIST) is one of the most common types of submucosal tumors (SMTs). Because of GIST’s malignant potential, it is crucial to differentiate it from other SMTs. The present study aimed to identify characteristic endoscopic findings of GISTs in the small intestine. Methods We reviewed the clinicopathological and endoscopic findings of 38 patients with endoscopically or surgically resected SMTs in the small intestine. SMTs were classified into GIST and non-GIST groups, and clinicopathological and endoscopic findings were compared between the 2 groups. Results Fifteen patients had GIST and 23 patients had other types of SMTs in the small intestine. Comparison of the endoscopic findings between the 2 groups revealed that dilated vessels in the surrounding mucosa were significantly more in number in the GIST group than in the non-GIST group (P<0.05). However, there were no other differences in endoscopic findings between the 2 groups. Among patients with GISTs, the presence of dilated vessels in the surrounding mucosa was not associated with bleeding risk, tumor size, or metastasis rate at diagnosis. Conclusions Dilated vessels in the surrounding mucosa, identified during balloon-assisted endoscopy, may be a diagnostic indicator for GIST in the small intestine. However, its clinical significance should be further analyzed.
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Affiliation(s)
- Yutaro Ihara
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takehiro Torisu
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomohiko Moriyama
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Junji Umeno
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Atsushi Hirano
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasuharu Okamoto
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshifumi Hori
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hidetaka Yamamoto
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Motohiro Esaki
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Endoscopic Diagnostics and Therapeutics, Saga University Hospital, Saga, Japan
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Mazzocca A, Napolitano A, Silletta M, Spalato Ceruso M, Santini D, Tonini G, Vincenzi B. New frontiers in the medical management of gastrointestinal stromal tumours. Ther Adv Med Oncol 2019; 11:1758835919841946. [PMID: 31205499 PMCID: PMC6535752 DOI: 10.1177/1758835919841946] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 03/13/2019] [Indexed: 12/11/2022] Open
Abstract
The tyrosine kinase inhibitor (TKI) imatinib has radically changed the natural history of KIT-driven gastrointestinal stromal tumours (GISTs). Approved second-line and third-line medical therapies are represented by the TKIs sunitinib and regorafenib, respectively. While imatinib remains the cardinal drug for patients with GISTs, novel therapies are being developed and clinically tested to overcome the mechanisms of resistance after treatments with the approved TKI, or to treat subsets of GISTs driven by rarer molecular events. Here, we review the therapy of GISTs, with a particular focus on the newest drugs in advanced phases of clinical testing that might soon change the current therapeutic algorithm.
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Affiliation(s)
| | | | | | | | | | | | - Bruno Vincenzi
- Medical Oncology, Università Campus Bio-Medico, Via Alvaro del Portillo 200, Rome, Italy
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Abstract
Once a pelvic mass is identified on an ultrasound examination, the first step in the differential diagnostic work up is to determine its origin. Most lateral pelvic masses in women are ovarian in origin, and the distinction between ovarian and nonovarian mimics of ovarian cancer is critical for appropriate clinical and surgical management. Adnexal masses detected on ultrasound can be further characterized by magnetic resonance imaging (MRI) when needed. Superior contrast resolution, multiplanar imaging, characteristic signal intensity of common pathology such as dermoid tumors or endometriomas allows one to accurately evaluate adnexal tumors with supplemental use of MRI. Commonly encountered extraovarian abnormalities that mimic ovarian malignancies are categorized as being either predominantly cystic or solid. The common causes of such extraovarian lesions that mimic ovarian pathology include fallopian tube diseases, paroaovarian cysts, peritoneal inclusion cysts, and a pedunculated or a broad ligament fibroid. Less common causes of cystic and solid nonovarian mimics of ovarian malignancy include mucocele of the appendix, lymphocele, spinal meningeal cysts, extraovarian endometriomas, extraovarian fibrothecomas, and gastrointestinal stromal tumors (Table 1). Identifying a normal appearing ovary is the key in distinguishing an extraovarian pelvic mass from an ovarian tumor. This becomes particularly challenging in postmenopausal women with atrophic ovaries. In this scenario, MRI comes into use by identifying small atrophic ovaries more often than ultrasound is able to. Extraovarian lesions typically displace the pelvic sidewall vasculature medially, ureters tend to be compressed, encased or medially displaced, enhancement matches pelvic arteries and may be associated with engorged mesenteric vessels compared to gonadal vessel engorgement seen with ovarian tumors.
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Chen T, Xu L, Ye L, Qiu H, Hu Y, Liu H, Zhou Z, Li G, Yu J. A new nomogram for recurrence-free survival prediction of gastrointestinal stromal tumors: Comparison with current risk classification methods. Eur J Surg Oncol 2018; 45:1109-1114. [PMID: 30594406 DOI: 10.1016/j.ejso.2018.12.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 12/08/2018] [Accepted: 12/19/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND This study aimed to build a new risk stratification nomogram for gastrointestinal stromal tumors (GISTs) focused on a popular factor Ki-67 to enable individualized and precise predictions of the most suitable candidates for imatinib therapy. METHODS We retrospectively collected clinicopathologic data of the patients diagnosed with GISTs from January 1998 to December 2015 at Southern Medical University Nanfang Hospital as the experiment group. And patients with GISTs at the Sun Yat-sen University Cancer Center from January 2007 to December 2012 were included as the validation group. The nomogram was built using Kaplan-Meier method and the Cox proportional hazards regression model. The receiver operating characteristic (ROC) curves were established to compare the discriminative ability of the new nomogram with other risk stratification systems, including the modified National Institute of Health (modified NIH) criteria, Armed Forces Institute of Pathology (AFIP) criteria, Memorial Sloan Kettering Cancer Center (MSKCC) prognostic nomogram, and contour maps. RESULTS In univariate analysis, the tumor size, site, mitotic count, tumor rupture and Ki-67 labeling index were significant factors (all P < 0.05) and included in the Cox model to build our nomogram. According to the ROC curve, our new nomogram showed the largest AUC value (0.778) compared with that of the other classification methods (contour maps, AUC = 0.743; AFIP, AUC = 0.719; MSKCC, AUC = 0.712; and modified NIH, AUC = 0.719). CONCLUSION Our new nomogram exhibits an excellent performance and might become a potential risk stratification to support therapeutic decision-making for GISTs.
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Affiliation(s)
- Tao Chen
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangdong Provincial Engineering Technology Research Center of Minimally Invasive Surgery, Guangzhou, 510515, Guangdong Province, China.
| | - Lili Xu
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangdong Provincial Engineering Technology Research Center of Minimally Invasive Surgery, Guangzhou, 510515, Guangdong Province, China
| | - Liangying Ye
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangdong Provincial Engineering Technology Research Center of Minimally Invasive Surgery, Guangzhou, 510515, Guangdong Province, China
| | - Haibo Qiu
- Department of Gastric Surgery, Sun Yat-sen University Cancer Center, Sun Yat-sen University, Guangzhou, 510060, Guangdong Province, China
| | - Yanfeng Hu
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangdong Provincial Engineering Technology Research Center of Minimally Invasive Surgery, Guangzhou, 510515, Guangdong Province, China
| | - Hao Liu
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangdong Provincial Engineering Technology Research Center of Minimally Invasive Surgery, Guangzhou, 510515, Guangdong Province, China
| | - Zhiwei Zhou
- Department of Gastric Surgery, Sun Yat-sen University Cancer Center, Sun Yat-sen University, Guangzhou, 510060, Guangdong Province, China
| | - Guoxin Li
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangdong Provincial Engineering Technology Research Center of Minimally Invasive Surgery, Guangzhou, 510515, Guangdong Province, China
| | - Jiang Yu
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangdong Provincial Engineering Technology Research Center of Minimally Invasive Surgery, Guangzhou, 510515, Guangdong Province, China.
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Kaneko M, Emoto S, Murono K, Sonoda H, Hiyoshi M, Sasaki K, Shuno Y, Nishikawa T, Tanaka T, Hata K, Kawai K, Nozawa H. Neoadjuvant imatinib therapy in rectal gastrointestinal stromal tumors. Surg Today 2018; 49:460-466. [DOI: 10.1007/s00595-018-1737-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 10/20/2018] [Indexed: 02/09/2023]
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Villano AM, Lofthus A, Watson TJ, Haddad NG, Marshall MB. Minimally Invasive Intragastric Approach to Gastroesophageal Junction Disease. Ann Thorac Surg 2018; 107:412-417. [PMID: 30315795 DOI: 10.1016/j.athoracsur.2018.08.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 08/02/2018] [Accepted: 08/20/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND A minimally invasive intragastric approach to the gastroesophageal junction (GEJ) allows resection of intramural disease while avoiding disruption of the lower esophageal sphincter and vagus nerves. Few surgeons use this approach; thus little is known regarding its indications, feasibility, technical aspects, complication profile, and long-term outcomes. This study reviewed the experience with this technique. METHODS A retrospective review was performed of a prospectively maintained, Institutional Review Board-approved database covering the period from January 1, 2005 to August 1, 2017. Indications, operative details, postoperative complications, and outcomes were assessed. RESULTS There were 12 patients identified. The mean age of these patients was 51.9 years. The indications for resection included 10 symptomatic leiomyomas, one gastrointestinal stromal tumor, and three cancers of the GEJ. Mean and median length of stay were 4.9 and 2.5 days, respectively. There were two postoperative esophageal leaks managed with laparoscopic repair. Of the 3 patients with cancer, 2 underwent an R0 resection, whereas 1 patient underwent an R1 resection. There were no other complications or recurrences. Mean follow-up was 6.0 years (range, 0.5 to 12.6 years); no patients had stricture or symptomatic gastroesophageal reflux on long term follow-up. CONCLUSIONS Resection of selected intramural GEJ disorders through a minimally invasive transgastric approach can be performed safely with acceptable morbidity and good long-term results. The approach allows preservation of the lower esophageal sphincter and vagus nerves, a potential advantage compared with other surgical alternatives to resection in this region.
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Affiliation(s)
- Anthony M Villano
- Department of Surgery, MedStar-Georgetown University Hospital, Washington, DC.
| | - Alexander Lofthus
- Department of Surgery, MedStar-Georgetown University Hospital, Washington, DC
| | - Thomas J Watson
- Department of Thoracic Surgery, MedStar-Georgetown University Hospital, Washington, DC; Regional Department of Surgery and Thoracic Surgery, MedStar Health, Washington, DC
| | - Nadim G Haddad
- Department of Gastroenterology, MedStar-Georgetown University Hospital Washington, DC
| | - M Blair Marshall
- Department of Surgery, MedStar-Georgetown University Hospital, Washington, DC; Department of Thoracic Surgery, MedStar-Georgetown University Hospital, Washington, DC
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Gönüllü D, Demiray O, İlgün S, Yıldız UM, Gedik ML, Er M, İğdem A, Kimiloglu E, Köksoy FN. Gastrointestinal stromal tumors: A clinical and histopathological presentation of 27 cases. Turk J Surg 2018; 34:259-263. [PMID: 30248289 PMCID: PMC6340664 DOI: 10.5152/turkjsurg.2018.4019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 02/07/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors that express type 3 tyrosine kinase receptors and are thought to develop from the neoplastic transformation of the interstitial Cajal cells. The present study was performed to morphologically and immunohistologically evaluate GISTs, to compare their qualities using a GIST risk categorization system, and to identify the diagnostic and prognostic parameters of GISTs. MATERIAL AND METHODS A total of 27 patients with GISTs underwent treatment and were followed up at the Gaziosmanpaşa Taksim Training and Research Hospital. Descriptive statistics was used to calculate the mean and median values. Survival analysis was performed by the Kaplan-Meier method. The analyses were performed using the SPSS version 22.0 software. RESULTS The mean follow-up time was 3.5 (5 months to 13 years) years. The mean age was 60.4 (29-82) years. The tumors were localized in the stomach (62.9%), extraintestinal areas (14.8%), intestine (7.4%), esophagus (7.4%), and rectum (7.4%). Twenty-four patients were classified according to the Fletcher system. Of these patients, 7 (25.9%) were classified as very low risk, 8 (29.6%) as low risk, 7 (25.9%) as intermediate risk, and 2 (7.4%) as high risk. Twenty-four patients underwent surgery. Of the 3 patients who did not undergo surgery, 1 had metastatic disease at the time of diagnosis, and 2 had mini- or micro-GISTs in the stomach. On endoscopic surveillance, all tumors remained stable. Three out of the 27 patients were lost to follow-up. Two patients developed recurrence, and 1 patient died of GIST. CONCLUSION We analyzed the clinical and pathological characteristics of GIST. The most common site of tumor origin was the stomach. The size, mitotic index, and Ki-67 values were to be found high in intermediate- and high-risk groups and metastatic diseases.
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Affiliation(s)
- Doğan Gönüllü
- Department of General Surgery, University of Health Sciences, Gaziosmanpaşa Taksim Training and Research Hospital, İstanbul, Turkey
| | - Okan Demiray
- Department of General Surgery, University of Health Sciences, Gaziosmanpaşa Taksim Training and Research Hospital, İstanbul, Turkey
| | - Serkan İlgün
- Department of General Surgery, University of Health Sciences, Gaziosmanpaşa Taksim Training and Research Hospital, İstanbul, Turkey
| | - Ufuk Mete Yıldız
- Department of General Surgery, University of Health Sciences, Gaziosmanpaşa Taksim Training and Research Hospital, İstanbul, Turkey
| | - Mehmet Lari Gedik
- Department of General Surgery, Ministry of Health, Fatsa State Hospital, Ordu, Turkey
| | - Muzaffer Er
- Department of General Surgery, University of Health Sciences, Gaziosmanpaşa Taksim Training and Research Hospital, İstanbul, Turkey
| | - Ayşenur İğdem
- Department of Pathology, University of Health Sciences, Gaziosmanpaşa Taksim Training and Research Hospital, İstanbul, Turkey
| | - Elife Kimiloglu
- Department of Pathology, University of Health Sciences, Gaziosmanpaşa Taksim Training and Research Hospital, İstanbul, Turkey
| | - Ferda N. Köksoy
- Department of General Surgery, University of Health Sciences, Gaziosmanpaşa Taksim Training and Research Hospital, İstanbul, Turkey
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Abstract
BACKGROUND In general, laparoscopic resection for gastric gastrointestinal stromal tumors (GISTs) >5 cm is not recommended. However, there is a lack of evidence to support this recommendation. PATIENTS AND METHODS This study included 108 patients who underwent laparoscopic surgery for gastric GISTs. Of the 108 patients, 23 had GISTs>5 cm. The aim of this study is to evaluate the oncological safety of laparoscopic surgery for large gastric GISTs. In addition, we performed a rapid systematic review of laparoscopic surgery for large gastric GISTs. RESULTS In our cases, all patients were performed R0 resection without capsular rupture and surgical margins were negative on pathologic examination. In all studies, en bloc resection was achieved without capsular rupture in all patients. The average positive surgical margins rate was 1.6% in total reports. CONCLUSIONS The laparoscopic approach for large gastric GISTs>5 cm has been proposed as safe when performed by experienced surgeons.
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Cai MY, Zhu BQ, Xu MD, Qin WZ, Zhang YQ, Chen WF, Ooi M, Li QL, Yao LQ, Zhou PH. Submucosal tunnel endoscopic resection for extraluminal tumors: a novel endoscopic method for en bloc resection of predominant extraluminal growing subepithelial tumors or extra-gastrointestinal tumors (with videos). Gastrointest Endosc 2018; 88:160-167. [PMID: 29499127 DOI: 10.1016/j.gie.2018.02.032] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 02/20/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS The management of subepithelial tumors with a predominant extraluminal growth pattern or extra-GI tumors can be challenging and traditionally requires a surgical resection that is not only invasive but may carry a significant risk of morbidity and mortality. We aimed to assess the feasibility, safety, and efficacy of a novel endoscopic technique termed submucosal tunnel endoscopic resection for extraluminal tumors (STER-ET). METHODS We prospectively enrolled patients who underwent STER-ET for GI subepithelial tumors with a predominant extraluminal growth pattern or extra-GI tumors located at the level of cardia or the proximal part of the lesser curvature of the stomach seen on cross-sectional imaging between January 2016 and March 2017. RESULTS Eight patients underwent STER-ET. The mean (± standard deviation) tumor size was 2.8 ± 0.6 cm and 2.3 ± 0.8 cm in longest and shortest dimension, respectively. The average procedure time was 67 ± 4.4 minutes. The rates of curative en bloc resection and en bloc retrieval was 100% and 87.5%, respectively. On final histology, 6 tumors were GI stromal tumors, 1 was a schwannoma, and 1 was a foregut cyst. Five patients had capnoperitoneum during the procedure and required abdominal decompression. One patient had a small mucosotomy successfully treated with a hemostatic clip. There were no major adverse events or deaths. The median length of hospital stay was 3 days. There was no residual tumor on surveillance imaging after a mean follow-up period of 10.0 ± 2.1 months. CONCLUSIONS STER-ET is a novel technique that appears to be safe and effective in achieving a curative resection for GI subepithelial tumors with a predominantly extraluminal growth pattern or extraluminal tumors in a selected group of patients. However, larger studies are required to validate our finding.
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Affiliation(s)
- Ming-Yan Cai
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Bo-Qun Zhu
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Mei-Dong Xu
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wen-Zheng Qin
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yi-Qun Zhang
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei-Feng Chen
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Marie Ooi
- Department of Gastroenterology, Royal Adelaide Hospital, South Adelaide, Australia
| | - Quan-Lin Li
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Li-Qing Yao
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ping-Hong Zhou
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
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Surgical Management of Gastric Gastrointestinal Stromal Tumours: Comparison of Outcomes for Local and Radical Resection. Gastroenterol Res Pract 2018; 2018:2140253. [PMID: 30034464 PMCID: PMC6033293 DOI: 10.1155/2018/2140253] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 04/24/2018] [Indexed: 12/31/2022] Open
Abstract
Gastrointestinal stromal tumours (GISTs) most commonly originate from the stomach. Their treatment is dependent on size and whether they are symptomatic. Curative treatment requires surgery, which may be preceded by neoadjuvant imatinib if it is felt that this will aid in achieving clear (R0) resection margins. The aim of this study was to evaluate outcomes from patients that underwent a "local" organ-preserving operation, with those that required a more radical resection, and the influences on selecting a more radical resection. A retrospective review of patients undergoing surgery for symptomatic gastric GISTs from a single institution over 9 years was carried out. Patients were divided into three cohorts dependent on whether they had a "local" resection, "anatomical" resection, or "extended" resection. 71 patients were included. Overall, 5-year survival was 92%. Operating time, blood loss, and length of stay were significantly lower in the group undergoing local resection (p < 0.05). Tumour size was also smaller in the local group (median 4 cm versus 5 cm p < 0.05). Tumour location also influenced the type of surgery performed, with tumours at the cardia, gastroesophageal junction, and antrum all having "anatomical" resections. Lymphadenectomy did not appear to impact on outcomes. These findings indicate that local excision, where possible, does not impair oncological outcomes.
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Thacoor A. Gastrointestinal stromal tumours: advances in surgical and pharmacological management options. J Gastrointest Oncol 2018; 9:573-578. [PMID: 29998023 DOI: 10.21037/jgo.2018.01.10] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Gastrointestinal stromal tumours (GISTs) are the most common mesenchymal neoplasm of the gastrointestinal tract. The stomach is most commonly affected. Advances in immunopathology have identified a mutation in the c-KIT proto-oncogene, leading to the development of the tyrosine-kinase inhibitor Imatinib as targeted therapy for advanced disease. Surgery, however, remains the only curative treatment of resectable primary GIST. This review article aims at reviewing the management of primary GISTs, investigating recurrences, exploring the role of surgery in metastatic disease and looking into combined surgery and molecular therapy for GISTs.
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Liu Z, Zheng G, Liu J, Liu S, Xu G, Wang Q, Guo M, Lian X, Zhang H, Feng F. Clinicopathological features, surgical strategy and prognosis of duodenal gastrointestinal stromal tumors: a series of 300 patients. BMC Cancer 2018; 18:563. [PMID: 29764388 PMCID: PMC5952823 DOI: 10.1186/s12885-018-4485-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 05/08/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The relatively low incidence of duodenal gastrointestinal stromal tumors (GISTs) and the unique anatomy make the surgical management and outcomes of this kind of tumor still under debate. Thus, this study aimed to explore the optimal surgical strategy and prognosis of duodenal GISTs. METHODS A total of 300 cases of duodenal GISTs were obtained from our center (37 cases) and from case reports or series (263 cases) extracted from MEDLINE. Clinicopathological features, type of resections and survivals of duodenal GISTs were analyzed. RESULTS The most common location of duodenal GISTs was descending portion (137/266, 51.5%). The median tumor size was 4 cm (0.1-28). Most patients (66.3%) received limited resection (LR). Pancreaticoduodenectomy (PD) was mainly performed for GISTs with larger tumor size or arose from descending portion (both P < 0.05). For both the entire cohort and tumors located in the descending portion, PD was not an independent risk factor for disease-free survival (DFS) and disease-specific survival (DSS) (both P > 0.05). Duodenal GISTs were significantly different from gastric GISTs with respect to tumor size, mitotic index and NIH risk category (all P < 0.05). The DFS and DSS of duodenal GISTs was significantly worse than that of gastric GISTs (both P < 0.05). CONCLUSIONS LR was a more prevalent surgical procedure and PD was mainly performed for tumors with larger diameter or located in descending portion. Type of resection was not an independent risk factor for the prognosis of duodenal GISTs. Prognosis of duodenal GISTs was significantly worse than that of gastric GISTs.
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Affiliation(s)
- Zhen Liu
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, 127 West Changle Road, 710032, Xi’an, Shaanxi Province China
- Department of General Surgery, No.1 Hospital of PLA, 74 Jingning Road, Lanzhou, 730030 China
| | - Gaozan Zheng
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, 127 West Changle Road, 710032, Xi’an, Shaanxi Province China
| | - Jinqiang Liu
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, 127 West Changle Road, 710032, Xi’an, Shaanxi Province China
- Cadre’ s sanitarium, 62101 Army of PLA, 67 Nahu Road, Xinyang, 464000 Henan China
| | - Shushang Liu
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, 127 West Changle Road, 710032, Xi’an, Shaanxi Province China
| | - Guanghui Xu
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, 127 West Changle Road, 710032, Xi’an, Shaanxi Province China
| | - Qiao Wang
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, 127 West Changle Road, 710032, Xi’an, Shaanxi Province China
- Department of General Surgery, No. 91 Hospital of PLA, 239 Gongye Road, Jiaozuo, 454000 Henan China
| | - Man Guo
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, 127 West Changle Road, 710032, Xi’an, Shaanxi Province China
| | - Xiao Lian
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, 127 West Changle Road, 710032, Xi’an, Shaanxi Province China
| | - Hongwei Zhang
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, 127 West Changle Road, 710032, Xi’an, Shaanxi Province China
| | - Fan Feng
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, 127 West Changle Road, 710032, Xi’an, Shaanxi Province China
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Cipolla C, Fulfaro F, Sandonato L, Fricano S, Pantuso G, Grassi N, Vieni S, Valerio MR, Lo Dico R, Gebbia N, Latteri MA. Clinical Presentation and Treatment of Gastrointestinal Stromal Tumors. TUMORI JOURNAL 2018; 92:279-84. [PMID: 17036516 DOI: 10.1177/030089160609200403] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Aims and background Gastrointestinal stromal tumors (GISTs), although rare, are the most common mesenchymal neoplasms affecting the gastrointestinal tract. We present our experience in the treatment of localized and metastatic disease and a review of literature. Patients and methods Nine patients were observed from April 2002 to July 2004. Eight tumors were in the gastric area and J was in the small bowel. In 5 cases, complete surgical removal was performed, and none of these patients underwent adjuvant therapy. The remaining 4 cases, with locally advanced or recurrent disease, were treated with imatinib. Results The patients with localized disease treated only by surgery did not relapse. In the patients with locally advanced or metastatic disease treated by imatinib, we observed 3 partial responses, and one case was not assessable because he had no measurable disease. In 2 of 3 responders, it was possible to perform a new radical surgery. Conclusions Our series is too small to draw any conclusion. According to our review of the literature, surgery remains the standard treatment for non-metastatic GISTs. Imatinib mesylate represents a major breakthrough in the treatment of advanced GISTs and is the first effective systemic therapy for the disease.
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Affiliation(s)
- Calogero Cipolla
- University of Palermo, Department of Oncology, Division of General and Oncological Surgery, Italy.
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Degrate L, Nobili C, Garancini M, Scotti MA, Scotti M, Romano F, Franciosi C, Caprotti R, Uggeri F. Challenging Diagnosis of Ileal Gastrointestinal Stromal Tumor Presenting with Obscure Digestive Bleeding. TUMORI JOURNAL 2018; 95:823-7. [DOI: 10.1177/030089160909500630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
We report a case of a patient observed in emergency condition for recurrent episodes of massive obscure gastrointestinal bleeding that required surgical control. At laparotomy we found an ileal mass with the characteristics of a gastrointestinal stromal tumor (GIST) at histopathological analysis. GISTs should always be considered as a possible cause of obscure gastrointestinal bleeding, although they are often difficult to diagnose preoperatively. Laparotomy is sometimes the only way to obtain a diagnosis. Starting from this case, we reviewed the literature about GISTs, focusing our attention on their diagnosis and the possible surgical and nonsurgical therapies.
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Affiliation(s)
- Luca Degrate
- Department of Surgery, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Cinzia Nobili
- Department of Surgery, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Mattia Garancini
- Department of Surgery, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | | | - Marco Scotti
- Department of Surgery, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Fabrizio Romano
- Department of Surgery, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Claudio Franciosi
- Department of Surgery, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Roberto Caprotti
- Department of Surgery, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Franco Uggeri
- Department of Surgery, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
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Ciresa M, D'Angelillo RM, Ramella S, Cellini F, Gaudino D, Stimato G, Fiore M, Greco C, Nudo R, Trodella L. Molecularly Targeted Therapy and Radiotherapy in the Management of Localized Gastrointestinal Stromal Tumor (GIST) of the Rectum: A Case Report. TUMORI JOURNAL 2018; 95:236-9. [DOI: 10.1177/030089160909500217] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract. The main treatment for localized gastrointestinal stromal tumors is surgical resection. These tumors respond poorly to conventional cytotoxic chemotherapy agents and to radiotherapy. Imatinib mesylate, a small-molecule kinase inhibitor, has proved useful in the treatment of recurrent or metastatic GISTs and is now being tested in the adjuvant and neoadjuvant setting. The role of radiotherapy in the management of patients with GIST is currently restricted to symptomatic palliation. We present the case of a 54-year-old man affected by rectal GIST extending to the anal canal, with constipation, hematochezia, and anal pain. He received imatinib, 400 mg orally per day, for a week before and during radiation therapy. Irradiation was delivered to the gross tumor volume by 3D conformal therapy. The planned total dose was 50.4 Gy in fractions of 1.8 Gy daily. We observed a partial clinical response 3 weeks after the end of combination treatment. The patient then underwent a sphincter-saving surgical procedure. There was no perioperative morbidity and a complete pathological response was obtained. At the present time, the role of radiotherapy in the management of patients with GIST is restricted to symptomatic palliation. The introduction of molecularly targeted therapy combined with radiation therapy could improve the outcomes for patients diagnosed with GIST.
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Affiliation(s)
- Marzia Ciresa
- Cattedra di Radioterapia Oncologica, Università Campus Bio-Medico, Rome, Italy
| | | | - Sara Ramella
- Cattedra di Radioterapia Oncologica, Università Campus Bio-Medico, Rome, Italy
| | - Francesco Cellini
- Cattedra di Radioterapia Oncologica, Università Campus Bio-Medico, Rome, Italy
| | - Diego Gaudino
- Cattedra di Radioterapia Oncologica, Università Campus Bio-Medico, Rome, Italy
| | - Gerardina Stimato
- Cattedra di Radioterapia Oncologica, Università Campus Bio-Medico, Rome, Italy
| | - Michele Fiore
- Cattedra di Radioterapia Oncologica, Università Campus Bio-Medico, Rome, Italy
| | - Carlo Greco
- Cattedra di Radioterapia Oncologica, Università Campus Bio-Medico, Rome, Italy
| | - Raffaele Nudo
- Chirurgia Generale, Casa di Cura Fabia Mater, Rome, Italy
| | - Lucio Trodella
- Cattedra di Radioterapia Oncologica, Università Campus Bio-Medico, Rome, Italy
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Sarmiento R, Bonginelli P, Cacciamani F, Salerno F, Gasparini G. Gastrointestinal Stromal Tumors (GISTs): From Science to Targeted Therapy. Int J Biol Markers 2018; 23:96-110. [DOI: 10.1177/172460080802300206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. GISTs represent a distinct category of tumors characterized by oncogenic mutations of the KIT receptor tyrosine kinase in a majority of patients. KIT is useful not only for the diagnosis but also for targeted therapy of this disease. Imatinib, a tyrosine kinase inhibitor, is widely used in advanced and metastatic GISTs. This agent revolutionized the treatment strategy of advanced disease and is being tested in the neoadjuvant and adjuvant settings with encouraging results. New therapeutic agents like sunitinib have now been approved, enriching the treatment scenario for imatinib-resistant GISTs. The present review reports on the peculiar characteristics of this disease through its biology and molecular patterns, focusing on the predictive value of KIT mutations and their correlation with clinical outcome as well as on the activity of and resistance to approved targeted drugs.
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Affiliation(s)
- R. Sarmiento
- Division of Medical Oncology, San Filippo Neri Hospital, Rome - Italy
| | - P. Bonginelli
- Division of Medical Oncology, San Filippo Neri Hospital, Rome - Italy
| | - F. Cacciamani
- Division of Medical Oncology, San Filippo Neri Hospital, Rome - Italy
| | - F. Salerno
- Division of Medical Oncology, San Filippo Neri Hospital, Rome - Italy
| | - G. Gasparini
- Division of Medical Oncology, San Filippo Neri Hospital, Rome - Italy
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50
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Masouminia M, Ghani HA, Foote D, Hari D, French S. Rare presentation of the glomus tumor in the stomach. Exp Mol Pathol 2017; 104:9-11. [PMID: 29221662 DOI: 10.1016/j.yexmp.2017.11.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 11/22/2017] [Indexed: 12/29/2022]
Affiliation(s)
- Maryam Masouminia
- Department of Pathology, Harbor-UCLA Medical Center, 1000 W Carson st, Torrance, CA 90502, United States
| | - Hassan Abdul Ghani
- Department of Pathology, Harbor-UCLA Medical Center, 1000 W Carson st, Torrance, CA 90502, United States
| | - Dingle Foote
- Department of Radiology, Harbor-UCLA Medical Center, 1000 W Carson st, Torrance, CA 90502, United States
| | - Danielle Hari
- Department of Surgery, Harbor-UCLA Medical Center, 1000 W Carson st, Torrance, CA 90502, United States
| | - Samuel French
- Department of Pathology, Harbor-UCLA Medical Center, 1000 W Carson st, Torrance, CA 90502, United States.
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