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Yan M, Lin J, Shu M, Luo Y, Sun K, Yang S, Zhang X. Diagnosis, Treatment, and Prognosis of Patients with Primary Familial Gastrointestinal Stromal Tumor: A Case Report and Literature Review. Oncologist 2023; 28:e1134-e1141. [PMID: 37311038 PMCID: PMC10712720 DOI: 10.1093/oncolo/oyad168] [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: 03/19/2023] [Accepted: 05/24/2023] [Indexed: 06/15/2023] Open
Abstract
Gastrointestinal stromal tumors are the most common mesenchymal tumors of the digestive tract, most of which are sporadic, and familial GISTs with germline mutations are rarely seen. Here, we report a 26-year-old female with a germline p. W557R mutation in exon 11 of the KIT gene. The proband and her father and sister presented with multifocal GIST and pigmented nevi. All 3 patients underwent surgery and imatinib therapy. To date, only 49 kindreds with germline KIT mutations and 6 kindreds with germline PDGFRA mutations have been reported. Summarizing the reported kindreds, the majority of familial GISTs manifest as multiple primary GISTs complicated with special clinical manifestations, including cutaneous hyperpigmentation, dysphagia, mastocytosis, inflammatory fibrous polyps, and large hands. Familial GISTs are generally thought to exhibit TKI sensitivity similar to that of sporadic GISTs with the same mutation.
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Affiliation(s)
- Miao Yan
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People’s Republic of China
| | - Jianghua Lin
- Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Man Shu
- Department of Pathology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Yanji Luo
- Department of Radiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Kaiyu Sun
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People’s Republic of China
| | - Shaohua Yang
- Center of Digestive Disease, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen, People's Republic of China
| | - Xinhua Zhang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People’s Republic of China
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Rojo E, Miranda P, Herranz R, de la Morena F. Hereditary GIST syndrome secondary to germline mutation in KIT. GASTROENTEROLOGIA Y HEPATOLOGIA 2023; 46:645-646. [PMID: 36634869 DOI: 10.1016/j.gastrohep.2022.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 12/17/2022] [Accepted: 12/26/2022] [Indexed: 01/11/2023]
Affiliation(s)
- Eukene Rojo
- Servicio de Gastroenterología, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP) y Universidad Autónoma de Madrid, Madrid, España.
| | - Pablo Miranda
- Servicio de Gastroenterología, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP) y Universidad Autónoma de Madrid, Madrid, España
| | - Raquel Herranz
- Servicio de Gastroenterología, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP) y Universidad Autónoma de Madrid, Madrid, España
| | - Felipe de la Morena
- Servicio de Gastroenterología, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP) y Universidad Autónoma de Madrid, Madrid, España
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Wong NACS, Garcia-Petit C, Dangoor A, Andrew N. A literature review and database of how the primary KIT/PDGFRA variant of a gastrointestinal stromal tumour predicts for sensitivity to imatinib. Cancer Genet 2022; 268-269:46-54. [PMID: 36155382 DOI: 10.1016/j.cancergen.2022.09.002] [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: 06/15/2022] [Revised: 07/18/2022] [Accepted: 09/05/2022] [Indexed: 01/25/2023]
Abstract
It is well recognized that the primary KIT or PDGFRA variant of a gastrointestinal stromal tumour (GIST) can predict sensitivity to imatinib. However, these data are currently spread across a wide range of publications and have not been collated as one reference. A broad-ranging literature search was therefore performed to assemble such a database which should help optimize imatinib-based management of GIST patients henceforth. Having excluded wild type GISTs and results for imatinib used as adjuvant therapy, 79 publications (dated August 2001 to March 2022) underwent data extraction. These data on imatinib sensitivity were either derived from in vitro studies, predicted by in silico analysis or based on in vivo clinical patient response. Data interpretation carried some caveats: there was a potential for replication of patient-derived data between older and new publications; only predicted protein sequences were presented; the criteria used to record clinical response were not uniform across all publications; and imatinib dosage could vary between different clinical publications. However, these data showed broad agreement of imatinib sensitivity amongst similar subtypes of KIT or PDGFRA variant. There was also agreement between in vivo versus in vitro/in silico derived sensitivity data for most variants when both data types were available.
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Affiliation(s)
- Newton A C S Wong
- Department of Cellular Pathology, Southmead Hospital, Bristol, United Kingdom, BS10 5NB.
| | - Christel Garcia-Petit
- East of Scotland Regional Genetic Service, Ninewells Hospital, Dundee, United Kingdom, DD1 9SY
| | - Adam Dangoor
- Bristol Haematology and Oncology Centre, University Hospitals Bristol & Weston NHS Trust, Bristol, United Kingdom, BS2 8ED
| | - Nicola Andrew
- East of Scotland Regional Genetic Service, Ninewells Hospital, Dundee, United Kingdom, DD1 9SY
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Brodey A, Kounnis V, Hawkes L, Jones RL, McVeigh TP, Cojocaru E. KIT-Associated Familial GIST Syndrome: Response to Tyrosine Kinase Inhibitors and Implications for Risk Management. Oncologist 2022; 27:615-620. [PMID: 35791894 PMCID: PMC9355806 DOI: 10.1093/oncolo/oyac120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 05/23/2022] [Indexed: 01/09/2023] Open
Abstract
Sporadic gastrointestinal stromal tumors (GIST) are rare tumors, with a median age at diagnosis of 60 years. Familial GISTs are very rare and typically associated with earlier onset, with an average age at diagnosis of 48 years. To date, just over 50 familial cases associated with a germline variant KIT or PDGFRa genes have been published. Therefore, there are many challenges in managing these patients, including the timing of starting systemic treatment, considering that most patients have been asymptomatic for a long period before being diagnosed, as well as the choice of tyrosine kinase inhibitor and the plan for surveillance. It is uncertain if early diagnosis through screening of asymptomatic individuals improves overall survival. Screening could start from the age of 18 years but may be considered at earlier ages depending on the underlying genotype and family history. The long-term benefit of early diagnosis or palliative/prophylactic treatment with tyrosine kinase inhibitors is unknown as there are no data available. Long-term side effects of treatment with imatinib are rare but well documented and could be damaging in patients who have no or minimal disease. We present the case of a 53-year-old Caucasian patient who was diagnosed with multifocal GIST and subsequently found to be a carrier of a pathogenic germline KIT variant in exon 11. We discuss the implication of treatment and genetic testing in this case and in familial KIT associated GISTs.
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Affiliation(s)
- Alexandra Brodey
- Department of Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Valentinos Kounnis
- Department of Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Lara Hawkes
- Oxford Centre for Genomic Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Robin L Jones
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London, UK.,Institute of Cancer Research, London, UK
| | - Terri P McVeigh
- Institute of Cancer Research, London, UK.,Cancer Genetics Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Elena Cojocaru
- Department of Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Cancer Genetics Unit, The Royal Marsden NHS Foundation Trust, London, UK
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Yuan W, Huang W, Ren L, Xu C, Luan LJ, Huang J, Xue AW, Fang Y, Gao XD, Shen KT, Lv JH, Hou YY. Familial gastrointestinal stromal tumors with KIT germline mutation in a Chinese family: A case report. World J Clin Cases 2022; 10:4878-4885. [PMID: 35801023 PMCID: PMC9198863 DOI: 10.12998/wjcc.v10.i15.4878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 10/29/2021] [Accepted: 03/26/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Familial gastrointestinal stromal tumors (GISTs) is a rare autosomal dominant disorder characterized by an array of clinical manifestations. Only 35 kindreds with germline KIT mutations and six with germline PDGFRA mutations have been reported so far. It is often characterized by a series of manifestations, such as multiple lesions and hyperpigmentation. However, the effect of imatinib treatment in these patients is still uncertain.
CASE SUMMARY Here, we report two patients (father and daughter) in a Chinese family (for the first time) with germline KIT mutation, and described their pathology, genetics and clinical manifestations. A 25-year-old Chinese woman went to hospital because of abdominal pain, and computed tomography showed multiple tumors in the small intestine. Small pigmented spots appeared on the skin within a few months after birth. Her father also had multiple pigmented spots and a history of multifocal GISTs. Multiple GISTs associated with diffuse interstitial Cajal cells (ICCs) hyperplasia were positive for CD117 and DOG-1. Gene sequencing revealed a germline mutation at codon 560 of exon 11 (p.V560G) of KIT gene in these two patients. Imatinib therapy showed the long-lasting disease stability after resection. Remarkably, the hypopigmentation of the skin could also be observed. Luckily germline KIT mutation has not been identified yet in the 3-year-old daughter of the female patient.
CONCLUSION Diagnosis of familial GISTs depends on combination of diffuse ICCs hyperplasia, germline KIT/PDGFRA mutation, hyperpigmentation and family history.
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Affiliation(s)
- Wei Yuan
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Wen Huang
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Lei Ren
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Chen Xu
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Li-Juan Luan
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Jie Huang
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - An-Wei Xue
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yong Fang
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Xiao-Dong Gao
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Kun-Tang Shen
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Jing-Huan Lv
- Department of Pathology, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou 215002, Jiangsu Province, China
| | - Ying-Yong Hou
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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Fornasarig M, Gasparotto D, Foltran L, Campigotto M, Lombardi S, Del Savio E, Buonadonna A, Puglisi F, Sulfaro S, Canzonieri V, Cannizzaro R, Maestro R. A Novel Kindred with Familial Gastrointestinal Stromal Tumors Caused by a Rare KIT Germline Mutation (N655K): Clinico-Pathological Presentation and TKI Sensitivity. J Pers Med 2020; 10:jpm10040234. [PMID: 33212994 PMCID: PMC7711910 DOI: 10.3390/jpm10040234] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/09/2020] [Accepted: 11/14/2020] [Indexed: 02/07/2023] Open
Abstract
Gastrointestinal stromal tumors (GISTs), the most common mesenchymal tumors of the gastrointestinal tract, are characterized by activating mutations in KIT or PDGFRA genes. The vast majority of GISTs are sporadic, but rare hereditary forms have been reported, often featuring multifocality and younger age of onset. We here report the identification of a novel kindred affected by familial GIST caused by a KIT germline mutation in exon 13 (N655K). No family affected by hereditary GIST due to this KIT variant has been reported in literature so far. We were able to track the mutation in three members of the family (proband, mother, and second-degree cousin), all affected by multiple GISTs. Due to its rarity, the N655K variant is poorly characterized. We conducted in vitro drug sensitivity assays that indicated that most tyrosine kinase inhibitors (TKIs) currently included in the therapeutic armamentarium for GISTs have a limited inhibitory activity toward this mutation. However, when compared to a classical imatinib-resistant KIT mutation (T670I), N655K was slightly more sensitive to imatinib, and encouraging responses were observed with last-generation TKIs.
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Affiliation(s)
- Mara Fornasarig
- Unit of Oncological Gastroenterology, Centro di Riferimento Oncologico di Aviano (CRO Aviano), IRCCS, 33081 Aviano, Italy; (M.F.); (R.C.)
| | - Daniela Gasparotto
- Unit of Oncogenetics and Functional Oncogenomics, Centro di Riferimento Oncologico di Aviano (CRO Aviano), IRCCS, 33081 Aviano, Italy; (D.G.); (S.L.); (E.D.S.)
| | - Luisa Foltran
- Unit of Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico di Aviano (CRO Aviano), IRCCS, 33081 Aviano, Italy; (L.F.); (A.B.); (F.P.)
| | - Michele Campigotto
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34127 Trieste, Italy; (M.C.); (V.C.)
| | - Sara Lombardi
- Unit of Oncogenetics and Functional Oncogenomics, Centro di Riferimento Oncologico di Aviano (CRO Aviano), IRCCS, 33081 Aviano, Italy; (D.G.); (S.L.); (E.D.S.)
| | - Elisa Del Savio
- Unit of Oncogenetics and Functional Oncogenomics, Centro di Riferimento Oncologico di Aviano (CRO Aviano), IRCCS, 33081 Aviano, Italy; (D.G.); (S.L.); (E.D.S.)
| | - Angela Buonadonna
- Unit of Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico di Aviano (CRO Aviano), IRCCS, 33081 Aviano, Italy; (L.F.); (A.B.); (F.P.)
| | - Fabio Puglisi
- Unit of Medical Oncology and Cancer Prevention, Centro di Riferimento Oncologico di Aviano (CRO Aviano), IRCCS, 33081 Aviano, Italy; (L.F.); (A.B.); (F.P.)
- Department of Medicine, University of Udine, 3310 Udine, Italy
| | - Sandro Sulfaro
- Unit of Pathology, Santa Maria Degli Angeli General Hospital, 33170 Pordenone, Italy;
| | - Vincenzo Canzonieri
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34127 Trieste, Italy; (M.C.); (V.C.)
- Unit of Pathology, Centro di Riferimento Oncologico di Aviano (CRO Aviano), IRCCS, 33081 Aviano, Italy
| | - Renato Cannizzaro
- Unit of Oncological Gastroenterology, Centro di Riferimento Oncologico di Aviano (CRO Aviano), IRCCS, 33081 Aviano, Italy; (M.F.); (R.C.)
| | - Roberta Maestro
- Unit of Oncogenetics and Functional Oncogenomics, Centro di Riferimento Oncologico di Aviano (CRO Aviano), IRCCS, 33081 Aviano, Italy; (D.G.); (S.L.); (E.D.S.)
- Correspondence:
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Abstract
BACKGROUND Gastrointestinal stromal tumor (GIST) is the most appearing mesenchymal tumor of the gastrointestinal system. In this study, we are aiming to share the most up to date knowledge about diagnosis and treatment of these tumors by transferring our clinical experience about GISTs. METHODS The 151 patients who were operated between 2006-2020 and whose pathological examination was reported as GIST were analyzed retrospectively. Demographic, clinical, and pathological features and treatment methods of patients were evaluated. RESULTS Seeventy-six of the patients were women and 75 of them were men whose age averages were 66.1 (31-86). The most common location was the stomach (55.6%), followed by the small intestine, retroperitoneal, large intestine, rectum, esophagus, and another organ. With surgical intervention, 139 of them had been cured. Twelve of cases were accepted as inoperable. The diameter of tumors in our cases were between 0.4 cm and 35 cm. Determined mitotic activity was ≤ 5 in 71 patients and 5 < in 80 patients. In 8 of 12 unresectable cases, it has been seen that partial remission after the treatment of 12-month tyrosine kinase inhibitors, C-KIT, was positive in 96.7% of our cases. CD34 and Ki-67 was analyzed in patients. CD34 was found positive in 98 (64.9%) of them, Ki-67 was positive in 82 (54.3%) patients. Patients had been observed for 40 months. CONCLUSION Despite GISTs are not appearing frequently, nowadays they have started to be seen more frequently than before with the growing present-day diagnostic methods. The ideal treatment is performing radical resection without leaving any tumor cells behind. Tyrosine kinase inhibitors have an important place in unresectable cases.
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Menge F, Jakob J, Kasper B, Smakic A, Gaiser T, Hohenberger P. Clinical Presentation of Gastrointestinal Stromal Tumors. Visc Med 2018; 34:335-340. [PMID: 30498699 DOI: 10.1159/000494303] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract. They constitute 1-2% of all gastrointestinal neoplasms but are the most common subtype of soft tissue sarcomas, accounting for 20-25%. In the late 1990s, GISTs were more and more recognized as a particular tumor entity. The tumors are supposed to originate from the interstitial pacemaker cells of Cajal. They are usually well circumscribed and can be located in every part of the tubular gastrointestinal tract. Most often GISTs occur in the stomach, followed by the small bowel and colon/rectum. In contrast to epithelial tumors, GISTs grow transmurally and submucosal. GISTs can be found with highly variable growth features including tumors with intraluminal, intra- or transmural, and pedunculated appearance. Here we describe the most common clinical presentation of GISTs on the basis of our 809 patients managed from 2004 to 2017. The median age of our patients was 59 years and the average size of GIST was 75 mm (range: 4 mm to 35 cm). The clinical presentation is very heterogeneous, depending on tumor site, size, and growth pattern. GISTs of the stomach is the group with the lowest rate of acute or emergency symptoms with 31%, followed by GISTs of the duodenum with 42%, whereas GISTs of the small bowel show acute symptoms in more than 50% of the cases and have an emergency surgery rate of almost 15%. Many patients are diagnosed accidentally, through screening examinations, or with latent, unspecific symptoms.
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Affiliation(s)
- Franka Menge
- Division of Surgical Oncology, Mannheim University Medical Center, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Jens Jakob
- Department of Surgery, Mannheim University Medical Center, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Bernd Kasper
- Interdisciplinary Tumor Center, Mannheim University Medical Center, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Armand Smakic
- Institute of Clinical Radiology and Nuclear Medicine, Mannheim University Medical Center, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Timo Gaiser
- Institute of Pathology, Mannheim University Medical Center, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Peter Hohenberger
- Division of Surgical Oncology, Mannheim University Medical Center, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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