Multislice CT imaging of gastrointestinal stromal tumors (GISTs)

Gastro-intestinal stromal tumor (GIST): Experience from a tertiary care center in a low resource country

Objectives

The aim of this retrospective study was to review the overall survival (OS) and disease-free survival (DFS) of GISTs treated surgically at our center over the past decade.

Material and Methods

We undertook a 12-year retrospective review of our experience in treating this condition with a focus on long-term outcomes of treated patients in a resource-constrained environment. Incomplete follow-up information continues to be a major problem with studies conducted in low resource settings, and in order to overcome this, we undertook telephonic contact with patients or their relatives to get the necessary information about their clinical status.

Results

Fifty-seven patients with GIST underwent surgical resection during this period of time. The stomach was the most common organ involved in the disease, with 74% of the patients. Surgical resection was the main treatment approach, with R0 resection possible in 88%. Nine percent of the patients were given Imatinib as neoadjuvant treatment and 61% were offered the same, as adjuvant therapy. The duration of adjuvant treatment changed from one year to three years over the study period. Pathological risk assessment categorized the patients as Stage I, 33%; Stage II, 19%; Stage III, 39%; and Stage IV, 9%. Of the 40 patients who were at least three years from surgery, 35 were traceable giving an 87.5%, overall three-year survival. Thirty-one patients (77.5%) were confirmed to be disease-free at three years.

Conclusion

This is the first report of mid-long-term outcomes of the multimodality treatment of GIST from Pakistan. Upfront surgery continues to be the main modality. OS & DFS in resource-poor environments can be similar to those seen in a better-structured healthcare setting.

Massive bleeding of a jejunal gastrointestinal stromal tumour: a rare case of a life-threatening presentation

A jejunal gastrointestinal stromal tumour (GIST) is a rare neoplasm of the gastrointestinal tract. Massive bleeding due to a jejunal GIST is a diagnostic challenge and could present as a life-threatening situation needing urgent intervention. A 54-year-old woman presented with episodes of melaena and haematochezia for the previous 3 days. An oesophagoduodenoscopy was inconclusive. A contrast computed tomography (CT) scan showed a well-defined extraluminal mass in the proximal jejunum suggestive of a bleeding GIST. Her haemodynamic state deteriorated despite initial supportive therapy including a blood transfusion. An urgent laparotomy to excise the jejunal mass was performed. Histopathology and immunohistochemical studies confirmed the diagnosis. She subsequently received adjuvant imatinib therapy. She has remained symptom free at 5 months post-op. We therefore present a rare case of obscure massive gastrointestinal bleeding due to a jejunal GIST. The CT scan was the most effective investigation to detect the source of bleeding in this case.

Atypical presentation of a gastric stromal tumor masquerading as a giant intraabdominal cyst: A case report

Gastrointestinal stromal tumors (GISTs) are mesenchymal neoplasms that arise in the gastrointestinal tract, accounting for ~1% of gastric malignancies. The present study reports the case of a GIST of the stomach in a 75-year-old man who presented with abdominal distension and anorexia for 1 month. Gastroscopy was unremarkable. Ultrasound and computed tomography (CT) scans showed a giant intraabdominal cystic lesion of unknown origin. The lesion was initially believed to be a duplication cyst, a pancreatic pseudocyst or a liver cyst in the pre-operative diagnosis. Exploratory laparotomy revealed a cystic lesion of the lesser sac originating from the lesser curvature of the stomach. A distal gastrectomy with en bloc resection of the lesion was performed. The intraoperative frozen section showed a spindle-cell GIST and microscopically negative margins. The patient was treated with imatinib for 1 year. The latest CT scan at 14 months post-surgery did not show any recurrence. Although GISTs presenting as predominantly cystic lesions are very rare, they should be considered in the differential diagnosis of cystic lesions of the upper abdomen.