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Baskaran A, Ravikumar S, Sivakumar K, Ilango J, Chelliah R. Concurrent Oral Squamous Cell Carcinoma and Incidental Papillary Thyroid Carcinoma Metastasis in Cervical Lymph Nodes: A Case Report. Cureus 2024; 16:e66413. [PMID: 39246869 PMCID: PMC11380068 DOI: 10.7759/cureus.66413] [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] [Accepted: 08/07/2024] [Indexed: 09/10/2024] Open
Abstract
Oral squamous cell carcinoma (OSCC) is the most common of all head and neck cancers accounting for 90% of all oral malignancies. It is commonly associated with the use of tobacco smoking or quid form. The incidence of oral carcinoma is higher in males than females with a ratio of 1.4:1, though females commonly adopt tobacco quid chewing habit. OSCC metastasis to cervical lymph node at the rate of 20-42.6% according to studies reported so far. Papillary thyroid carcinoma (PTC) occurs with a higher incidence in females than males with metastasis into cervical lymph nodes though the primary lesion frequently goes undetected. Concurrent metastasis of OSCC and PTC to the cervical lymph node during neck dissection has been reported rarely in the literature. This case report presents a 48-year-old female with lymph node metastasis of carcinoma of the right mandibular posterior alveolar region concurrently with metastasis of PTC (with primary lesion clinically undetected) encountered during cervical lymph node examination.
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Affiliation(s)
- Adhithya Baskaran
- Department of Oral Pathology, Adhiparasakthi Dental College and Hospital, Melmaruvathur, IND
| | - Shamala Ravikumar
- Department of Oral Pathology, Adhiparasakthi Dental College and Hospital, Melmaruvathur, IND
| | - Kokila Sivakumar
- Department of Oral Pathology, Adhiparasakthi Dental College and Hospital, Melmaruvathur, IND
| | - Janani Ilango
- Department of Oral Pathology, Adhiparasakthi Dental College and Hospital, Melmaruvathur, IND
| | - Radhika Chelliah
- Department of Oral Pathology, Adhiparasakthi Dental College and Hospital, Melmaruvathur, IND
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Martí-Obiol R, Martí-Fernández R, Fernández-Moreno MC, Barrios-Carvajal ME, López-Mozos F. Characteristics of gastrointestinal stromal tumors associated to other tumors: Características de los tumores del estroma gastrointestinal asociados a otras neoplasias. Cir Esp 2024; 102:135-141. [PMID: 38135151 DOI: 10.1016/j.cireng.2023.11.014] [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: 08/16/2023] [Accepted: 11/02/2023] [Indexed: 12/24/2023]
Abstract
INTRODUCTION Our aim is to analyze the differences between sporadic gastrointestinal stromal tumors and those associated with other tumors. METHODS Retrospective cohort study including patients with diagnosis of gastrointestinal stromal tumors operated at our center. Patients were divided into two groups, according to whether or not they had associated other tumors, both synchronously and metachronously. Disease free survival and overall survival were calculated for both groups. RESULTS 96 patients were included, 60 (62.5%) were male, with a median age of 66.8 (35-84). An association with other tumors was found in 33 cases (34.3%); 12 were synchronous (36.3%) and 21 metachronous (63.7%). The presence of mutations in associated tumors was 70% and in non-associated tumors 75%. Associated tumors were classified as low risk tumors based on Fletcher's stratification scale (p = 0.001) as they usually were smaller in size and had less than ≤5 mitosis per 50 HPF compared to non-associated tumors. When analyzing overall survival, there were statistically significant differences (p = 0,035) between both groups. CONCLUSION The relatively high proportion of gastrointestinal stromal tumors cases with associated tumors suggests the need to carry out a study to rule out presence of a second neoplasm and a long-term follow-up should be carried out in order to diagnose a possible second neoplasm. Gastrointestinal stromal tumors associated with other tumors have usually low risk of recurrence with a good long-term prognosis.
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Affiliation(s)
- Roberto Martí-Obiol
- Upper Gastrointestinal Surgery Unit, Hospital Clínico Universitario, Valencia, Spain
| | - Rosa Martí-Fernández
- Upper Gastrointestinal Surgery Unit, Hospital Clínico Universitario, Valencia, Spain.
| | | | | | - Fernando López-Mozos
- Upper Gastrointestinal Surgery Unit, Hospital Clínico Universitario, Valencia, Spain; Department of Surgery, Universidad de Valencia, Valencia, Spain
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The association of genitourinary cancer among Saudi patients with gastrointestinal stromal tumors and a systematic literature review. Sci Rep 2023; 13:4325. [PMID: 36922517 PMCID: PMC10017771 DOI: 10.1038/s41598-023-28060-x] [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: 05/14/2022] [Accepted: 01/12/2023] [Indexed: 03/17/2023] Open
Abstract
The gastrointestinal tract's most commonly occurring primary mesenchymal tumor is the gastrointestinal stromal tumor (GIST). However, few cases worldwide were reported associated with renal cell carcinoma (RCC). Therefore, we aimed to identify the association of genitourinary tumors in patients with GIST in our tertiary care hospital in Saudi Arabia and compare it to the literature. We identified all patients in the pathology department database with the diagnosis of GIST. We excluded duplicate and recurrent cases. We examined patients' files for the presence of RCC, adrenal tumors, or other genitourinary cancer. A systematic review of the association was conducted. From 2003 to 2020, 170 patients had a histopathologic diagnosis of primary GIST, 100 men and 70 women, median age of 57 (range 9-91) years at the time of diagnosis. The site of primary GIST was gastric 103, small bowel 43, mesenteric 5, omentum/peritoneum 7, abdomen 4, isolated adrenal 1, and other 7. Six patients had associated primary genitourinary cancer. Three patients had RCC (two clear cell RCC and one radiologic diagnosis only), and three had adrenal tumors (one adrenal carcinoma, one an isolated adrenal GIST, and one pheochromocytoma). In addition, two patients had a tumor invading the urinary bladder. Although the cohort included 63 men aged 60 or above (median 71 ± 8.7 years, range 60-94), none demonstrated clinical prostatic carcinoma. Data was compared to 69 systematic review articles. We report the rare association between GIST tumors and primary genitourinary cancer, mainly RCC and adrenal tumors. Also, we identified a secondary invasion of the urinary bladder. Unlike the reported series, none of the older male patients had clinical prostate cancer.
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Matli VVK, Zibari GB, Wellman G, Ramadas P, Pandit S, Morris J. A rare synchrony of adenocarcinoma of the ampulla with an ileal gastrointestinal stromal tumor: A case report. World J Gastrointest Oncol 2022; 14:2253-2265. [PMID: 36438708 PMCID: PMC9694268 DOI: 10.4251/wjgo.v14.i11.2253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/15/2022] [Accepted: 10/02/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND This is a unique case of a patient who was found to have two extremely rare primary malignancies synchronously, i.e., an ampullary adenocarcinoma arising from a high-grade dysplastic tubulovillous adenoma of the ampulla of Vater (TVAoA) with a high-grade ileal gastrointestinal stromal tumor (GIST). Based on a literature review and to the best of our knowledge, this is the first report of this synchronicity. Primary ampullary tumors are extremely rare, with an incidence of four cases per million population, which is approximately 0.0004%. Distal duodenal polyps are uncommon and have a preponderance of occurring around the ampulla of Vater. An adenoma of the ampulla ( AoA) may occur sporadically or with a familial inheritance pattern, as in hereditary genetic polyposis syndrome such as familial adenomatous polyposis syndrome (FAPS). We report a case of a 77-year-old male who was admitted for painless obstructive jaundice with a 40-pound weight loss over a two-month period and who was subsequently diagnosed with two extremely rare primary malignancies, i.e., an adenocarcinoma of the ampulla arising from a high-grade TVAoA and a high-grade ileal GIST found synchronously.
CASE SUMMARY A 77-year-old male was admitted for generalized weakness with an associated weight loss of 40 pounds in the previous two months and was noted to have painless obstructive jaundice. The physical examination was benign except for bilateral scleral and palmar icterus. Lab results were significant for an obstructive pattern on liver enzymes. Serum lipase and carbohydrate antigen-19-9 levels were elevated. Computed tomography (CT) of the abdomen and pelvis and magnetic resonance cholangiopancreatography were consistent with a polypoid mass at the level of the common bile duct (CBD) and the ampulla of Vater with CBD dilatation. The same lesions were visualized with endoscopic retrograde cholangiopancreatography. Histopathology of endoscopic forceps biopsy showed TVAoA. Histopathology of the surgical specimen of the resected ampulla showed an adenocarcinoma arising from the TVAoA. Abdominal and pelvic CT also showed a coexisting heterogeneously enhancing, lobulated mass in the posterior pelvis originating from the ileum. The patient underwent ampullectomy and resection of the mass and ileo-ileal side-to-side anastomosis followed by chemoradiation. Histopathology of the resected mass confirmed it as a high-grade, spindle cell GIST. The patient is currently on imatinib, and a recent follow-up positron emission tomography (PET) scan showed a complete metabolic response.
CONCLUSION This case is distinctive because the patient was diagnosed with two synchronous and extremely rare high-grade primary malignancies, i.e., an ampullary adenocarcinoma arising from a high-grade dysplastic TVAoA with a high-grade ileal GIST. An AoA can occur sporadically and in a familial inheritance pattern in the setting of FAPS. We emphasize screening and surveillance colonoscopy when one encounters an AoA in upper endoscopy to check for FAPS. An AoA is a premalignant lesion, particularly in the setting of FAPS that carries a high risk of metamorphism to an ampullary adenocarcinoma. Final diagnosis should be based on a histopathologic study of the surgically resected ampullary specimen and not on endoscopic forceps biopsy. The diagnosis of AoA is usually incidental on upper endoscopy. However, patients can present with constitutional symptoms such as significant weight loss and obstructive symptoms such as painless jaundice, both of which occurred in our patient. Patient underwent ampullectomy with clear margins and ileal GIST resection. Patient is currently on imatinib adjuvant therapy and showed complete metabolic response on follow up PET scan.
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Affiliation(s)
- Venkata Vinod Kumar Matli
- Department of Internal Medicine, Christus Highland Medical Center, Shreveport, LA 71106, United States
| | - Gazi B Zibari
- Division of Hepatobiliary Surgery, Willis-Knighton Health System, Shreveport, LA 711103, United States
| | - Gregory Wellman
- Department of Gastrointestinal and Liver Pathology, Christus Highland Medical Center, Shreveport, LA 71105, United States
| | - Poornima Ramadas
- Division of Hematology and Oncology, Louisiana State University Health Sciences Center, Shreveport, LA 71103, United States
| | - Sudha Pandit
- Division of Gastroenterology and Hepatology, Louisiana State University Health Sciences Center, Shreveport, LA 71103, United States
| | - James Morris
- Division of Gastroenterology and Hepatology, Louisiana State University Health Sciences Center, Shreveport, LA 71103, United States
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Kersting S, Janot-Matuschek MS, Schnitzler C, Chourio Barboza DE, Uhl W, Mittelkötter U. GIST: Correlation of risk classifications and outcome. J Med Life 2022; 15:932-943. [PMID: 36188659 PMCID: PMC9514809 DOI: 10.25122/jml-2021-0110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 06/22/2022] [Indexed: 11/05/2022] Open
Abstract
In clinical practice, there are often discrepancies between the oncological prognosis of gastrointestinal stromal tumors (GIST) and the actual clinical course. This study aimed to check with our collective how reliably the current classifications (Miettinen, Fletcher) predict the prognosis of GIST and to evaluate whether an extension of the classifications by the parameter proliferation activity could make sense. This prospective study enrolled 58 patients who underwent surgery on GIST from 01/2006 to 12/2016. The postoperative course (curation, recurrence, progress) was correlated with the identified risk classification and the proliferative activity. Coincidences with other tumors were strikingly common in patients with GIST (43%). Based on the risk group assignment of GIST, no assessment of the probability of the occurrence of second neoplasia could be derived. Individual patients were under- or over-graduated concerning the assessment of biological behavior based on the standard risk classifications. The inclusion of proliferative activity did not allow for a more precise predictive power - neither to the risk of recurrence and metastasis nor to the development of a second neoplasia. The study showed that there is currently no parameter or logarithm that reliably predicts the biological behavior of GIST. Due to the frequency of coincidence of second neoplasia and (rare) distant metastases, for everyday clinical practice, appropriate staging diagnostic and regular follow-up care should also be used for benign GIST.
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Affiliation(s)
- Sabine Kersting
- Department of General Surgery, Christliches Klinikum Unna Mitte, Unna, Germany,Corresponding Author: Sabine Kersting, Department of General Surgery, Christliches Klinikum Unna Mitte, Unna, Germany. E-mail:
| | | | - Carina Schnitzler
- Department of General Surgery, Christliches Klinikum Unna Mitte, Unna, Germany
| | | | - Waldemar Uhl
- Department of General Surgery, St. Josef-Hospital Bochum, Ruhr-University Bochum, Bochum, Germany
| | - Ulrich Mittelkötter
- Department of General Surgery, Christliches Klinikum Unna Mitte, Unna, Germany
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Hussein MRA, Alqahtani AS, Mohamed AM, Assiri YI, Alqahtani NI, Alqahtani SA, Ali HM, Elyas AAA, Al-Shraim MM, Hussain SS, Abu-Dief EE. A Unique Coexistence of Rectal Adenocarcinoma and Gastric Antral Gastrointestinal Stromal Tumor: A Case Report and Minireview. Gastroenterology Res 2022; 14:340-347. [PMID: 35059068 PMCID: PMC8734494 DOI: 10.14740/gr1482] [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: 11/09/2021] [Accepted: 12/04/2021] [Indexed: 12/03/2022] Open
Abstract
Several studies have reported the coexistence of gastric gastrointestinal stromal tumors (GISTs) with many primary carcinomas such as gastric and renal cell carcinomas. However, to date reports about the coexistence of gastric GISTs and colorectal adenocarcinoma are limited. Herein we report a unique case of gastric GIST coexisting synchronously with rectal adenocarcinoma in a 36-year-old male patient who presented with weight loss, vomiting, and bleeding per rectum. Computed tomography (CT) revealed circumferential rectal mass coexistent with an irregular gastric soft tissue mass. The diagnosis of rectal adenocarcinoma and gastric GIST was established by immunohistological evaluation of the colonoscopic (rectum) and CT-guided (stomach) biopsies. The patient received concomitant chemoradiotherapy for the rectal adenocarcinoma and neoadjuvant imatinib for the gastric GIST. This was followed by low anterior resection with total mesorectal excision and wedge resection of the gastric mass. Follow-up of the patient for 1.5 years revealed no evidence of disease recurrence. We also present a minireview of the literature that provides insights into this subject as a separate section.
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Affiliation(s)
| | | | | | - Yahia Ibraheem Assiri
- Department of Radiology, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | | | - Saeed Ali Alqahtani
- Department of General Surgery, Armed Forces Hospital, Southern Region, Saudi Arabia
| | - Hatim Mahgoub Ali
- Department of Oncology, Armed Forces Hospital, Southern Region, Saudi Arabia
| | | | | | | | - Eman E Abu-Dief
- Department of Histology, Faculty of Medicine, Sohag and Merit Universities, Sohag, Egypt
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Coexistence of multiple liver metastases from sigmoid colon cancer and a gastrointestinal stromal tumor in the small intestine. Clin J Gastroenterol 2022; 15:117-122. [PMID: 34988880 DOI: 10.1007/s12328-021-01556-7] [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: 07/15/2021] [Accepted: 11/09/2021] [Indexed: 02/07/2023]
Abstract
A 60-year-old man was referred to our hospital for the evaluation and treatment of general malaise. Contrast-enhanced computed tomography detected sigmoid colon cancer that had invaded the bladder, multiple liver metastases, and a small intestinal tumor. Hartmann's procedure was performed, with partial bladder and small bowel resection. A pathological examination revealed that the patient had sigmoid colon cancer and a gastrointestinal stromal tumor. The biopsy findings of a tumor in segment 8 of the liver indicated the presence of adenocarcinoma, thereby indicating the origin of multiple liver metastases from sigmoid colon cancer. On chemotherapy, the tumors in liver segments 2/3 and 8 shrank. However, the tumor in segment 6 enlarged. Since radical resection of all metastatic liver tumors was possible, hepatectomy was performed 10 months after the initial surgery. A pathological examination revealed that the tumors in segments 2/3, 4, and 8 were adenocarcinomas and the tumors in segments 4, 6, and 7 had originated from the gastrointestinal stromal tumor. This suggested the coexistence of liver metastases from sigmoid colon cancer and the gastrointestinal stromal tumor. In cases involving multiple primary tumors, it is necessary to consider the possible coexistence of multiple metastases from different primary tumors.
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Aloraini AM, Helmi HA, Aljomah NA, Zubaidi AM. Multiple primary gastrointestinal tumors of gastric, pancreatic and rectal origin; a case report. Int J Surg Case Rep 2021; 89:106610. [PMID: 34864258 PMCID: PMC8645915 DOI: 10.1016/j.ijscr.2021.106610] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/09/2021] [Accepted: 11/13/2021] [Indexed: 01/20/2023] Open
Abstract
Introduction The occurrence of multiple primary synchronous or metachronous malignancies is a described phenomenon. Such cases may have genetic predisposition or could be related to environmental risk factors but may also be sporadic. We are reporting a unique combination of triple primary synchronous malignancies in the same patient. Case presentation A 71 year old man presented with constipation and per rectal bleeding with a palpable mass 5–6 cm from the anal verge on physical examination. Colonoscopy with biopsy confirmed adenocarcinoma of rectal origin. After multi-disciplinary tumor board meeting, the patient received neoadjuvant chemoradiation therapy followed by single-stage surgery. Re-staging work up showed the presence of pancreatic lesion. Incidental finding of a gastric nodule upon surgical exploration which was confirmed to be a gastrointestinal stromal tumor. The patient had an uneventful postoperative course. Discussion Multiple primary malignancies of the gastrointestinal system has previously been reported in the literature; whether in the form of double, triple, quadruple or even quintuple primaries. Furthermore, gastrointestinal malignancies have been reported to be combined with extra-intestinal malignancies. However, this unique combination of pancreatic adenocarcinoma, rectal adenocarcinoma and gastric gastrointestinal stromal tumor has not been previously reported in the literature. Single-stage multiple resections was successful. Conclusion We are reporting a unique case of three primary malignancies involving the rectum, pancreas and stomach. For such patients, there is no clear guidelines regarding management or surveillance, but rather should be individualized. Multiple primary malignancies is becoming an increasingly common phenomenon. We are reporting a case of multiple primary malignancies involving 3 organs successfully managed by single-stage surgery. No guidelines exist for the management of such cases, although multi-disciplinary team approach is of value.
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Affiliation(s)
| | - Hadeel Ayman Helmi
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | | | - Ahmad Mohmmed Zubaidi
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Zhou J, Yang Z, Yang CS, Lin H. Paraneoplastic focal segmental glomerulosclerosis associated with gastrointestinal stromal tumor with cutaneous metastasis: A case report. World J Clin Cases 2021; 9:8120-8126. [PMID: 34621870 PMCID: PMC8462187 DOI: 10.12998/wjcc.v9.i27.8120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 07/25/2021] [Accepted: 08/05/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Gastrointestinal stromal tumor (GIST) with cutaneous metastasis is very rare. As a result, cutaneous GISTs have not been well characterized. Focal segmental glomerulosclerosis (FSGS) is also a rare symptom among paraneoplastic nephritic syndromes (PNS).
CASE SUMMARY In this case report, we describe a patient with cutaneous metastatic GIST accompanied by nephrotic syndrome occurring as a malignancy-associated PNS, for whom symptomatic treatment was ineffective, but clinical remission was achieved after surgery. Moreover, the patient has a missense mutation in NPHP4, which can explain the occurrences of GIST and FSGS in this patient and indicates that the association is not random.
CONCLUSION This is the first reported case of a GIST with cutaneous metastasis accompanied by nephrotic syndrome manifesting as a PNS.
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Affiliation(s)
- Jun Zhou
- Department of Nephrology and Rheumatology, Haikou People’s Hospital Affiliated to Xiangya School of Medicine of Central South University, Haikou 570208, Hainan Province, China
| | - Zhen Yang
- Department of Nephrology and Rheumatology, Haikou People’s Hospital Affiliated to Xiangya School of Medicine of Central South University, Haikou 570208, Hainan Province, China
| | - Cui-Shun Yang
- Department of Nephrology and Rheumatology, Haikou People’s Hospital Affiliated to Xiangya School of Medicine of Central South University, Haikou 570208, Hainan Province, China
| | - Hua Lin
- Department of Nursing, Haikou Affiliated Hospital of Central South University Xiangya School of Medicine, Haikou 570208, Hainan Province, China
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Petrelli F, Spagnoli L, Giusti A, Perotti B, Cavazzana A, Arganini M, Ambrosio MR. Jejunal gastrointestinal stromal tumor with rectal lymph nodes metastases synchronous to intestinal adenocarcinoma: a possible common origin. Dig Liver Dis 2021; 53:796-798. [PMID: 33896750 DOI: 10.1016/j.dld.2021.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 03/30/2021] [Indexed: 12/11/2022]
Affiliation(s)
- Federica Petrelli
- Pathology Unit, U.O.C. Anatomia Patologica, Azienda Toscana Nord Ovest, Via A. Cocchi, Pisa (PI) 56121, Italy
| | - Luigi Spagnoli
- Pathology Unit, U.O.C. Anatomia Patologica, Azienda Toscana Nord Ovest, Via A. Cocchi, Pisa (PI) 56121, Italy
| | - Andrea Giusti
- Pathology Unit, U.O.C. Anatomia Patologica, Azienda Toscana Nord Ovest, Via A. Cocchi, Pisa (PI) 56121, Italy
| | - Bruno Perotti
- Surgery Unit, Azienda Toscana Nord Ovest, Via A. Cocchi, Pisa (PI) 56121, Italy
| | - Andrea Cavazzana
- Pathology Unit, U.O.C. Anatomia Patologica, Azienda Toscana Nord Ovest, Via A. Cocchi, Pisa (PI) 56121, Italy
| | - Marco Arganini
- Surgery Unit, Azienda Toscana Nord Ovest, Via A. Cocchi, Pisa (PI) 56121, Italy
| | - Maria Raffaella Ambrosio
- Pathology Unit, U.O.C. Anatomia Patologica, Azienda Toscana Nord Ovest, Via A. Cocchi, Pisa (PI) 56121, Italy.
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Koçer M, Muallaoğlu S, Çetin B, Coşkun HŞ, Karahan N, Gürdal O. Second Primary Tumors in Patients with Gastrointestinal Stromal Tumors: A Single-Center Experience. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57050494. [PMID: 34068309 PMCID: PMC8153290 DOI: 10.3390/medicina57050494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 05/07/2021] [Accepted: 05/11/2021] [Indexed: 11/18/2022]
Abstract
Background and Objectives: In this study, we investigated the frequency and type of second primary malignant tumors (SPMTs) accompanying gastrointestinal stromal tumors (GISTs), patient and tumor characteristics, and follow-up and survival data. Materials and Methods: We included 20 patients with SPMTs from a total of 103 patients with GISTs in a single center in Turkey. At the time of GIST diagnosis, patient age, sex, presentation symptoms, localization, pathological features of the tumor, stage, recurrence risk scoring for localized disease, treatments received, time of SPMT association, follow-up times, and survival analysis were recorded for each patient. Localization, histopathology, and stage of SPMT accompanying GISTs were also recorded accordingly. Results: SPMT was detected in 19.4% of patients with GISTs. Of the patients, 50% were men and 50% were women. The mean age at the time of diagnosis of GIST was 63.8 ± 10.81 years (range: 39–77 years). Of the GISTs, 60% were localized in the stomach, 25% in the small intestine, and 70% were at low risk. Of the SPMTs, 60% were in the gastrointestinal system. SPMTs were diagnosed as synchronous with GISTs in 50% of the patients. The mean follow-up period of the patients from the diagnosis of GIST was 45.6 (0.43–129.6) months. When the data were finalized, 5% died due to GIST, 35% died due to SPMT, and 15% died due to non-disease-related causes. Conclusions: SPMT was detected in 19.4% of patients with GISTs. GISTs were frequently located in the stomach, and most of them were at low risk. The most common SPMTs were gastrointestinal system tumors, and their coexistence was found to be synchronous. Most patients died due to SPMT during follow-up.
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Affiliation(s)
- Murat Koçer
- Medical Oncology Subdivision, Department of Internal Medicine, Antalya Training and Research Hospital, Health Sciences University, Muratpaşa, Antalya 07100, Turkey
- Correspondence: ; Tel.: +90-542-513-9666
| | - Sadık Muallaoğlu
- Medical Oncology Clinic, Private Iskenderun Gelişim Hospital, Iskenderun 31200, Turkey;
| | - Bülent Çetin
- Medical Oncology Subdivision, Department of Internal Medicine, Süleyman Demirel University Faculty of Medicine, Isparta 32260, Turkey;
| | - Hasan Şenol Coşkun
- Medical Oncology Subdivision, Department of Internal Medicine, Akdeniz University Faculty of Medicine, Konyaaltı, Antalya 07070, Turkey;
| | - Nermin Karahan
- Department of Pathology, Süleyman Demirel University Faculty of Medicine, Isparta 32260, Turkey;
| | - Osman Gürdal
- Department of Biostatistics and Medical Informatics, Süleyman Demirel University Faculty of Medicine, Isparta 32260, Turkey;
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Dudzisz-Śledź M, Bylina E, Teterycz P, Rutkowski P. Treatment of Metastatic Gastrointestinal Stromal Tumors (GIST): A Focus on Older Patients. Drugs Aging 2021; 38:375-396. [PMID: 33651369 PMCID: PMC8096750 DOI: 10.1007/s40266-021-00841-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 11/24/2022]
Abstract
Gastrointestinal stromal tumors (GIST) originating in the Cajal cells are the most common mesenchymal neoplasms of the gastrointestinal tract. The median age of patients with this diagnosis is 65 years, and over 20% of cases affect people over the age of 70 years. The effectiveness and tolerability of systemic treatment with tyrosine kinase inhibitors in older patients with GIST seem to be similar to that in younger patients, but some studies have shown that treatment of older patients is suboptimal. Disability, frailty, comorbidities, and concomitant medications may influence treatment decisions, and toxicities also more often lead to treatment discontinuation. The known safety profile and oral administration route of the tyrosine kinase inhibitors used in GIST may allow maximization of treatment and the best efficacy, especially in older patients. This review summarizes the efficacy data for the systemic treatment of GIST, including data for older patients and from real-world experiences, if available and significant. The reported safety data and general rules for toxicity management, including appropriate patient selection and the need for careful monitoring during treatment, are also discussed.
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Affiliation(s)
- Monika Dudzisz-Śledź
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Roentgena 5, 02-781, Warsaw, Poland.
| | - Elżbieta Bylina
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Roentgena 5, 02-781, Warsaw, Poland
| | - Paweł Teterycz
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Roentgena 5, 02-781, Warsaw, Poland
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Roentgena 5, 02-781, Warsaw, Poland
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Characteristics of Gastrointestinal Stromal Tumors incidentally discovered during abdominal surgery. Am J Surg 2021; 222:983-988. [PMID: 33933208 DOI: 10.1016/j.amjsurg.2021.04.010] [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: 10/17/2020] [Revised: 03/17/2021] [Accepted: 04/12/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Gastrointestinal Stromal Tumors (GISTs) are rare sarcomas with 5000 new cases arising in the United States each year. Despite their low incidence, general surgeons should be familiar with GISTs since a quarter of these neoplasms are encountered incidentally. METHODS A retrospective medical records review was conducted to create a database of all GISTs resected from January 2005 to May 2019. We isolated patients who had incidental discovery of GISTs intraoperatively or within final pathology. Characteristics of patient (Age, gender), index procedure (malignant vs. benign, elective vs. emergent) and tumor (location, size and mitotic rate) were analyzed. RESULTS A total 48 patients were incidentally discovered to have a GIST excised during index operation. The mean age of these patients was 62 years, with 27 females and 21 males. The primary location of tumors in descending frequency was stomach (30), small bowel (15), colon/rectum (2) and esophagus (1). The average size of all tumors was 1.2 cm, with the average size of the stomach, small bowel, colon/rectum and esophagus at 0.9 cm, 1.7 cm, 0.9 cm and 0.3 cm respectively. Mitotic rate was less than 5 mitosis per 50 HPF in 96% of patients. Incidental tumors were identified during both bariatric (13) and non-bariatric stomach surgery (8), colorectal surgery (14), hernia repair (4), ampullary/pancreatic surgery (5), esophageal surgery (2) liver surgery (1) and uterine surgery (1). Most incidental-GISTs were identified during elective surgery (81%, 39). Finally, 15 of the tumors were identified during surgery for other malignancies. CONCLUSIONS One quarter (25%) of the GISTs encountered at our academic community cancer center over a 15-year period were discovered incidentally. These tumors had less malignant characteristics overall and were likely cured with surgical resection.
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Podda M, Ferraro G, Di Saverio S, Cois A, Nardello O, Poillucci G, Marino MV, Pisanu A. Association Between Gastrointestinal Stromal Tumors and Other Malignancies: It Is Only a Matter of Time ? A Case Series and an Overview of Systematic Reviews. J Gastrointest Cancer 2021; 51:914-924. [PMID: 31713047 DOI: 10.1007/s12029-019-00324-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE Little is known about the sporadic coincidence of gastrointestinal stromal tumors (GISTs) with second primary tumors (SPTs). The aim of this study is to clarify if there is a clinicopathologic correlation responsible for the synchronous or metachronous occurrence of SPTs in GIST patients. METHODS We carried out a single-center, retrospective analysis on patients with GISTs surgically treated at our institution from January 2019 to June 2019. Two groups of patients were identified: isolated GIST (group A) and GIST associated with SPT (group B). A meta-review was conducted with the aim to examine the published systematic reviews that included studies assessing the SPT risk in GIST patients. RESULTS Thirty-nine patients were surgically treated for GIST during the study period, with seven (17.9%) of them having other SPTs. SPTs were most frequent in the colon. Group A patients had a lower mean age at initial diagnosis (56.8 ± 15.2 vs. 73.4 ± 16.6, P = 0.012). No statistically significant difference was found between the two groups in terms of tumor location, mitotic index, Ki-67 expression, risk classification, and imatinib therapy. The overview showed that the cumulative prevalence rate of SPTs ranged from 9.3 to 18.0%. SPTs were more frequent in the gastrointestinal tract (37.9-95.0%), followed by the genitourinary tract. CONCLUSION GIST patients under our care experienced a 17.9% overall risk of developing SPTs with different histology. When comparing patients with isolated GIST and patients with GIST and SPT, age was the only variable significantly related to the development of other neoplasms. However, the potential non-random association and causal relationship between GISTs and SPTs remain to be investigated.
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Affiliation(s)
- Mauro Podda
- Department of Surgery, Cagliari University Hospital "D. Casula", University of Cagliari, SS 554, Km 4,500, 09042, Cagliari, Monserrato, Italy.
| | - Giulia Ferraro
- Department of Surgery, Cagliari University Hospital "D. Casula", University of Cagliari, SS 554, Km 4,500, 09042, Cagliari, Monserrato, Italy
| | - Salomone Di Saverio
- Department of Surgery, Cambridge Colorectal Unit, Addenbrooke's Hospital NHS Foundation Trust, University of Cambridge, Cambridge, UK
| | - Alessandro Cois
- Department of Surgery, Cagliari University Hospital "D. Casula", University of Cagliari, SS 554, Km 4,500, 09042, Cagliari, Monserrato, Italy
| | - Oreste Nardello
- Department of Surgery, Cagliari University Hospital "D. Casula", University of Cagliari, SS 554, Km 4,500, 09042, Cagliari, Monserrato, Italy
| | - Gaetano Poillucci
- Department of Surgery "Paride Stefanini", Policlinico Universitario Umberto I, Sapienza University, Rome, Italy
| | - Marco Vito Marino
- Department of General Surgery, Hospital Universitario Marques de Valdecilla, Santander, Cantabria, Spain
| | - Adolfo Pisanu
- Department of Surgery, Cagliari University Hospital "D. Casula", University of Cagliari, SS 554, Km 4,500, 09042, Cagliari, Monserrato, Italy
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Kohno S, Aoki H, Ogawa M, Yoshida K, Yanaga K. Significance of Primary Malignant Tumors on the Outcome of Patients With Resected Gastrointestinal Stromal Tumors. In Vivo 2021; 34:1201-1205. [PMID: 32354910 DOI: 10.21873/invivo.11893] [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: 02/13/2020] [Revised: 02/28/2020] [Accepted: 03/04/2020] [Indexed: 11/10/2022]
Abstract
AIM This study aimed to clarify the significance of primary malignant tumors for the outcome of resected gastrointestinal stromal tumors (GISTs). PATIENTS AND METHODS The medical history, pathological findings and prognosis of 66 patients with GISTs resected at our institute between January 2003 and December 2018 were investigated retrospectively and compared statistically. RESULTS Among 66 patients with GISTs, 24 (36%) had concomitant malignant tumors. In an average study period of 57 months, one patient died from GIST, seven from other malignant tumors, and one from another disease. Only coexistence of GIST and other malignant tumors was recognized as a prognostic factor. Increasing age was significantly correlated with other malignant tumor in combination with GIST. When comparing patients with GIST alone and GIST with other malignant tumors, the latter showed significantly poorer prognosis. CONCLUSION Coexistence of other malignant tumors was commonly observed in patients with GIST, and was associated with poorer prognosis. This association should be carefully considered and monitored in patients with GISTs.
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Affiliation(s)
- Shuzo Kohno
- Department of Surgery, The Jikei University Katsushika Medical Center, Tokyo, Japan
| | - Hiroaki Aoki
- Department of Surgery, The Jikei University Katsushika Medical Center, Tokyo, Japan
| | - Masaichi Ogawa
- Department of Surgery, The Jikei University Katsushika Medical Center, Tokyo, Japan
| | - Kazuhiko Yoshida
- Department of Surgery, The Jikei University Katsushika Medical Center, Tokyo, Japan
| | - Katsuhiko Yanaga
- Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
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Talwar D, Kumar K, Prajapat D, Prakash A, Dabral C. Double hit: Synchronous gastrointestinal stromal tumour (GIST) & lung neuroendocrine tumour − a rare case of multiple primary malignancies. THE JOURNAL OF ASSOCIATION OF CHEST PHYSICIANS 2021. [DOI: 10.4103/jacp.jacp_16_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
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17
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Cross-testing of major molecular markers indicates distinct pathways of tumorigenesis in gastric adenocarcinomas and synchronous gastrointestinal stromal tumors. Sci Rep 2020; 10:22212. [PMID: 33335133 PMCID: PMC7747598 DOI: 10.1038/s41598-020-78232-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 11/11/2020] [Indexed: 12/12/2022] Open
Abstract
Small subtype of the gastrointestinal stromal tumor (micro-GIST, MG) is usually asymptomatic and is frequently found incidentally in association with gastric adenocarcinoma (GAC). The background of this coincidence is still an open question. This study comprehensively characterized nine MGs and GACs present in the same surgical specimen by cross-testing the markers of the major pathogenetic pathways of both tumor types. All of the MGs were immunohistochemically positive for CD117/KIT, CD34, and DOG1. DOG1 was also detected in four GACs. Four MGs carried mutations in c-KIT (exons 9, 11, and 13) and two cases in PDGFRα (exon 18). None of the GACs carried activating mutations in c-KIT or PDGFRα. MMR immunopanel identified one GAC as microsatellite unstable tumor. No EBV-positive tumor was found. According to the TCGA molecular classification, one GAC was categorized in the MSI subgroup, three GACs in the genomically stable subgroup, and the rest into the chromosomal instability subgroup. Although a common carcinogenic effect cannot be ruled out, our data suggest a distinct molecular background in the evolvement of the synchronous MGs and GACs. The presence of a MG in gastric resection specimens may be indicative of the development of synchronous malignant tumors in or outside the stomach.
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Gupta R, Singh A, Ammar H. A Case of Incidental Gastrointestinal Stromal Tumor in a Patient With Walled-Off Pancreatic Necrosis. Cureus 2020; 12:e10681. [PMID: 33133847 PMCID: PMC7593124 DOI: 10.7759/cureus.10681] [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] [Indexed: 11/05/2022] Open
Abstract
Acute pancreatitis is a common clinical disorder of the pancreas that can present with walled-abdominal pain and vomiting. We report a case of a 45-year-old man with alcohol-related acute pancreatitis who developed a large walled-off pancreatic necrosis. Incidentally, the patient had a small gastrointestinal stromal tumor in the adjoining wall of the stomach that was missed on preoperative radiological imaging. A small submucosal lesion was detected during cystogastrostomy and was excised. The diagnosis of a gastrointestinal stromal tumor was confirmed on histopathology.
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Affiliation(s)
- Rahul Gupta
- Gastroenterology, Synergy Institute of Medical Sciences, Dehradun, IND
| | - Arvind Singh
- Gastroenterology, Synergy Institute of Medical Sciences, Dehradun, IND
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19
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Pancreatic Neuroendocrine Neoplasms and Gastrointestinal Stromal Tumors: A Single-Institution Experience of a Rare Association and Review of the Literature. Pancreas 2020; 49:918-923. [PMID: 32658075 DOI: 10.1097/mpa.0000000000001599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE Pancreatic neuroendocrine neoplasms (pNENs) and gastrointestinal stromal tumors (GISTs) represent rare neoplasms. Nonsyndromic cases of pNENs associated with a synchronous GIST were evaluated, and a review of the literature was performed. METHODS We evaluated clinicopathologic features, postoperative outcome, and follow-up of patients operated on for nonsyndromic synchronous pNENs and GISTs in our unit (2003-2017). RESULTS Five (3.2%) of 156 patients with a pNEN had an associated GIST (3 male/2 female; average age, 67 years). They were diagnosed with a pNEN preoperatively and underwent pancreatic surgery. In 4 patients, GISTs were detected intraoperatively. Histology showed 3 G1 and 2 G2 pNENs. All GISTs were low risk (median size, 0.9 cm). Two patients were alive without disease 108 and 132 months after surgery. In the literature, 7 cases were described. They had low-risk GISTs, with a gastric location in 6 cases (median size, 2.85 cm). CONCLUSIONS Sporadic pNENs coexisting with a GIST have been demonstrated in 12 cases. This association is considered fortuitous, and its true incidence may be underestimated. Surgery should be performed on the GIST during the pancreatic surgery. The prognosis strictly depends on the pancreatic NENs.
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20
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Farhat W, Ammar H, Mizouni A, Harrabi F, Bouazzi A, Hammami E, Gupta R, Said MA, Ben Mabrouk M, Ben Ali A. Osteoclastic giant cell tumor of the pancreas with synchronous jejunal gastrointestinal stromal tumor: A case report. Ann Med Surg (Lond) 2020; 51:28-30. [PMID: 32153772 PMCID: PMC7058842 DOI: 10.1016/j.amsu.2019.11.008] [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] [Received: 07/25/2019] [Revised: 11/14/2019] [Accepted: 11/19/2019] [Indexed: 11/05/2022] Open
Abstract
Osteoclastic giant cell tumor of the pancreas is a rare aggressive tumor, counting for 2–7% of all pancreatic cancers. Surgery is considered the most appropriate treatment. We report a case of a 84-year-old man with incidentally detected 11cm tumor in the pancreatic tail and another 6 cm tumor located in the jejunum on abdominal computed tomography. The patient underwent distal pancreatectomy with splenectomy along with segmental resection of the tumor bearing part of the jejunum. On histological examination, osteoclast-like giant cells with some areas of metaplastic bone were observed which confirmed the diagnosis of osteoclastic tumor of the pancreas. The jejunal tumor was strongly c-kit positive on immunohistochemistry which confirmed the diagnosis of GIST. On the last follow up at 2 years after surgery, there is no evidence of recurrence or distant metastasis. Pancreatic OGCT has a better prognosis after resection than pancreatic adenocarcinoma. Its co-existence jejunal GIST, as seen in the index case, has not been reported in the English literature till date. Osteoclastic giant cell tumor of the pancreas is a rare aggressive tumor, counting 2–7% of all pancreatic cancers. Surgery is considered the most appropriate treatment. Pancreatic OGCT has a better prognosis, after resection than pancreatic adenocarcinoma. Its co-existence jejunal GIST, as seen in the index case, has not been reported in the English literature till date.
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Affiliation(s)
- Waad Farhat
- Department of Gastrointestinal Surgery, University of Sousse, Sahloul Hospital, Sousse, Tunisia
| | - Houssem Ammar
- Department of Gastrointestinal Surgery, University of Sousse, Sahloul Hospital, Sousse, Tunisia
| | - Abdelkader Mizouni
- Department of Gastrointestinal Surgery, University of Sousse, Sahloul Hospital, Sousse, Tunisia
| | - Fathia Harrabi
- Department of Gastrointestinal Surgery, University of Sousse, Sahloul Hospital, Sousse, Tunisia
| | - Amal Bouazzi
- Department of Gastrointestinal Surgery, University of Sousse, Sahloul Hospital, Sousse, Tunisia
| | - Eya Hammami
- Department of Gastroenterology, University of Sousse, Sahloul Hospital, Sousse, Tunisia
| | - Rahul Gupta
- Department of Gastrointestinal Surgery, Synergy Institute of Medical Sciences, Dehradun, India
| | - Mohamed Amine Said
- Department of Gastrointestinal Surgery, University of Sousse, Sahloul Hospital, Sousse, Tunisia
| | - Mohamed Ben Mabrouk
- Department of Gastrointestinal Surgery, University of Sousse, Sahloul Hospital, Sousse, Tunisia
| | - Ali Ben Ali
- Department of Gastrointestinal Surgery, University of Sousse, Sahloul Hospital, Sousse, Tunisia
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Asvadi Kermani T, Kakaei F, Tarvirdizade K. Coincident of Gastrointestinal Stromal Tumor and Two Other Primary Malignancies: A Case Report. IRANIAN RED CRESCENT MEDICAL JOURNAL 2019; 21. [DOI: 10.5812/ircmj.90287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 09/14/2019] [Accepted: 09/17/2019] [Indexed: 08/29/2023]
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Li Y, Teng Y, Wei X, Tian Z, Cao Y, Liu X, Duan X. A rare simultaneous coexistence of epithelioid gastrointestinal stromal tumors and schwannoma in the stomach: a case report. Diagn Pathol 2019; 14:116. [PMID: 31647020 PMCID: PMC6813059 DOI: 10.1186/s13000-019-0898-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 10/04/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Gastrointestinal stromal tumors (GISTs), a type of mesenchymal tumor in the gastrointestinal tract, are believed to be closely associated with PDGFRA and C-KIT mutations. Schwannoma in the stomach, which is an unusual location, is a rare disorder. The simultaneous occurrence of the two diseases is rarer than metachronous occurrences, and its pathological characteristics have not been reported to date. We present a case report on a patient with simultaneous coexistence of gastric schwannoma and GISTs. CASE PRESENTATION A 39-year-old female visited our hospital complaining of intermittent abdominal pain for the previous 3 months. CT revealed a 3.4 cm slight homogeneous enhancement in the lesser curvature of the stomach; the mass was nodular soft tissue, which was removed by radical surgery. Two solid tumors with different volumes were located in the stomach. Histologically and immunohistochemically different, the larger tumor consisted of spindle cells surrounded by a peripheral lymphoid cuff, and was positive for S-100. The larger tumor was therefore classified as a gastric schwannoma. The smaller tumor was composed of medium-sized round, oval cells with amphiphilic granular cytoplasm; vacuolization was also observed. The tumor cells were positive for DOG1 and sporadically positive for CD34 and CD117. Hence, the smaller tumor was diagnosed as epithelioid GISTs. Sanger sequencing revealed that the GIST tumor cells contained a deletion mutation (c.2527_2538 del12,843-846del4), which was located in exon 18 of PDGFRA. CONCLUSION GISTs combined with gastric schwannoma are a considerably rare subgroup of gastric tumors. Related clinical research is comparatively weak, and the mechanism remains unknown. We reviewed related articles to provide knowledge to improve the correct identification, diagnosis and management of patients with gastric cancer. All pathologists involved in the diagnosis and clinicians involved in the treatment should be aware of this new kind of disease pattern to improve their understanding of the disease.
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Affiliation(s)
- Yuxin Li
- Department of Pathology, the First Hospital of Jilin University, Changchun, China
| | - Yongliang Teng
- Department of Pathology, the First Hospital of Jilin University, Changchun, China
| | - Xiaofei Wei
- Department of Pathology, the First Hospital of Jilin University, Changchun, China
| | - Zhuang Tian
- Department of Pathology, the First Hospital of Jilin University, Changchun, China
| | - Yuqing Cao
- Department of Pathology, the First Hospital of Jilin University, Changchun, China
| | - Xiaona Liu
- Department of Pathology, the First Hospital of Jilin University, Changchun, China
| | - Xiumei Duan
- Department of Pathology, the First Hospital of Jilin University, Changchun, China.
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Juric I, Basic-Jukic N. Multiple Primary Malignancies: The First Case of a Combination of a Gastrointestinal Stromal Tumor and Renal Cell Carcinoma in a Kidney Transplant Recipient. Transplant Proc 2019; 51:3070-3071. [PMID: 31611119 DOI: 10.1016/j.transproceed.2019.04.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 04/05/2019] [Indexed: 10/25/2022]
Abstract
There is limited data on multiple primary malignancies in the kidney transplant population. Gastrointestinal stromal tumors (GISTs) are rare tumors in kidney transplant recipients, with only 5 cases reported in the literature to date. GIST patients are at an increased risk for developing additional malignancies, with other histologic types of gastrointestinal tract malignancies being the most frequent and other types of malignancies rare. There is evidence in the literature suggesting an association between GIST and renal cell carcinomas. We report on the first case of a GIST and a renal cell carcinoma in a kidney transplant recipient and in other solid organ transplant recipients.
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Affiliation(s)
- Ivana Juric
- Department of Nephrology, Arterial Hypertension, Dialysis, and Transplantation, University Hospital Centre Zagreb, Zagreb, Croatia.
| | - Nikolina Basic-Jukic
- Department of Nephrology, Arterial Hypertension, Dialysis, and Transplantation, University Hospital Centre Zagreb, Zagreb, Croatia
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Waidhauser J, Bornemann A, Trepel M, Märkl B. Frequency, localization, and types of gastrointestinal stromal tumor-associated neoplasia. World J Gastroenterol 2019; 25:4261-4277. [PMID: 31435178 PMCID: PMC6700699 DOI: 10.3748/wjg.v25.i30.4261] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 06/22/2019] [Accepted: 07/05/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In recent years, increasing evidence of second neoplasms associated with gastrointestinal stromal tumors (GIST) has been found. Numerous case reports, mostly retrospective studies and a few reviews, have been published. To our knowledge, however, no systematic review or meta-analysis of the existing data has been performed so far. AIM To prepare a compilation, as complete as possible, of all reported second tumor entities that have been described in association with GIST and to systematically analyze the published studies with regard to frequency, localization, and types of GIST-associated neoplasms. METHODS The MEDLINE and EBSCO databases were searched for a combination of the keywords GIST/secondary, synchronous, coincident/tumor, neoplasm, and relevant publications were selected by two independent authors. RESULTS Initially, 3042 publications were found. After deletion of duplicates, 1631 remained, and 130 papers were selected; 22 of these were original studies with a minimum of 20 patients, and 108 were case reports. In the 22 selected studies, comprising a total number of 12050 patients, an overall rate of GIST-associated neoplasias of 20% could be calculated. Most second neoplasias were found in the gastrointestinal tract (32%) and in the male and female urogenital tract (30%). The specific risk scores of GISTs associated with other tumors were significantly lower than those without associated neoplasias. CONCLUSION In this first systematic review, we could confirm previously reported findings of a more than coincidental association between GIST and other neoplasias. The question whether there is an underlying causal association will need further investigation. Our data suggest that even GIST with a very low risk of disease progression should prompt screening for second neoplasia and subsequent frequent controls or extended staging.
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Affiliation(s)
- Johanna Waidhauser
- Institute of Pathology and Molecular Diagnostics, University Medical Center Augsburg, Augsburg 86156, Germany
- Department of Hematology and Clinical Oncology, University Medical Center Augsburg, Augsburg 86156, Germany
| | - Anne Bornemann
- Institute of Pathology and Molecular Diagnostics, University Medical Center Augsburg, Augsburg 86156, Germany
| | - Martin Trepel
- Department of Hematology and Clinical Oncology, University Medical Center Augsburg, Augsburg 86156, Germany
| | - Bruno Märkl
- Institute of Pathology and Molecular Diagnostics, University Medical Center Augsburg, Augsburg 86156, Germany
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Malignancies associated with GIST: a retrospective study with molecular analysis of KIT and PDGFRA. Langenbecks Arch Surg 2019; 404:605-613. [PMID: 30877378 DOI: 10.1007/s00423-019-01773-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 02/27/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE Gastrointestinal stromal tumors (GISTs) are the most common soft tissue tumors of the GI tract. Studies have been published reporting additional neoplasms in GIST patients. This study aimed to evaluate possible associations of mutation type, morphology, and clinical aspects of GISTs. METHODS All cases of GIST were identified from our pathology files. Coding exons of KIT and PDGFRA in GISTs with additional malignancies were sequenced. RESULTS A total of 70 of 188 (37%) retrieved patients with confirmed diagnosis of GIST showed at least one additional malignant neoplasm. Fifty of these GISTs were located in the stomach (71%), 8 in the small intestine (11%), 5 in the colon/rectum (7%), and 7 cases (6.2%) were of undetermined sites of origin. The distribution of identified mutations was similar to that described in GISTs without secondary malignancies. A total of 37 of 57 cases (65%) showed mutations in the KIT gene exon 11, 3 (5%) cases in exon 9, and 1 (2%) case in exon 13. Nine tumors (16%) had mutations of the PDGFRA gene. KIT and PDGFRA wild-type status were found in seven cases (12%). Most of the secondary neoplasms were located within the GI tract (34%), in the urogenital system (24%), or the breast/female genital tract (20%). CONCLUSION This study confirms the high rate of additional malignant tumors in GIST patients. GIST features in these cases are very similar to those with sole GIST.
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Risk of second primary tumors in GIST survivors: A systematic review and meta-analysis. Surg Oncol 2019; 29:64-70. [PMID: 31196495 DOI: 10.1016/j.suronc.2019.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 02/02/2019] [Accepted: 03/02/2019] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Gastrointestinal stromal tumors (GISTs) are rare mesenchymal tumors arising in the gastrointestinal tract. Second primary tumors (SPTs) have been reported frequently, either synchronously or during follow-up, in patients diagnosed with GISTs. METHODS We carried out an electronic search of PubMed, SCOPUS, Web of Science, EMBASE, and the Cochrane Library seeking articles investigating the incidence of SPTs in patients with concomitant GIST. All studies were evaluated for heterogeneity before meta-analysis and for publication bias. Pooled incidence rate was estimated using fixed- and random-effects models. Subsite of SPTs was also investigated. RESULTS A total of 32 studies met the inclusion criteria, for a total of 19,627 patients with a diagnosis of GIST. The pooled prevalence of SPTs was 20%, with 14% and 3% being synchronous and metachronous tumors, respectively. We found a risk for several specific cancer sites, in particular gastrointestinal (5%) and genitourinary tract cancers (3%). The most frequently associated malignancies were: colorectal (17%), prostate (14%), gastric (9%), esophageal (5.5%), lung (5.4%), hepato-biliopancreatic (4.7%), breast (4.6%), lymphoma (4.4%), kidney (4.35%), and sarcomas (3.3%). Regression analyses revealed a significant positive association for all SPTs with follow-up and Miettinen risk. CONCLUSIONS Our results indicate that 20% of patients with GIST experienced a SPT, primarily synchronously with a diagnosis of GIST. In particular, we observed an excess of incident gastrointestinal tumors. These findings have important implications for both pathologists, who should perform extensive molecular analysis of surgical non-GIST specimens in resected patients, and for oncologists, who should continue to follow up GIST patients.
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Fernández JA, Olivares V, Gómez-Ruiz AJ, Ferri B, Frutos MD, Soria T, Torres G, Parrilla P. Additional malignancies in patients with gastrointestinal stromal tumors (GIST): incidence, pathology and prognosis according to a time of occurrence-based classification. Clin Transl Oncol 2018; 21:646-655. [PMID: 30368726 DOI: 10.1007/s12094-018-1966-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 10/12/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND The aim of the study is to clarify if a classification based on the time of occurrence of associated malignancies in GIST patients can help in the understanding of the clinical controversies observed in these patients. METHODS We retrospectively reviewed all the patients diagnosed with GIST tumors between January 1999 and October 2016. They were divided into GIST patients associated with other tumors (A-GIST) and those not associated (NA-GIST). A-GIST patients were also divided into four types according to the proposed classification. RESULTS Of 104 GIST patients, 32 (30.7%) (A-GIST group) had at least one additional primary malignancy. The most frequent location of the associated malignancy was the GI tract (26%). Compared to NA-GIST, A-GIST were more often asymptomatic with a lower risk of recurrence. The main cause of death in NAGIST was GIST itself, being associated tumors the main cause of death in A-GIST group. No differences were found in DFS and OS between A-GIST and NA-GIST. CONCLUSIONS The use of the proposed classification classifies GIST patients with associated malignancies in different subtypes that differ substantially in terms of incidence, type of neoplasms associated, cause of the association and prognosis.
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Affiliation(s)
- J A Fernández
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Clínico Universitario "Virgen de la Arrixaca", Ctra. El Palmar s/n, CP: 30120, Murcia, Spain.
| | - V Olivares
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Clínico Universitario "Virgen de la Arrixaca", Ctra. El Palmar s/n, CP: 30120, Murcia, Spain
| | - A J Gómez-Ruiz
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Clínico Universitario "Virgen de la Arrixaca", Ctra. El Palmar s/n, CP: 30120, Murcia, Spain
| | - B Ferri
- Servicio de Anatomía Patológica, Hospital Clínico Universitario "Virgen de la Arrixaca", Ctra. El Palmar s/n, Murcia, Spain
| | - M D Frutos
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Clínico Universitario "Virgen de la Arrixaca", Ctra. El Palmar s/n, CP: 30120, Murcia, Spain
| | - T Soria
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Clínico Universitario "Virgen de la Arrixaca", Ctra. El Palmar s/n, CP: 30120, Murcia, Spain
| | - G Torres
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Clínico Universitario "Virgen de la Arrixaca", Ctra. El Palmar s/n, CP: 30120, Murcia, Spain
| | - P Parrilla
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Clínico Universitario "Virgen de la Arrixaca", Ctra. El Palmar s/n, CP: 30120, Murcia, Spain
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Mendonca SJ, Sanchez A, Blum KA, Ghanaat M, Kashan MY, Benfante N, Russo P, Coleman JA, Crago AM, Hakimi AA. The association of renal cell carcinoma with gastrointestinal stromal tumors. J Surg Oncol 2018; 117:1716-1720. [PMID: 29878354 DOI: 10.1002/jso.25080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 03/27/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND OBJECTIVES Prior small studies have reported a possible association between renal cell carcinoma (RCC) and gastrointestinal stromal tumors (GISTs). In the largest known series, our objective was to describe the prevalence of RCC among patients with GISTs over 26 years at Memorial Sloan Kettering Cancer Center (MSKCC). METHODS We retrospectively reviewed MSKCC's prospectively maintained sarcoma and RCC databases and identified all patients with both RCC and GIST between 1980 and 2016. Demographic and clinicopathological characteristics were obtained. RESULTS A total of 9/405 (2.2%) GIST patients were identified with RCC, with a mean follow-up of 9.2 (range 3.8-28.4) years. Five out of nine (55.6%) patients had RCC and GIST diagnosis within 6 months of each other. Mean RCC tumor size was 3.0 (range 1.8-8) cm and 8/9 (88.9%) patients were RCC stage 1. A total of 4/9 (44.4%) patients had papillary RCC (pRCC) histology, 5/9 (55.6%) had additional alternative malignancies, and 4/9 (44.4%) had primary small bowel GIST. CONCLUSIONS Our series suggests a possible association of RCC with GISTs. In addition, we found a high frequency of pRCC histology, alternative malignancies, and small bowel GISTs in co-occurring RCC-GIST patients. Further investigation to identify genetic mutations, in this population, would assist in surveillance and treatment.
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Affiliation(s)
- Shawn J Mendonca
- Division of Urology, Department of Surgery, Sidney Kimmel Center for Prostate, and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, New York.,Department of Urology, Lenox Hill Hospital, Northwell Health, New York, New York
| | - Alejandro Sanchez
- Division of Urology, Department of Surgery, Sidney Kimmel Center for Prostate, and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Kyle A Blum
- Division of Urology, Department of Surgery, Sidney Kimmel Center for Prostate, and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Mazyar Ghanaat
- Division of Urology, Department of Surgery, Sidney Kimmel Center for Prostate, and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Mahyar Y Kashan
- Division of Urology, Department of Surgery, Sidney Kimmel Center for Prostate, and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Nicole Benfante
- Division of Urology, Department of Surgery, Sidney Kimmel Center for Prostate, and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Paul Russo
- Division of Urology, Department of Surgery, Sidney Kimmel Center for Prostate, and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Jonathan A Coleman
- Division of Urology, Department of Surgery, Sidney Kimmel Center for Prostate, and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Aimee M Crago
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - A Ari Hakimi
- Division of Urology, Department of Surgery, Sidney Kimmel Center for Prostate, and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, New York
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Treatment outcomes in older patients with advanced gastrointestinal stromal tumor (GIST). J Geriatr Oncol 2018; 9:520-525. [PMID: 29602734 DOI: 10.1016/j.jgo.2018.03.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 02/25/2018] [Accepted: 03/16/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND The aim of the study was to analyze the treatment results of advanced GIST in the largest, homogenous series of older patients. METHODS Between 2001 and 2016, 686 patients with metastatic/unresectable GIST were treated initially with imatinib and 656 were included in the analysis. Subsequently 232 patients were treated with sunitinib after imatinib failure. We have analyzed the outcomes of patients who have been treated with the tyrosine kinase inhibitor at the age ≥ 70 years and compared to control group of patients younger than 70 years old. RESULTS In the group of patients treated with imatinib, 139 (21%) started therapy at the age of at least 70 years (median age of the entire cohort: 60). Median progression-free survival (PFS) on 1st line imatinib did not differ between patients ≥70 yo (years old) and < 70yo (38.5 vs 44.9 months), but median overall survival (OS) was significantly better for younger patients (81 months vs. 50; p = 0.0001; although disease-specific survival - DSS was similar). Distribution of primary tumor mutational status was generally similar in older and younger patients. Permanent dose reduction (300-100 mg/day) was required for 23 patients (16.9%) in the older group and was significantly more frequent as compared to younger patients (5%). Drug-related adverse events were mainly of grades 1/2, but grade 3/4 toxicity occurred more frequently in older (14.7%) than in younger patients (3.8%). Similarly in group of patients treated with second-line sunitinib median PFS and DSS were comparable in groups of patients ≥70 yo (n = 55) and < 70yo (9.7 months vs 10.3 months; p = 0.7, and 21.5 vs 22.9 months). >40% of patients in both groups required dose adjustments to 37.5-25 mg daily. CONCLUSIONS Our study confirms that current therapy of advanced GIST with tyrosine kinase inhibitors (both in 1st and 2nd line) in older patients enable to achieve the similar disease control rate and final outcomes as in younger patients, but it demands close cooperation of experienced oncologist with patients for dose modifications and side effects management. Limitation of our study is that the patients did not undergo a comprehensive geriatric assessment, what might be helpful for personalized management of patients. Nevertheless, we confirm that older patients with GIST should not receive less treatment irrespective of comorbidities.
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Clinical and pathological features of "small" GIST (≤2 cm). What is their prognostic value? Eur J Surg Oncol 2018; 44:580-586. [PMID: 29478742 DOI: 10.1016/j.ejso.2018.01.087] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 01/08/2018] [Accepted: 01/16/2018] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Small GIST (<2 cm) are tumors whose biological behavior is benign and frequently involutes. Despite their increasing incidence, few studies have addressed the characteristics of these GIST. The aim of this work is to clarify the management of this entity. PATIENTS AND METHOD The characteristics of ≤2 cm GIST were initially described, and then compared with those >2 cm. This series comprises 104 patients and they were divided according to tumor size in 4 groups: tumors which are ≤2 cm (group 1, G1), >2 and ≤ 5 cm (G2), >5 and ≤ 10 cm (G3) and >10 cm (G4). RESULTS AND DISCUSSION Most of small GIST were asymptomatic and incidental, and were located in the stomach. There is an association between patients with associated tumors and asymptomatic GIST. A high overall mortality rate of up to 40% is observed being disease-specific mortality 4.5%. The disease-specific mortality increases proportionally with size. The overall survival (OS) at 5 years are lower for both <2 cm (61%) and >10 cm (53%) than the rest (85-91%). When analyzing the impact of tumor association on <2 cm GIST, we observed that the OS of patients with non-associated tumors was much higher than in the associated ones (90% vs 32% at 5 years, respectively), while no differences were observed in the disease specific survival. CONCLUSIONS Small GIST are tumors that are very often incidentally discovered in the course of complementary examinations. Its prognosis is very good, but it depends on the associated tumor.
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Rodriquenz MG, Rossi S, Ricci R, Martini M, Larocca M, Dipasquale A, Quirino M, Schinzari G, Basso M, D’Argento E, Strippoli A, Barone C, Cassano A. Gastrointestinal stromal tumors (GISTs) and second malignancies: A novel "sentinel tumor"? A monoinstitutional, STROBE-compliant observational analysis. Medicine (Baltimore) 2016; 95:e4718. [PMID: 27661019 PMCID: PMC5044889 DOI: 10.1097/md.0000000000004718] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Several evidences showed that patients with gastrointestinal stromal tumors (GISTs) develop additional malignancies. However, thorough incidence of second tumors remains uncertain as the possibility of a common molecular pathogenesis.A retrospective series of 128 patients with histologically proven GIST treated at our institution was evaluated. Molecular analysis of KIT and PDGFR-α genes was performed in all patients. Following the involvement of KRAS mutation in many tumors' pathogenesis, analysis of KRAS was performed in patients with also second neoplasms.Forty-six out of 128 GIST patients (35.9%) had a second neoplasm. Most second tumors (52%) raised from gastrointestinal tract and 19.6% from genitourinary tract. Benign neoplasms were also included (21.7%). Molecular analysis was available for 29/46 patients with a second tumor: wild-type GISTs (n. 5), exon 11 (n. 16), exon 13 (n. 1), exon 9 (n. 1) KIT mutations, exon 14 PDGFR-α mutation (n. 2) and exon 18 PDGFR-α mutation (n. 4). KIT exon 11 mutations were more frequent between patients who developed a second tumor (P = 0.0003). Mutational analysis of KRAS showed a wild-type sequence in all cases. In metachronous cases, the median time interval between GIST and second tumor was 21.5 months.The high frequency of second tumors suggests that an unknown common molecular mechanism might play a role, but it is not likely that KRAS is involved in this common pathogenesis. The short interval between GIST diagnosis and the onset of second neoplasms asks for a careful follow-up, particularly in the first 3 years after diagnosis.
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Affiliation(s)
| | - Sabrina Rossi
- Department of Medical Oncology, Humanitas Clinical and Research Center, Rozzano (MI)
- Correspondence: Sabrina Rossi, Humanitas Clinical and Research Center, Via Manzoni, 56, 20089 Rozzano (MI), Italy (e-mail: )
| | - Riccardo Ricci
- Department of Pathology, Catholic University of Sacred Heart, Rome
| | - Maurizio Martini
- Department of Pathology, Catholic University of Sacred Heart, Rome
| | - Mario Larocca
- Department of Medical Oncology, Catholic University of Sacred Heart, Rome, Italy
| | - Angelo Dipasquale
- Department of Medical Oncology, Catholic University of Sacred Heart, Rome, Italy
| | - Michela Quirino
- Department of Medical Oncology, Catholic University of Sacred Heart, Rome, Italy
| | - Giovanni Schinzari
- Department of Medical Oncology, Catholic University of Sacred Heart, Rome, Italy
| | - Michele Basso
- Department of Medical Oncology, Catholic University of Sacred Heart, Rome, Italy
| | - Ettore D’Argento
- Department of Medical Oncology, Catholic University of Sacred Heart, Rome, Italy
| | - Antonia Strippoli
- Department of Medical Oncology, Catholic University of Sacred Heart, Rome, Italy
| | - Carlo Barone
- Department of Medical Oncology, Catholic University of Sacred Heart, Rome, Italy
| | - Alessandra Cassano
- Department of Medical Oncology, Catholic University of Sacred Heart, Rome, Italy
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Yamashita K, Baba Y, Kurashige J, Iwatsuki M, Imai K, Hashimoto D, Sakamoto Y, Chikamoto A, Yoshida N, Beppu T, Baba H. Co-occurrence of liver metastasis of gastrointestinal stromal tumor and hepatocellular carcinoma: a case report. Surg Case Rep 2016; 2:86. [PMID: 27586263 PMCID: PMC5009055 DOI: 10.1186/s40792-016-0212-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 08/05/2016] [Indexed: 12/14/2022] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are potentially malignant mesenchymal tumors that can give rise to distant metastases, mainly in the liver. The co-occurrence of synchronous primary liver tumors (e.g., hepatocellular carcinoma (HCC)) in patients with GIST is extremely rare. This report describes a 77-year-old male patient with liver metastasis of GIST originating in the small intestine and synchronous HCC. The patient had undergone resection of the small intestine for the primary GIST 3 years earlier and partial hepatectomy and radiofrequency ablation for liver metastases of GIST 1 year earlier. Despite the continuation of adjuvant therapy with imatinib, two new lesions in the liver were detected by follow-up computed tomography scanning, which showed the gradual enlargement of one tumor. A second hepatectomy was performed. Pathological examination revealed that one tumor was a liver metastasis of GIST and the other was a primary HCC. To our knowledge, this is the first report of the synchronous co-occurrence of a liver metastasis of GIST and a primary HCC.
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Affiliation(s)
- Kohei Yamashita
- Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, 1-1-1 Honjo, Chuo-ku, Kumamoto City, 860-8556, Japan
| | - Yoshifumi Baba
- Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, 1-1-1 Honjo, Chuo-ku, Kumamoto City, 860-8556, Japan
| | - Junji Kurashige
- Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, 1-1-1 Honjo, Chuo-ku, Kumamoto City, 860-8556, Japan
| | - Masaaki Iwatsuki
- Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, 1-1-1 Honjo, Chuo-ku, Kumamoto City, 860-8556, Japan
| | - Katsunori Imai
- Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, 1-1-1 Honjo, Chuo-ku, Kumamoto City, 860-8556, Japan
| | - Daisuke Hashimoto
- Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, 1-1-1 Honjo, Chuo-ku, Kumamoto City, 860-8556, Japan
| | - Yasuo Sakamoto
- Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, 1-1-1 Honjo, Chuo-ku, Kumamoto City, 860-8556, Japan
| | - Akira Chikamoto
- Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, 1-1-1 Honjo, Chuo-ku, Kumamoto City, 860-8556, Japan
| | - Naoya Yoshida
- Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, 1-1-1 Honjo, Chuo-ku, Kumamoto City, 860-8556, Japan
| | - Toru Beppu
- Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, 1-1-1 Honjo, Chuo-ku, Kumamoto City, 860-8556, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, 1-1-1 Honjo, Chuo-ku, Kumamoto City, 860-8556, Japan.
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Fernández Hernández JÁ, Olivares Ripoll V, Parrilla Paricio P. [Additional primary malignancies in patients with gastrointestinal stromal tumors. Proposal for a new classification]. Med Clin (Barc) 2016; 147:405-409. [PMID: 27431886 DOI: 10.1016/j.medcli.2016.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 05/31/2016] [Accepted: 06/02/2016] [Indexed: 12/14/2022]
Abstract
Additional primary malignancies in patients with gastrointestinal stromal tumor (GIST) is not only common but of growing interest in the scientific literature. This association is of great importance in terms of clinical challenge, diagnosis and therapy as well as for the prognosis impact it implies. In the published series there is a tendency to group these patients to determine the specific and distinguishable characteristics of GIST associated with other malignancies. On the other hand, there is no general consensus or unified classification. This classification would be of great interest, as it would unify criteria, agree groups to compare different series and demonstrate whether the aetiology underlying both tumours and the GIST's own characteristics really vary according to the type in question. We undertook a medical literature review and proposed a new classification for patients with GIST associated with other tumours.
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Affiliation(s)
- Juan Ángel Fernández Hernández
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - Vicente Olivares Ripoll
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España.
| | - Pascual Parrilla Paricio
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
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Accordi ED, Xekouki P, Azevedo B, de Alexandre RB, Frasson C, Gantzel SM, Papadakis GZ, Angelousi A, Stratakis CA, Sotomaior VS, Faucz FR. Familiar Papillary Thyroid Carcinoma in a Large Brazilian Family Is Not Associated with Succinate Dehydrogenase Defects. Eur Thyroid J 2016; 5:94-9. [PMID: 27493882 PMCID: PMC4949364 DOI: 10.1159/000444522] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 02/02/2016] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Thyroid cancer is the most common endocrine gland malignancy. Advances in understanding the genetic basis for thyroid cancer revealed the potential involvement of several genes in the formation of thyroid tumors. Mutations in the gene coding for succinate dehydrogenase subtype B (SDHB) have been implicated in papillary thyroid cancer (PTC). Succinate dehydrogenase (SDH) is a heterotetrameric protein composed of four subunits, SDHA, SDHB, SDHC, and SDHD, and participates in both the electron transport chain and the tricarboxylic acid cycle. The aim of the study was to evaluate the association between variants in the SDHA, SDHB, SDHC, and SDHD genes and familiar PTC in a large Brazilian family. METHOD Four patients with PTC, 1 patient with PTC and gastrointestinal stromal tumor (GIST), 1 patient with GIST, and their relatives - several of them with different thyroid problems - from a large Brazilian family were screened for genetic variations of SDHx genes with the use of polymerase chain reaction-single-stranded conformational polymorphism and direct sequencing. RESULTS Only one rare variation in SDHA was found in some of the family members, but not segregating with the disease. No other genetic variants of these genes were detected in the family members that presented with PTC and/or GIST. CONCLUSION Familiar PTC and a GIST were not associated with SDHx mutations; additional genetic defects, yet unknown, may be responsible for the development of tumor.
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Affiliation(s)
- Elen Dias Accordi
- Group for Advanced Molecular Investigation (NIMA), Graduate Program in Health Sciences (PPGCS), School of Medicine (EM), Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil
| | - Paraskevi Xekouki
- Section on Endocrinology and Genetics, Program on Developmental Endocrinology and Genetics (PDEGEN) and Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Md., USA
| | - Bruna Azevedo
- Group for Advanced Molecular Investigation (NIMA), Graduate Program in Health Sciences (PPGCS), School of Medicine (EM), Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil
| | - Rodrigo Bertollo de Alexandre
- Group for Advanced Molecular Investigation (NIMA), Graduate Program in Health Sciences (PPGCS), School of Medicine (EM), Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil
| | - Carla Frasson
- Group for Advanced Molecular Investigation (NIMA), Graduate Program in Health Sciences (PPGCS), School of Medicine (EM), Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil
- Álvaro Center for Analysis and Clinical Research - Diagnósticos da América (DASA), Cascavel, Brazil
| | - Siliane Marie Gantzel
- Group for Advanced Molecular Investigation (NIMA), Graduate Program in Health Sciences (PPGCS), School of Medicine (EM), Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil
| | - Georgios Z. Papadakis
- Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health (NIH), Bethesda, Md., USA
| | - Anna Angelousi
- Section on Endocrinology and Genetics, Program on Developmental Endocrinology and Genetics (PDEGEN) and Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Md., USA
| | - Constantine A. Stratakis
- Section on Endocrinology and Genetics, Program on Developmental Endocrinology and Genetics (PDEGEN) and Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Md., USA
| | - Vanessa Santos Sotomaior
- Group for Advanced Molecular Investigation (NIMA), Graduate Program in Health Sciences (PPGCS), School of Medicine (EM), Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil
| | - Fabio R. Faucz
- Group for Advanced Molecular Investigation (NIMA), Graduate Program in Health Sciences (PPGCS), School of Medicine (EM), Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil
- Section on Endocrinology and Genetics, Program on Developmental Endocrinology and Genetics (PDEGEN) and Pediatric Endocrinology Inter-Institute Training Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Md., USA
- *Fabio R. Faucz, PhD, Section on Endocrinology and Genetics, Program on Developmental Endocrinology and Genetics, NICHD, National Institutes of Health, 10 Center Drive, CRC, Room 1-3216, MSC1103, Bethesda, MD 20892 (USA), E-Mail
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Gavriilidis P, Nikolaidou A. Colon Adenocarcinoma Associated with Synchronous Extramural Gastrointestinal Stromal Tumor (GIST) of the Ileum. AMERICAN JOURNAL OF CASE REPORTS 2015; 16:837-9. [PMID: 26608682 PMCID: PMC4671400 DOI: 10.12659/ajcr.894845] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Patient: Female, 68 Final Diagnosis: Gastrointestinal stromal tumour and colon adenocarcinoma Symptoms: Fatigue Medication: — Clinical Procedure: Right Hemicolectomy and enterectomy Specialty: Surgery
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Affiliation(s)
- Paschalis Gavriilidis
- Department of Surgical Oncology, Theageneio Anticancer Hospital, Thessaloniki, Greece
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Kramer K, Wolf S, Mayer B, Schmidt SA, Agaimy A, Henne-Bruns D, Knippschild U, Schwab M, Schmieder M. Frequence, spectrum and prognostic impact of additional malignancies in patients with gastrointestinal stromal tumors. Neoplasia 2015; 17:134-40. [PMID: 25622906 PMCID: PMC4309732 DOI: 10.1016/j.neo.2014.12.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Accepted: 12/04/2014] [Indexed: 02/08/2023] Open
Abstract
Currently available data on prognostic implication of additional neoplasms in GIST miss comprehensive information on patient outcome with regard to overall or disease specific and disease free survival. Registry data of GIST patients with and without additional neoplasm were compared in retrospective case series. We investigated a total of 836 patients from the multi-center Ulmer GIST registry. Additionally, a second cohort encompassing 143 consecutively recruited patients of a single oncology center were analyzed. The frequency of additional malignant neoplasms in GIST patients was 31.9% and 42.0% in both cohorts with a mean follow-up time of 54 and 65 months (median 48 and 60 months), respectively. The spectrum of additional neoplasms in both cohorts encompasses gastrointestinal tumors (43.5%), uro-genital and breast cancers (34.1%), hematological malignancies (7.3%), skin cancer (7.3%) and others. Additional neoplasms have had a significant impact on patient outcome. The five year overall survival in GIST with additional malignant neoplasms (n = 267) was 62.8% compared to 83.4% in patients without other tumors (n = 569) (P < .001, HR=0.397, 95% CI: 0.298-0.530). Five-year disease specific survival was not different between both groups (90.8% versus 90.9%). 34.2% of all deaths (n = 66 of n = 193) were GIST-related. The presented data suggest a close association between the duration of follow-up and the rate of additional malignancies in GIST patients. Moreover the data indicate a strong impact of additional malignant neoplasms in GIST on patient outcome. A comprehensive follow-up strategy of GIST patients appears to be warranted.
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Affiliation(s)
- K Kramer
- Department of General and Visceral Surgery, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm Germany.
| | - S Wolf
- Department of Surgery, District-Hospital St. Gallen, Rorschacher Strasse 95, 9007 St.Gallen, Switzerland.
| | - B Mayer
- Institute of Epidemiology and Medical Biometry, Schwabstr. 13, University of Ulm, 89075 Ulm, Germany.
| | - S A Schmidt
- Department of Diagnostic and Interventional Radiology, University of Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany.
| | - A Agaimy
- Institute of Pathology, University of Erlangen, Krankenhausstr. 8-10, 91054 Erlangen Germany.
| | - D Henne-Bruns
- Department of General and Visceral Surgery, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm Germany.
| | - U Knippschild
- Department of General and Visceral Surgery, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm Germany.
| | - M Schwab
- Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Auerbachstraße 112, 70376 Stuttgart, Germany; Department of Clinical Pharmacology, University Hospital, Wilhelmstraße 56, 72074 Tübingen, Germany.
| | - M Schmieder
- Department of Internal Medicine, Alb-Fils-Kliniken, Eichertstr. 3, 73035 Goeppingen, Germany.
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Ferreira E Mora H, Pinto de Sousa J, Devesa V, Barbosa J, Costa J, Portugal R, Costa Maia J. Gastrointestinal stromal tumor of the stomach and hepatocellular carcinoma: An unusual association. Int J Surg Case Rep 2015; 12:75-7. [PMID: 26026880 PMCID: PMC4486102 DOI: 10.1016/j.ijscr.2015.05.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 05/04/2015] [Accepted: 05/09/2015] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Gastrointestinal stromal tumors (GIST) are uncommon, potentially malignant tumors, that arise in the wall of the gastrointestinal tract. Up to 50% can develop metastasis, mainly in the liver, but the occurrence of synchronous primary liver tumors is a rare event in these patients. PRESENTATION OF CASE The authors report a case of the association of gastric GIST and hepatocellular carcinoma (HCC) in a non-cirrhotic liver in a 76 year-old patient. DISCUSSION The appearance of an hepatic lesion in a GIST patient does not necessarily imply its secondary nature. CONCLUSION In diagnosed GIST patients, all efforts should be pursued to characterize synchronous hepatic lesions, in order to plan a correct and tailored treatment of the patients.
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Affiliation(s)
| | - J Pinto de Sousa
- Serviço de Cirurgia Geral, Centro Hospitalar de São João, Portugal
| | - V Devesa
- Serviço de Cirurgia Geral, Centro Hospitalar de São João, Portugal
| | - J Barbosa
- Serviço de Cirurgia Geral, Centro Hospitalar de São João, Portugal
| | - J Costa
- Serviço de Anatomia Patológica, Centro Hospitalar de São João, Portugal
| | - R Portugal
- Serviço de Anatomia Patológica, Centro Hospitalar de São João, Portugal
| | - J Costa Maia
- Serviço de Cirurgia Geral, Centro Hospitalar de São João, Portugal
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Kramer K, Knippschild U, Mayer B, Bögelspacher K, Spatz H, Henne-Bruns D, Agaimy A, Schwab M, Schmieder M. Impact of age and gender on tumor related prognosis in gastrointestinal stromal tumors (GIST). BMC Cancer 2015; 15:57. [PMID: 25886494 PMCID: PMC4384379 DOI: 10.1186/s12885-015-1054-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 01/29/2015] [Indexed: 02/07/2023] Open
Abstract
Background Risk classification and prediction of prognosis in GIST is still a matter of debate. Data on the impact of age and gender as potential confounding factors are limited. Therefore we comprehensively investigated age and gender as independent risk factors for GIST. Methods Two independent patient cohorts (cohort I, n = 87 [<50 years]; cohort II, n = 125 [≥50 years]) were extracted from the multicentre Ulmer GIST registry including a total of 659 GIST patients retrospectively collected in 18 collaborative German oncological centers. Based on demographic and clinicopathological parameters and a median follow-up time of 4.3 years (range 0.56; 21.33) disease-specific-survival (DSS), disease-free-survival (DFS) and overall survival (OS) were calculated. Results GIST patients older than fifty years showed significantly worse DSS compared to younger patients (p = 0.021; HR = 0.307, 95% CI [0.113; 0.834]). DSS was significantly more favorable in younger female GIST patients compared with elderly females (p = 0.008). Female gender resulted again in better prognosis in younger patients (p = 0.033). Conclusions Patient age (<50 years) and female gender were significantly associated with a more favourable prognosis in GIST. Extended studies are warranted to confirm our clinical results and to elucidate underlying pathophysiological mechanisms. Electronic supplementary material The online version of this article (doi:10.1186/s12885-015-1054-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Klaus Kramer
- Department of General and Visceral Surgery, University Hospital Ulm, Albert-Einstein-Allee 23, Ulm, 89081, Germany.
| | - Uwe Knippschild
- Department of General and Visceral Surgery, University Hospital Ulm, Albert-Einstein-Allee 23, Ulm, 89081, Germany.
| | - Benjamin Mayer
- Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, 89075, Germany.
| | - Kira Bögelspacher
- Department of Anesthesiology, Alb-Fils-Kliniken, Goeppingen, Goeppingen, 73035, Germany.
| | - Hanno Spatz
- Department of General and Visceral Surgery, Krankenhaus der Barmherzigen Brüder, Romanstraße 93, München, 80639, Germany.
| | - Doris Henne-Bruns
- Department of General and Visceral Surgery, University Hospital Ulm, Albert-Einstein-Allee 23, Ulm, 89081, Germany.
| | - Abbas Agaimy
- Department of Clinical, Institute of Pathology, University of Erlangen, Erlangen, 91054, Germany.
| | - Matthias Schwab
- Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, 70376, Germany. .,Department of Clinical Pharmacology, University Hospital, Tübingen, 72076, Germany.
| | - Michael Schmieder
- Department of Internal Medicine, Alb-Fils-Kliniken, Goeppingen, Goeppingen, 73035, Germany.
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