Hemangiopericytoma: characteristic features observed by magnetic resonance imaging and angiography

Comparative Efficacy and Safety of Different Regimens of Advanced Gastrointestinal Stromal Tumors After Failure Prior Tyrosine Kinase Inhibitors: A Network Meta-Analysis

INTRODUCTION

The prospect of targeted therapies for advanced gastrointestinal stromal tumors (GISTs) has been dramatically transformed after encouraging results achieved in recent clinical trials. At present, the number of second- and third-line treatments are increasing, although the challenge is to take into account the differences between these interventions. Therefore, our goal is to evaluate the investigation of different regimens currently used in GISTs based on findings from phase II or phase III randomized controlled trials (RCTs), and then indirectly compare the effectiveness and safety of the available therapies.

METHODS

The qualified literatures in relevant sources were searched systematically. Studies to identify RCTs of which main endpoints were progression-free survival (PFS), overall survival (OS), and grade 3 or more adverse events (AEs) in patients with GISTs were considered for inclusion.

RESULTS

Eight RCTs met our inclusion criteria, which involved 2351 patients. For PFS, compared with placebo, imatinib, and sunitinib, regorafenib (HR = 0.12, 95% CI 0.07-0.23; HR = 0.27, 95% CI 0.19-0.39; HR = 0.36, 95% CI 0.19-0.72, respectively) and ripretinib (HR = 0.15, 95% CI 0.09-0.25; HR = 0.33, 95% CI 0.16-0.68; HR = 0.44, 95% CI 0.25-0.78, respectively) were significantly correlated with the improvement of PFS, and regorafenib may be the preferred option according to the analysis of treatment rankings. For OS, compared with placebo, imatinib, and sunitinib, masitinib (HR = 0.13, 95% CI 0.04-0.44; HR = 0.13, 95% CI 0.04-0.51; HR = 0.27, 95%CI 0.09-0.84) and ripretinib (HR = 0.36, 95% CI 0.21-0.62; HR = 0.36, 95% CI 0.16-0.80; HR = 0.18, 95% CI 0.09-0.36, respectively) were significantly more effective, and masitinib may be the best choice according to treatment ranking analysis. Statistically, regorafenib can be considered to be the highest in high-grade AEs, while the rate of severe AEs of ripretinib and masitinib was likely the lowest.

CONCLUSION

Our results show that ripretinib has the most favorable balance between effectiveness and tolerability among the different treatment regimens for GISTs.

New frontiers in the medical management of gastrointestinal stromal tumours

The tyrosine kinase inhibitor (TKI) imatinib has radically changed the natural history of KIT-driven gastrointestinal stromal tumours (GISTs). Approved second-line and third-line medical therapies are represented by the TKIs sunitinib and regorafenib, respectively. While imatinib remains the cardinal drug for patients with GISTs, novel therapies are being developed and clinically tested to overcome the mechanisms of resistance after treatments with the approved TKI, or to treat subsets of GISTs driven by rarer molecular events. Here, we review the therapy of GISTs, with a particular focus on the newest drugs in advanced phases of clinical testing that might soon change the current therapeutic algorithm.

Large Haemangiopericytoma of the Posterior Cervical Space

We report a case of a 39-year old woman who upon developing a rapidly enlarging posterior cervical space tumour, underwent incisional biopsy prior to diagnostic imaging that resulted in nearly catastrophic haemorrhage.

Subsequently, MR imaging showed evidence of marked hypervascularity, prompting diagnostic angiography and endovascular microembolization prior to surgical resection.

The tumour turned out to be a large haemangiopericytoma arising from the paravertebral musculature.

The case is instructive by highlighting the need for considering rare locations of hypervascular tumours in the head and neck region before attempting biopsy, which can be predicted by cross-sectional imaging studies, and the benefits of pre-operative devascularization with modern superselective microembolisation techniques.

Ocular adnexal (orbital) solitary fibrous tumor: nuclear STAT6 expression and literature review

PURPOSE

To report the clinico-pathological features of solitary fibrous tumor occurring in the ocular adnexa (OA) in a single center. To assess the presence of NAB2-STAT6 genes fusion in OA solitary fibrous tumor detected by nuclear overexpression of STAT6.

METHODS

Retrospective study including orbital and OA solitary fibrous tumors treated between 2006 and 2014 in our center. The clinical, radiological, and histopathological findings were evaluated. STAT6 expression was assessed by immunohistochemistry.

RESULTS

Five patients were identified and presented with a chronic OA mass. The tumors were radiologically well delimited, highly vascularized and without bone erosion. All the patients underwent complete surgical excision. Pathological examination confirmed solitary fibrous tumor in all cases. All tumors demonstrated a nuclear expression of STAT6. There were no recurrences, with a mean follow-up of 5 years after surgery. Our review demonstrated that proptosis was the most common presentation occurring in 60 % of the cases. In the ocular adnexa, adverse histological criteria were found in 19.7 % of the tumors, and recurrences were observed in 48 % of these cases. Thirty-six percent of patients presented at least one local recurrence, and metastastic spread was found in 2.4 % of the cases. Tumor-related death was described in two cases.

CONCLUSION

Ocular adnexal SFT are rare and usually present as a chronic orbital mass with proptosis. In the OA, solitary fibrous tumor demonstrates STAT6 nuclear expression, as documented in other locations. Recurrences are unusual and metastasis exceptional. Initial surgical resection should be complete in order to avoid recurrence.

Haemangiopericytoma: current status, diagnosis and management

Haemangiopericytoma (HPC) is a rare tumour, characterized by unidentifiable light microscopic features. Despite first being described over 50 years ago, nothing much was known about this tumour until the early 1980s, when ultrastructural studies and tumour markers made it possible to differentiate it from other mesenchymal tumours. Advancements in radiology and the emergence of MRI technology helped surgeons in better planning. Pre-operative vascular embolization helped to reduce the menace of operative haemorrhage. Improvements in localization and delivery of radiotherapy, coupled with early diagnosis, has tremendously improved the treatment outcome of haemangiopericytoma.

Current management and clinical outcome of hemangiopericytomas

Hemangiopericytoma is a rare vascular tumor with variable malignant potential. We report perioperative embolization of a hemangiopericytoma and review the Virginia Mason Clinic experience with six patients during the period 1975 to 1990 with respect to demographics, diagnosis, treatment, and outcome. Our experience suggests that hemangiopericytomas have a variable but predictable malignant potential based on histology and clinical behavior. Three of six patients died of their disease. The remainder were alive and well at 1, 3.5, and 12 postoperative years. These tumors can be specifically and completely delineated preoperatively using magnetic resonance imaging and angiography, the diagnostic procedures of choice. Hemangiopericytomas are highly vascular and amenable to preoperative transarterial embolization. Our most recent case was performed without blood transfusion. This differs from literature reports of massive transfusion requirements and two cases of exsanguination following resection. Finally, recent literature has reported these tumors to respond to greater than 4,500 cGy of local postoperative radiotherapy. We conclude that this interval review of hemangiopericytomas is both timely and relevant with respect to recent developments in imaging and catheter technology. We recommend routine angiography and perioperative embolization prior to wide excision and postoperative radiotherapy.