1
|
Lam TJR, Udonwa SA, Masuda Y, Yeo MHX, Farid Bin Harunal Ras M, Goh BKP. A systematic review and meta-analysis of neoadjuvant imatinib use in locally advanced and metastatic gastrointestinal stromal tumors. World J Surg 2024; 48:1681-1691. [PMID: 38757916 DOI: 10.1002/wjs.12210] [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: 12/26/2023] [Accepted: 04/10/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND Several doubts remain regarding the optimal use of neoadjuvant imatinib in gastrointestinal stromal tumors (GISTs), such as ideal treatment duration, patient selection, and long-term survival outcomes. This manuscript provides a comprehensive review on neoadjuvant imatinib treatment outcomes and facilitate evidence-based decision-making for the use of imatinib therapy in GISTs. METHODS Four databases (PubMed, EMBASE, Scopus, and Cochrane Library) were searched from inception to September 9, 2023. Meta-analyses of proportions were performed for the outcomes of R0 resection, disease responses, and 1-year, 3-year, and 5-year overall survival (OS) as well as 1-year, 3-year, and 5-year disease free survival (DFS). Sensitivity analyses in the form of leave-one-out analyses, meta-regression, and subgroup analyses were performed for outcomes with substantial statistical heterogeneity. RESULTS The search yielded 1254 articles, and 36 studies were included in our analysis. Meta-analysis of proportions revealed that 1-year, 3-year, and 5-year OS was 100%, 94%, and 88%, while 1-year, 3-year and 5-year DFS was 99%, 89%, and 79%, respectively. An R0 resection rate of 89% and a disease response rate of 67% was achieved after a mean duration of treatment of 8.41 ± 0.367 months. KIT exon 9 mutation was significantly associated with poorer 5-year DFS. CONCLUSION This study quantified key outcomes for neoadjuvant imatinib in locally advanced and metastatic or recurrent GIST. Patients with gastric and rectal tumous stand to benefit from neoadjuvant imatinib with an optimal treatment duration of 8 months. Furthermore, the potential utility of mutational analysis in guiding treatment with neoadjuvant imatinib was demonstrated.
Collapse
Affiliation(s)
- Timothy Jia Rong Lam
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Shamill Amedot Udonwa
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yoshio Masuda
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Ministry of Health Holdings, Singapore, Singapore
| | - Mark Hao Xuan Yeo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Ministry of Health Holdings, Singapore, Singapore
| | | | - Brian K P Goh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore, Singapore
- Surgery Academic Clinical Programme, Duke-National University of Singapore Medical School, Singapore, Singapore
| |
Collapse
|
2
|
Pham AT, Pham AT, Truong CM, Nguyen TH, Trinh PH. Primary gastrointestinal stromal tumor of the liver: a case report. Ann Med Surg (Lond) 2024; 86:4284-4290. [PMID: 38989195 PMCID: PMC11230766 DOI: 10.1097/ms9.0000000000002228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 05/19/2024] [Indexed: 07/12/2024] Open
Abstract
Introduction and importance Primary gastrointestinal stromal tumors of the liver are exceedingly rare entities, presenting diagnostic and therapeutic challenges. The authors present a case of a 64-year-old male with a primary gastrointestinal stromal tumor (GIST) of the liver, emphasizing the importance of comprehensive diagnostic evaluation and multidisciplinary management in such uncommon cases. Case presentation The patient presented with persistent hypochondriac pain, leading to the discovery of a hepatic mass. Diagnostic work-ups, including imaging studies and biopsy, confirmed the diagnosis of primary GIST in the liver. Following thorough multidisciplinary consultation, the patient underwent right anterior segmentectomy of the liver, performed by our experienced surgeon. Postoperative pathology confirmed the diagnosis of GIST, and the patient was advised to use adjuvant imatinib. Clinical discussion Primary GISTs of the liver pose diagnostic challenges due to their rarity and varied clinical presentations. Imaging modalities, immunohistochemistry, and molecular genotyping are crucial in accurate diagnosis and treatment planning. Surgical resection remains the cornerstone of treatment for localized GISTs, with adjuvant therapy considered based on recurrence risk factors and molecular characteristics. Conclusion This case highlights the need for multidisciplinary consultation in managing primary GISTs of the liver. Accurate diagnosis, surgical expertise, and personalized adjuvant therapy are crucial for better patient outcomes. Further research is necessary to enhance our understanding of prognostic factors and treatment strategies for these rare tumors.
Collapse
Affiliation(s)
| | - Anh The Pham
- Hepatobiliary and Pancreatic Surgery, Vietnam National Cancer Hospital, 30 Cau Buou, Tan Trieu, Hanoi, Vietnam
| | - Cuong Manh Truong
- Hepatobiliary and Pancreatic Surgery, Vietnam National Cancer Hospital, 30 Cau Buou, Tan Trieu, Hanoi, Vietnam
| | | | - Phuong Huy Trinh
- Hepatobiliary and Pancreatic Surgery, Vietnam National Cancer Hospital, 30 Cau Buou, Tan Trieu, Hanoi, Vietnam
| |
Collapse
|
3
|
Schena CA, Luzzi AP, Laterza V, De Simone B, Aisoni F, Gavriilidis P, Catena F, Coccolini F, Morciano F, Rosa F, Marchegiani F, de'Angelis N. Gastrointestinal Stromal Tumors of the Stomach: Is There Any Advantage of Robotic Resections? A Systematic Review and Meta-Analysis. J Laparoendosc Adv Surg Tech A 2024; 34:603-613. [PMID: 38962886 DOI: 10.1089/lap.2024.0075] [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] [Indexed: 07/05/2024] Open
Abstract
Background: The role of robotic surgery for gastrointestinal stromal tumor (GIST) resection remains unclear. This systematic review and meta-analysis aimed to investigate the outcomes of robotic versus laparoscopic surgery in patients requiring surgery for gastric GISTs. Methods: MEDLINE, EMBASE, and the Cochrane databases were searched from inception to September 4, 2023. Two independent reviewers conducted a systematic review of the literature to select all types of analytic studies comparing robotic versus laparoscopic surgery for GISTs and reporting intraoperative, postoperative, and/or pathological outcomes. Results: Overall, 4 retrospective studies were selected, including a total of 264 patients, specifically 111 (42%) in the robotic and 153 (58%) in the laparoscopic group. Robotic surgery was associated with longer operating time (+42.46 min; 95% confidence interval [CI]: 9.34, 75.58; P=0.01; I2: 85%) and reduced use of mechanical staplers (odds ratio [OR]: 0.05; 95%CI: 0.02, 0.11; P<0.00001; I2: 92%;) compared with laparoscopy. Although nonsignificant, conversion to open surgery was less frequently reported for robotic surgery (2.7%) than laparoscopy (5.2%) (OR: 0.59; 95%CI: 0.17, 2.03; P=0.4; I2: 0%). No difference was found for postoperative and oncological outcomes. Conclusions: Robotic surgery for gastric GISTs provides similar intraoperative, postoperative, and pathological outcomes to laparoscopy, despite longer operative time.
Collapse
Affiliation(s)
- Carlo Alberto Schena
- Unit of Robotic and Minimally Invasive Digestive Surgery, Department of Surgery, Ferrara University Hospital Arcispedale Sant'Anna, Ferrara, Italy
| | - Andrea-Pierre Luzzi
- Dipartimento di Medicina Interna e Specialità Mediche (Di.M.I.), Università di Genova, Genoa, Italy
| | - Vito Laterza
- Department of Digestive Surgical Oncology, Liver Transplantation Unit, University Hospital of Besançon, Besançon, France
| | - Belinda De Simone
- Department of Minimally Invasive Surgery, Guastalla Hospital, AUSL-IRCCS Reggio, Emilia, Italy
| | - Filippo Aisoni
- Unit of Emergency Surgery, Department of Surgery, Ferrara University Hospital Arcispedale Sant'Anna, Ferrara, Italy
| | - Paschalis Gavriilidis
- Department of HBP Surgery, University Hospitals Coventry and Warwickshire NHS Trust,, Clifford Bridge Road, Coventry, CV2 2DX, United Kingdom
| | - Fausto Catena
- Department of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, Cesena, Italy
| | - Federico Coccolini
- General, Emergency and Trauma Department, Pisa University Hospital, Pisa, Italy
| | - Francesca Morciano
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital (AP-HP), Clichy, France
| | - Fausto Rosa
- Emergency and Trauma Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Marchegiani
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital (AP-HP), Clichy, France
| | - Nicola de'Angelis
- Unit of Robotic and Minimally Invasive Digestive Surgery, Department of Surgery, Ferrara University Hospital Arcispedale Sant'Anna, Ferrara, Italy
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| |
Collapse
|
4
|
Yang P, Wu J, Liu M, Zheng Y, Zhao X, Mao Y. Preoperative CT-based radiomics and deep learning model for predicting risk stratification of gastric gastrointestinal stromal tumors. Med Phys 2024. [PMID: 38935330 DOI: 10.1002/mp.17276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 05/21/2024] [Accepted: 06/16/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Gastrointestinal stromal tumors (GISTs) are clinically heterogeneous with various malignant potential in different individuals. It is crucial to explore a reliable method for preoperative risk stratification of gastric GISTs noninvasively. PURPOSE To establish and evaluate a machine learning model using the combination of computed tomography (CT) morphology, radiomics, and deep learning features to predict the risk stratification of primary gastric GISTs preoperatively. METHODS The 193 gastric GISTs lesions were randomly divided into training set, validation set, and test set in a ratio of 6:2:2. The qualitative and quantitative CT morphological features were assessed by two radiologists. The tumors were segmented manually, and then radiomic features were extracted using PyRadiomics and the deep learning features were extracted using pre-trained Resnet50 from arterial phase and venous phase CT images, respectively. Pearson correlation analysis and recursive feature elimination were used for feature selection. Support vector machines were employed to build a classifier for predicting the risk stratification of GISTs. This study compared the performance of models using different pre-trained convolutional neural networks (CNNs) to extract deep features for classification, as well as the performance of modeling features from single-phase and dual-phase images. The arterial phase, venous phase and dual-phase machine learning models were built, respectively, and the morphological features were added to the dual-phase machine learning model to construct a combined model. Receiver operating characteristic (ROC) curves were used to evaluate the efficacy of each model. The clinical application value of the combined model was determined through the decision curve analysis (DCA) and the net reclassification index (NRI) was analyzed. RESULTS The area under the curve (AUC) of the dual-phase machine learning model was 0.876, which was higher than that of the arterial phase model or venous phase model (0.813, 0.838, respectively). The combined model had best predictive performance than the above models with an AUC of 0.941 (95% CI: 0.887-0.974) (p = 0.012, Delong test). DCA demonstrated that the combined model had good clinical application value with an NRI of 0.575 (95% CI: 0.357-0.891). CONCLUSION In this study, we established a combined model that incorporated dual-phase morphology, radiomics, and deep learning characteristics, which can be used to predict the preoperative risk stratification of gastric GISTs.
Collapse
Affiliation(s)
- Ping Yang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiamei Wu
- Department of Radiology, Chongqing Dongnan Hospital, Chongqing, China
| | - Mengqi Liu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yineng Zheng
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaofang Zhao
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yun Mao
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| |
Collapse
|
5
|
Chai Y, Lin B, Zhong J, Wu X, Lin X, Ge X, Jiang J, Liang Z, Liu S, Gu C. Long-term outcomes of endoscopic therapy versus surgical resection for 2-5 cm gastric gastrointestinal stromal tumors: A population-based comparative study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108262. [PMID: 38531231 DOI: 10.1016/j.ejso.2024.108262] [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: 12/05/2023] [Revised: 03/02/2024] [Accepted: 03/08/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Endoscopic therapy (ET) of gastrointestinal stromal tumors (GIST) has become a viable treatment. We intended to compare long-term outcomes of ET versus surgical resection for 2-5 cm GIST using the Surveillance, Epidemiology, and End Results (SEER) database. METHODS A multicenter retrospective study was conducted to compare the long-term outcomes of patients treated with ET and surgical resection for GIST. The multivariate Cox proportional hazards models were used to identify predictors for patients survival. To balance the clinicopathologic characteristics, a 1:1 propensity score matching (PSM) was utilized. RESULTS A total of 749 patients with 2-5 cm GIST were enrolled, of whom 113 accepted ET and 636 underwent surgical resection. Before PSM, there was no significant difference in long-term outcomes between ET and surgical resection (5-year overall survival (OS): 93.5% vs. 91.6%, P=0.374; 5-year cancer-specific survival (CSS): 99.1% vs. 96.5%, P=0.546; 10-year OS: 71.1% vs. 78.2%, P=0.374; 10-year CSS: 93.6% vs. 92.7%, P=0.546). After adjusting for the relevant variables using the multivariable Cox proportional hazards models, we observed that the ET and surgical resection groups were similar in OS (HR 0.726, 95%CI 0.457-1.153, P=0.175) and CSS (HR 1.286, 95%CI 0.474-3.488, P=0.621). After PSM, the long-term OS and CSS of patients with 2-5 cm GIST after ET and surgical resection were comparable. CONCLUSIONS We found that the long-term survival of patients with 2-5 cm gastric GIST after ET and surgical resection were comparable. Further high-quality studies are needed to confirm the role of ET in 2-5 cm GIST.
Collapse
Affiliation(s)
- Yixia Chai
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Bitao Lin
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Jun Zhong
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Xiaosheng Wu
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Xin Lin
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Xiaoyue Ge
- Department of General Practice, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Jiayi Jiang
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Zhenye Liang
- Department of Gastrointestinal Surgery, The Third Affiliated Hospital of Sun Yat-Sen University · Zhao Qing Hospital, Zhaoqing 526000, China.
| | - Side Liu
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
| | - Chuncai Gu
- Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
| |
Collapse
|
6
|
Behi H, Omry A, Guelmami H, Changuel A, Kamtaoui A, Khalifa MB. A case report: Peritonitis secondary to perforated locally advanced gastrointestinal stromal tumor. Int J Surg Case Rep 2024; 119:109739. [PMID: 38728971 PMCID: PMC11101896 DOI: 10.1016/j.ijscr.2024.109739] [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: 03/31/2024] [Revised: 05/01/2024] [Accepted: 05/03/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Gastrointestinal stromal tumors (GISTs) are rare mesenchymal neoplasms predominantly affecting the gastrointestinal tract. While they often remain asymptomatic, GISTs can lead to acute abdominal emergencies, such as peritonitis secondary to tumor perforation, a rare yet serious complication. Here, we present a unique case of a locally advanced ileal gastrointestinal stromal tumor complicated by generalized purulent peritonitis, emphasizing the diagnostic and management challenges associated with this condition. CASE PRESENTATION A 68-year-old male presented with worsening abdominal pain, vomiting, fever, and weight loss. Imaging studies revealed a large solid-cystic mass originating from the terminal ileum, prompting emergency surgery. Intraoperative findings included a multilobulated tumor mass invading the mesocolon, necessitating hemicolectomy. Histopathological analysis confirmed a high-risk gastrointestinal stromal tumor, leading to initiation of adjuvant therapy with imatinib mesylate. CLINICAL DISCUSSION GISTs often present with nonspecific symptoms, posing diagnostic challenges. Peritonitis secondary to tumor perforation is a rare yet critical complication requiring prompt surgical intervention. Complete resection remains the mainstay of treatment, with adjuvant imatinib therapy showing promise in high-risk cases. CONCLUSION This case report sheds light on the complexities of diagnosing and managing locally advanced gastrointestinal stromal tumors (GISTs) complicated by peritonitis. Complete tumor resection is crucial for potential cure, with adjuvant therapy using imatinib showing promise, especially in high-risk cases. Thorough diagnostic assessment, timely intervention, and comprehensive follow-up are essential for optimizing outcomes in complex GIST presentations.
Collapse
Affiliation(s)
- Hager Behi
- General Surgery Department, Military Hospital of Tunis, Mont Fleury, 1008 Tunis, Tunisia; Faculty of Medicine of Tunis, 15, Djebel Lakhdhar Street, Bab Saadoun, 1007 Tunis, Tunisia
| | - Ahmed Omry
- General Surgery Department, Military Hospital of Tunis, Mont Fleury, 1008 Tunis, Tunisia; Faculty of Medicine of Tunis, 15, Djebel Lakhdhar Street, Bab Saadoun, 1007 Tunis, Tunisia.
| | - Hanene Guelmami
- General Surgery Department, Military Hospital of Tunis, Mont Fleury, 1008 Tunis, Tunisia; Faculty of Medicine of Tunis, 15, Djebel Lakhdhar Street, Bab Saadoun, 1007 Tunis, Tunisia
| | - Amel Changuel
- General Surgery Department, Military Hospital of Tunis, Mont Fleury, 1008 Tunis, Tunisia; Faculty of Medicine of Tunis, 15, Djebel Lakhdhar Street, Bab Saadoun, 1007 Tunis, Tunisia
| | - Amal Kamtaoui
- General Surgery Department, Military Hospital of Tunis, Mont Fleury, 1008 Tunis, Tunisia; Faculty of Medicine of Tunis, 15, Djebel Lakhdhar Street, Bab Saadoun, 1007 Tunis, Tunisia
| | - Med Bachir Khalifa
- General Surgery Department, Military Hospital of Tunis, Mont Fleury, 1008 Tunis, Tunisia; Faculty of Medicine of Tunis, 15, Djebel Lakhdhar Street, Bab Saadoun, 1007 Tunis, Tunisia
| |
Collapse
|
7
|
Dande A, Pajai S, Acharya N, Joshi KS, Patel DJ, Gupta A. Gastrointestinal Stromal Tumors Mimicking Ovarian Mass: A Case Report. Cureus 2024; 16:e58320. [PMID: 38752091 PMCID: PMC11094664 DOI: 10.7759/cureus.58320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 04/15/2024] [Indexed: 05/18/2024] Open
Abstract
Gastrointestinal stromal tumors (GIST) are common mesenchymal tumors of the gastrointestinal tract. Some somatic factors have been linked to an increased incidence risk. The diagnostic process for GIST poses difficulties since it bears limited resemblance to ovarian masses, given its manifestation through symptoms like abdominal pain, abdominal mass, fever, weight loss, and loss of appetite. Patients with GIST usually exhibit clinical symptoms and signs of an abdominal mass and chronic pelvic pain might look like an ovarian mass, and diagnosed as GIST on histological examination. A 50-year-old woman presented to the gynecology outpatient department with complaints of an abdominal lump accompanied by pain and decreased appetite persisting for five months, leading to a preliminary diagnosis of an ovarian mass. Further evaluation by histopathological examination was confirmed to be GIST on the final diagnosis.
Collapse
Affiliation(s)
- Anubha Dande
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research DU, Wardha, IND
| | - Sandhya Pajai
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research DU, Wardha, IND
| | - Neema Acharya
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research DU, Wardha, IND
| | - Ketav S Joshi
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research DU, Wardha, IND
| | - Dharmesh J Patel
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research DU, Wardha, IND
| | - Aishwarya Gupta
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research DU, Wardha, IND
| |
Collapse
|
8
|
Almeida M, Sousa F, Resende F, Devesa V, Ferrão A, Carneiro S, Canão P, Barbosa E, Barbosa J. Primary EGIST of the greater omentum - a rare presentation. Acta Chir Belg 2024; 124:137-142. [PMID: 37027318 DOI: 10.1080/00015458.2023.2201084] [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: 12/27/2022] [Accepted: 04/04/2023] [Indexed: 04/21/2023]
Abstract
Extragastrointestinal stromal tumors (EGISTs) are rare mesenchymal neoplasms, which develop in the retroperitoneum, mesentery, and omentum, lacking continuity to the stomach or intestines. Authors hereby present a female patient with a large heterogeneous abdominal mass as a case of an omental EGIST. A 46-year-old woman was referred to our hospital due to an insidious enlargement and colicky pain in the right iliac fossa. Abdominal palpation revealed a voluminous, freely mobile, and non-pulsatile mesoabdominal bulge expanding to the hypogastrium. On exploratory midline laparotomy, the tumor was densely fused to the greater omentum, not connected to the stomach, without gross involvement of adjacent structures. The large mass was completely excised after adequate mobilization. Immunohistochemical techniques showed strong and diffuse expression of WT1, actin and DOG-1, as well as multifocal c-KIT marking. Mutational study concluded a double mutation of KIT exon 9 and a mutation of PDGFRA exon 18. The patient was submitted to adjuvant treatment with imatinib mesylate 800 mg/day. Despite an extremely diverse presentation, omental EGISTs often remain clinically silent for a long time having enough space to grow before becoming symptomatic. These tumors have a consistent pattern of metastasis that typically spares lymph nodes unlike epithelial gut neoplasms. Surgery remains the preferred treatment for non-metastatic EGISTs of the greater omentum. It is possible that DOG-1 will supplant KIT as the leading marker in the future. The scarcity of knowledge on omental EGISTs implies a close monitoring of these patients to detect local relapse or distant metastasis.
Collapse
Affiliation(s)
- Miguel Almeida
- General Surgery Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Fabiana Sousa
- General Surgery Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Fernando Resende
- General Surgery Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Vítor Devesa
- General Surgery Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - António Ferrão
- General Surgery Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Silvestre Carneiro
- General Surgery Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Pedro Canão
- Pathology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Elisabete Barbosa
- General Surgery Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - José Barbosa
- General Surgery Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| |
Collapse
|
9
|
Abera SA, Tadesse AK, Abera KA, Zegeye KB, Ibrahim MA, Feleke AA, Gebrehiwet CL, Mengistu SB, Alemu HT, Molla YD. Duodenal gastrointestinal stromal tumor presenting with life-threatening upper GI bleeding in a young patient: A case report and literature review. Clin Case Rep 2024; 12:e8796. [PMID: 38634092 PMCID: PMC11022307 DOI: 10.1002/ccr3.8796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 02/28/2024] [Accepted: 03/07/2024] [Indexed: 04/19/2024] Open
Abstract
Key Clinical Message Duodenal GISTs are rare and challenging tumors. Acute life-threatening upper GI bleeding is a possible presentation of duodenal GISTs. Surgery is the standard treatment for localized duodenal GISTs. Imatinib is an effective adjuvant therapy for duodenal GISTs. Abstract GIST is the most common mesenchymal neoplasm of the gastrointestinal tract, accounting for 1%-2% of gastrointestinal tumors. They originate from the interstitial cells of Cajal and are rare in patients younger than 30 years. The stomach is the most common site, followed by the small intestine and colon. GISTs are caused by a gain-of-function mutation in the proto-oncogene receptor tyrosine kinase, with activating mutations in KIT being the most common. Most GISTs are asymptomatic. Even if gastrointestinal bleeding is the most common complication life-threatening hemorrhage is extremely uncommon. We present a case of a 31-year-old male patient presented with massive active hematemesis and melena with hemorrhagic shock. The patient presented with massive hematemesis and melena of 1 h duration. Endoscopy showed pulsating active bleeding from the third part of the duodenum which was difficult to manage via endoscopy. Histopathologic evaluation showed spindle cell type GIST. Intraoperatively, there was a nodular mass with active bleeding on the third part of the duodenum. Duodenectomy with end-to-end anastomosis was done. Discharged with no postoperative complication and was put on imatinib. There are considerable challenges that arise in the diagnosis and treatment of duodenal gastrointestinal stromal tumors (GISTs) when they present with life-threatening upper gastrointestinal hemorrhage. In order to achieve the best possible outcomes for patients, it is crucial to have a comprehensive understanding of the clinical presentation, diagnostic methods, and treatment approaches.
Collapse
Affiliation(s)
- Samuel Addisu Abera
- Department of Anatomic Pathology, College of Medicine and Health SciencesUniversity of GondarGondarEthiopia
| | - Amanuel Kassa Tadesse
- Department of Anatomic Pathology, College of Medicine and Health SciencesUniversity of GondarGondarEthiopia
| | - Kirubel Addisu Abera
- Department of Anatomic Pathology, College of Medicine and Health SciencesUniversity of GondarGondarEthiopia
| | - Kassa Berie Zegeye
- Department of Anatomic Pathology, College of Medicine and Health SciencesUniversity of GondarGondarEthiopia
| | - Mohammed Alemu Ibrahim
- Department of Surgery, College of Medicine and Health SciencesUniversity of GondarGondarEthiopia
| | - Ashenafi Amsalu Feleke
- Department of Surgery, College of Medicine and Health SciencesUniversity of GondarGondarEthiopia
| | - Cheru lilay Gebrehiwet
- Department of Surgery, College of Medicine and Health SciencesUniversity of GondarGondarEthiopia
| | - Segenet Bizuneh Mengistu
- Department of Internal medicine, College of Medicine and Health SciencesUniversity of GondarGondarEthiopia
| | | | - Yohannis Derbew Molla
- Department of Surgery, College of Medicine and Health SciencesUniversity of GondarGondarEthiopia
| |
Collapse
|
10
|
Wang SJ, Sun F. Lymph node metastasis in small intestinal gastrointestinal stromal tumors: A rare case report and literature review. Asian J Surg 2024; 47:592-595. [PMID: 37914648 DOI: 10.1016/j.asjsur.2023.09.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 09/22/2023] [Indexed: 11/03/2023] Open
Affiliation(s)
- Sheng Jin Wang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Kunming Medical University, NO.374 Dianmian avenue, Wuhua District, Kunming City, Yunnan Province, China.
| | - Feng Sun
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Kunming Medical University, NO.374 Dianmian avenue, Wuhua District, Kunming City, Yunnan Province, China.
| |
Collapse
|
11
|
Liu C, Zhou D, Yang K, Xu N, Peng J, Zhu Z. Research progress on the pathogenesis of the SDHB mutation and related diseases. Biomed Pharmacother 2023; 167:115500. [PMID: 37734265 DOI: 10.1016/j.biopha.2023.115500] [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: 06/12/2023] [Revised: 09/01/2023] [Accepted: 09/12/2023] [Indexed: 09/23/2023] Open
Abstract
With the improvement of genetic testing technology in diseases in recent years, researchers have a more detailed and clear understanding of the source of cancers. Succinate dehydrogenase B (SDHB), a mitochondrial gene, is related to the metabolic activities of cells and tissues throughout the body. The mutations of SDHB have been found in pheochromocytoma, paraganglioma and other cancers, and is proved to affect the occurrence and progress of those cancers due to the important structural functions. The importance of SDHB is attracting more and more attention of researchers, however, reviews on the structure and function of SDHB, as well as on the mechanism of its carcinogenesis is inadequate. This paper reviews the relationship between SDHB mutations and related cancers, discusses the molecular mechanism of SDHB mutations that may lead to tumor formation, analyzes the mutation spectrum, structural domains, and penetrance of SDHB and sorts out some of the previously discovered diseases. For the patients with SDHB mutation, it is recommended that people in SDHB mutation families undergo regular genetic testing or SDHB immunohistochemistry (IHC). The purpose of this paper is hopefully to provide some reference and help for follow-up researches on SDHB.
Collapse
Affiliation(s)
- Chang Liu
- Ambulatory Surgical Center, First Affiliated Hospital of Kunming Medical University, 295 Xichang Road, Kunming 650032, China
| | - Dayang Zhou
- Ambulatory Surgical Center, First Affiliated Hospital of Kunming Medical University, 295 Xichang Road, Kunming 650032, China
| | - Kexin Yang
- Department of Surgical oncology, Yunnan Cancer Hospital, 519 Kunzhou Road, Kunming, 650118, China
| | - Ning Xu
- Ambulatory Surgical Center, First Affiliated Hospital of Kunming Medical University, 295 Xichang Road, Kunming 650032, China
| | - Jibang Peng
- Department of Surgical oncology, First Affiliated Hospital of Kunming Medical University, 295 Xichang Road, Kunming 650032, China
| | - Zhu Zhu
- Ambulatory Surgical Center, First Affiliated Hospital of Kunming Medical University, 295 Xichang Road, Kunming 650032, China.
| |
Collapse
|
12
|
Galluzzo A, Boccioli S, Danti G, De Muzio F, Gabelloni M, Fusco R, Borgheresi A, Granata V, Giovagnoni A, Gandolfo N, Miele V. Radiomics in gastrointestinal stromal tumours: an up-to-date review. Jpn J Radiol 2023; 41:1051-1061. [PMID: 37171755 DOI: 10.1007/s11604-023-01441-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 04/29/2023] [Indexed: 05/13/2023]
Abstract
Gastrointestinal stromal tumours are rare mesenchymal neoplasms originating from the Cajal cells and represent the most common sarcomas in the gastroenteric tract. Symptoms may be absent or non-specific, ranging from fatigue and weight loss to acute abdomen. Nowadays endoscopy, echoendoscopy, contrast-enhanced computed tomography, magnetic resonance imaging and positron emission tomography are the main methods for diagnosis. Because of their rarity, these neoplasms may not be included immediately in the differential diagnosis of a solitary abdominal mass. Radiomics is an emerging technique that can extract medical imaging information, not visible to the human eye, transforming it into quantitative data. The purpose of this review is to demonstrate how radiomics can improve the already known imaging techniques by providing useful tools for the diagnosis, treatment, and prognosis of these tumours.
Collapse
Affiliation(s)
- Antonio Galluzzo
- Department of Radiology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Sofia Boccioli
- Department of Radiology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Ginevra Danti
- Department of Radiology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy.
| | - Federica De Muzio
- Department of Medicine and Health Sciences V. Tiberio, University of Molise, 86100, Campobasso, Italy
| | - Michela Gabelloni
- Department of Translational Research, Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy
| | - Roberta Fusco
- Medical Oncology Division, Igea SpA, 80013, Naples, Italy
| | - Alessandra Borgheresi
- Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, Via Conca 71, 60126, Ancona, Italy
- Department of Radiology, University Hospital "Azienda Ospedaliera Universitaria Delle Marche", Via Conca 71, 60126, Ancona, Italy
| | - Vincenza Granata
- Department of Radiology, "Istituto Nazionale Tumori IRCCS Fondazione, Pascale-IRCCS di Napoli", 80131, Naples, Italy
| | - Andrea Giovagnoni
- Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, Via Conca 71, 60126, Ancona, Italy
- Department of Radiology, University Hospital "Azienda Ospedaliera Universitaria Delle Marche", Via Conca 71, 60126, Ancona, Italy
| | - Nicoletta Gandolfo
- Diagnostic Imaging Department, Villa Scassi Hospital-ASL 3, Corso Scassi 1, 16149, Genoa, Italy
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Via Della Signora 2, 20122, Milan, Italy
| | - Vittorio Miele
- Department of Radiology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| |
Collapse
|
13
|
Bangolo A, Fwelo P, Al-Qatish T, Bukasa-Kakamba J, Lee T, Cayago AG, Potiguara S, Nagesh VK, Kawall J, Ahmed R, Asjad Abbas M, Nursjamsi N, Lee SH, Meti S, Arana GV, Joseph CA, Mohamed A, Alencar A, Hassan HG, Aryal P, Javed A, Kalinin M, Lawal G, Khalaf IY, Mathew M, Karamthoti P, Gupta B, Weissman S. Outcomes of Patients with Gastrointestinal Stromal Tumors in the Past Decade. Med Sci (Basel) 2023; 11:54. [PMID: 37755158 PMCID: PMC10536810 DOI: 10.3390/medsci11030054] [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: 07/03/2023] [Revised: 08/10/2023] [Accepted: 08/25/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Gastrointestinal stromal tumors (GISTs) are rare mesenchymal neoplasms of the gastrointestinal tract (GIT) that represent approximately 1 to 2 percent of primary gastrointestinal (GI) cancers. Owing to their rarity, very little is known about their overall epidemiology, and the prognostic factors of their pathology. The current study aimed to evaluate the independent determinants of mortality in patients diagnosed with GISTs over the past decade. METHODS Our study comprised 2374 patients diagnosed with GISTs from 2000 to 2017 from the Surveillance, Epidemiology, and End Results (SEER) database. We analyzed the baseline characteristics, and overall mortality (OM), as well as the cancer-specific mortality (CSM) of GISTs. Variables with a p value < 0.01 in the univariate Cox regression were incorporated into the multivariate Cox model, to determine the independent prognostic factors. RESULTS Multivariate Cox proportional hazard regression analyses of factors affecting the all-cause mortality and GIST-related mortality among US patients between 2010 and 2017 revealed a higher overall mortality in non-Hispanic Black patients (HR = 1.516, 95% CI 1.172-1.961, p = 0.002), patients aged 80+ (HR = 9.783, 95% CI 4.185-22.868, p = 0), followed by those aged 60-79 (HR = 3.408, 95% CI 1.488-7.807, p = 0.004); male patients (HR = 1.795, 95% CI 1.461-2.206, p < 0.001); patients with advanced disease with distant metastasis (HR = 3.865, 95% CI 2.977-5.019, p < 0.001), followed by cases with regional involvement via both direct extension and lymph node involvement (HR = 3.853, 95% CI 1.551-9.57, p = 0.004); and widowed patients (HR = 1.975, 95% CI 1.494-2.61, p < 0.001), followed by single patients (HR = 1.53, 95% CI 1.154-2.028, p = 0.003). The highest CSM was observed in the same groups, except widowed patients and patients aged 60-79. The highest CSM was also observed among patients that underwent chemotherapy (HR = 1.687, 95% CI 1.19-2.392, p = 0.003). CONCLUSION In this updated study on the outcomes of patients with GISTs, we found that non-Hispanic Black patients, male patients, and patients older than 60 years have a higher mortality with GISTs. Furthermore, patients who have received chemotherapy have a higher GIST-specific mortality, and married patients have a lower mortality. However, we do not know to what extent these independent prognostic factors interact with each other to influence mortality. This study paves the way for future studies addressing these interactions. The results of this study may help treating clinicians to identify patient populations associated with a dismal prognosis, as those may require closer follow-up and more intensive therapy; furthermore, with married patients having a better survival rate, we hope to encourage clinicians to involve family members of the affected patients early in the disease course, as the social support might impact the prognosis.
Collapse
Affiliation(s)
- Ayrton Bangolo
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA; (T.A.-Q.); (S.P.); (G.V.A.); (C.A.J.); (M.K.); (G.L.); (I.Y.K.)
| | - Pierre Fwelo
- Department of Epidemiology, Human Genetics and Environmental Sciences, UTHealth School of Public Health, Houston, TX 77204, USA
| | - Tha’er Al-Qatish
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA; (T.A.-Q.); (S.P.); (G.V.A.); (C.A.J.); (M.K.); (G.L.); (I.Y.K.)
| | - John Bukasa-Kakamba
- Division of Endocrinology, Department of Medicine, Kinshasa University Clinics, Kinshasa 7948, Democratic Republic of the Congo;
| | - Tiffany Lee
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA; (T.A.-Q.); (S.P.); (G.V.A.); (C.A.J.); (M.K.); (G.L.); (I.Y.K.)
| | - Akira G. Cayago
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA; (T.A.-Q.); (S.P.); (G.V.A.); (C.A.J.); (M.K.); (G.L.); (I.Y.K.)
| | - Sarah Potiguara
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA; (T.A.-Q.); (S.P.); (G.V.A.); (C.A.J.); (M.K.); (G.L.); (I.Y.K.)
| | - Vignesh K. Nagesh
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA; (T.A.-Q.); (S.P.); (G.V.A.); (C.A.J.); (M.K.); (G.L.); (I.Y.K.)
| | - Jessica Kawall
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA; (T.A.-Q.); (S.P.); (G.V.A.); (C.A.J.); (M.K.); (G.L.); (I.Y.K.)
| | - Rashid Ahmed
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA; (T.A.-Q.); (S.P.); (G.V.A.); (C.A.J.); (M.K.); (G.L.); (I.Y.K.)
| | - Muhammad Asjad Abbas
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA; (T.A.-Q.); (S.P.); (G.V.A.); (C.A.J.); (M.K.); (G.L.); (I.Y.K.)
| | - Narissa Nursjamsi
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA; (T.A.-Q.); (S.P.); (G.V.A.); (C.A.J.); (M.K.); (G.L.); (I.Y.K.)
| | - Stacy H. Lee
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA; (T.A.-Q.); (S.P.); (G.V.A.); (C.A.J.); (M.K.); (G.L.); (I.Y.K.)
| | - Shagi Meti
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA; (T.A.-Q.); (S.P.); (G.V.A.); (C.A.J.); (M.K.); (G.L.); (I.Y.K.)
| | - Georgemar V. Arana
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA; (T.A.-Q.); (S.P.); (G.V.A.); (C.A.J.); (M.K.); (G.L.); (I.Y.K.)
| | - Chrishanti A. Joseph
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA; (T.A.-Q.); (S.P.); (G.V.A.); (C.A.J.); (M.K.); (G.L.); (I.Y.K.)
| | - Abdifitah Mohamed
- Department of Medicine, University of Washington, Seattle, WA 98195, USA
| | - Arthur Alencar
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA; (T.A.-Q.); (S.P.); (G.V.A.); (C.A.J.); (M.K.); (G.L.); (I.Y.K.)
| | - Huzaifa G. Hassan
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA; (T.A.-Q.); (S.P.); (G.V.A.); (C.A.J.); (M.K.); (G.L.); (I.Y.K.)
| | - Pramanu Aryal
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA; (T.A.-Q.); (S.P.); (G.V.A.); (C.A.J.); (M.K.); (G.L.); (I.Y.K.)
| | - Aleena Javed
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA; (T.A.-Q.); (S.P.); (G.V.A.); (C.A.J.); (M.K.); (G.L.); (I.Y.K.)
| | - Maksim Kalinin
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA; (T.A.-Q.); (S.P.); (G.V.A.); (C.A.J.); (M.K.); (G.L.); (I.Y.K.)
| | - Gbenga Lawal
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA; (T.A.-Q.); (S.P.); (G.V.A.); (C.A.J.); (M.K.); (G.L.); (I.Y.K.)
| | - Ibtihal Y. Khalaf
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA; (T.A.-Q.); (S.P.); (G.V.A.); (C.A.J.); (M.K.); (G.L.); (I.Y.K.)
| | - Midhun Mathew
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA; (T.A.-Q.); (S.P.); (G.V.A.); (C.A.J.); (M.K.); (G.L.); (I.Y.K.)
| | - Praveena Karamthoti
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA; (T.A.-Q.); (S.P.); (G.V.A.); (C.A.J.); (M.K.); (G.L.); (I.Y.K.)
| | - Bhavna Gupta
- Division of Hematology and Oncology, Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA
| | - Simcha Weissman
- Department of Medicine, Hackensack Meridian Health/Palisades Medical Center, North Bergen, NJ 07047, USA; (T.A.-Q.); (S.P.); (G.V.A.); (C.A.J.); (M.K.); (G.L.); (I.Y.K.)
| |
Collapse
|
14
|
Serrano C, Martín-Broto J, Asencio-Pascual JM, López-Guerrero JA, Rubió-Casadevall J, Bagué S, García-del-Muro X, Fernández-Hernández JÁ, Herrero L, López-Pousa A, Poveda A, Martínez-Marín V. 2023 GEIS Guidelines for gastrointestinal stromal tumors. Ther Adv Med Oncol 2023; 15:17588359231192388. [PMID: 37655207 PMCID: PMC10467260 DOI: 10.1177/17588359231192388] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 07/19/2023] [Indexed: 09/02/2023] Open
Abstract
Gastrointestinal stromal tumor (GIST) is the most common malignant neoplasm of mesenchymal origin. GIST spans a wide clinical spectrum that ranges from tumors with essentially no metastatic potential to malignant and life-threatening spread diseases. Gain-of-function mutations in KIT or PDGFRA receptor tyrosine kinases are the crucial drivers of most GISTs, responsible for tumor initiation and evolution throughout the entire course of the disease. The introduction of tyrosine kinase inhibitors targeting these receptors has substantially improved the outcomes in this formerly chemoresistant cancer. As of today, five agents hold regulatory approval for the treatment of GIST: imatinib, sunitinib, regorafenib, ripretinib, and avapritinib. This, in turn, represents a success for a rare neoplasm. During the past two decades, GIST has become a paradigmatic model in cancer for multidisciplinary work, given the disease-specific particularities regarding tumor biology and tumor evolution. Herein, we review currently available evidence for the management of GIST. This clinical practice guideline has been developed by a multidisciplinary expert panel (oncologist, pathologist, surgeon, molecular biologist, radiologist, and representative of patients' advocacy groups) from the Spanish Group for Sarcoma Research, and it is conceived to provide, from a critical perspective, the standard approach for diagnosis, treatment, and follow-up.
Collapse
Affiliation(s)
- César Serrano
- Sarcoma Translational Research Group, Vall d’Hebron Institute of Oncology (VHIO), Vall d’Hebron University Hospital, Vall d’Hebron Barcelona Hospital Campus, Carrer de Natzaret, 115-117, Barcelona 08035, Spain
| | - Javier Martín-Broto
- Medical Oncology Department, Fundación Jimenez Diaz University Hospital, Madrid, Spain
- University Hospital General de Villalba, Madrid, Spain Instituto de investigación Sanitaria Fundación Jimenez Diaz (IIS/FJD; UAM), Madrid, Spain
| | - José Manuel Asencio-Pascual
- Department of General Surgery, Gregorio Marañón University Hospital, Madrid, Spain
- Department of Surgery, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Jordi Rubió-Casadevall
- Department of Medical Oncology, Catalan Institute of Oncology, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Silvia Bagué
- Department of Pathology, Santa Creu i Sant Pau University Hospital, Barcelona, Spain
| | - Xavier García-del-Muro
- Department of Medical Oncology, Institut Català d’Oncologia, IDIBELL and University of Barcelona, Barcelona, Spain
| | | | - Luís Herrero
- GIST advocacy group – Colectivo GIST, Valladolid, Spain
| | - Antonio López-Pousa
- Department of Pathology, Santa Creu i Sant Pau University Hospital, Barcelona, Spain
| | - Andrés Poveda
- Initia Oncologia, Hospital Quironsalud, Valencia, Spain
| | | |
Collapse
|
15
|
Wang TT, Liu WW, Liu XH, Gao RJ, Zhu CY, Wang Q, Zhao LP, Fan XM, Li J. Relationship between multi-slice computed tomography features and pathological risk stratification assessment in gastric gastrointestinal stromal tumors. World J Gastrointest Oncol 2023; 15:1073-1085. [PMID: 37389110 PMCID: PMC10303000 DOI: 10.4251/wjgo.v15.i6.1073] [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: 03/09/2023] [Revised: 04/02/2023] [Accepted: 04/25/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Computed tomography (CT) imaging features are associated with risk stratification of gastric gastrointestinal stromal tumors (GISTs).
AIM To determine the multi-slice CT imaging features for predicting risk stratification in patients with primary gastric GISTs.
METHODS The clinicopathological and CT imaging data for 147 patients with histologically confirmed primary gastric GISTs were retrospectively analyzed. All patients had received dynamic contrast-enhanced CT (CECT) followed by surgical resection. According to the modified National Institutes of Health criteria, 147 lesions were classified into the low malignant potential group (very low and low risk; 101 lesions) and high malignant potential group (medium and high-risk; 46 lesions). The association between malignant potential and CT characteristic features (including tumor location, size, growth pattern, contour, ulceration, cystic degeneration or necrosis, calcification within the tumor, lymphadenopathy, enhancement patterns, unenhanced CT and CECT attenuation value, and enhancement degree) was analyzed using univariate analysis. Multivariate logistic regression analysis was performed to identify significant predictors of high malignant potential. The receiver operating curve (ROC) was used to evaluate the predictive value of tumor size and the multinomial logistic regression model for risk classification.
RESULTS There were 46 patients with high malignant potential and 101 with low-malignant potential gastric GISTs. Univariate analysis showed no significant differences in age, gender, tumor location, calcification, unenhanced CT and CECT attenuation values, and enhancement degree between the two groups (P > 0.05). However, a significant difference was observed in tumor size (3.14 ± 0.94 vs 6.63 ± 3.26 cm, P < 0.001) between the low-grade and high-grade groups. The univariate analysis further revealed that CT imaging features, including tumor contours, lesion growth patterns, ulceration, cystic degeneration or necrosis, lymphadenopathy, and contrast enhancement patterns, were associated with risk stratification (P < 0.05). According to binary logistic regression analysis, tumor size [P < 0.001; odds ratio (OR) = 26.448; 95% confidence interval (CI): 4.854-144.099)], contours (P = 0.028; OR = 7.750; 95%CI: 1.253-47.955), and mixed growth pattern (P = 0.046; OR = 4.740; 95%CI: 1.029-21.828) were independent predictors for risk stratification of gastric GISTs. ROC curve analysis for the multinomial logistic regression model and tumor size to differentiate high-malignant potential from low-malignant potential GISTs achieved a maximum area under the curve of 0.919 (95%CI: 0.863-0.975) and 0.940 (95%CI: 0.893-0.986), respectively. The tumor size cutoff value between the low and high malignant potential groups was 4.05 cm, and the sensitivity and specificity were 93.5% and 84.2%, respectively.
CONCLUSION CT features, including tumor size, growth patterns, and lesion contours, were predictors of malignant potential for primary gastric GISTs.
Collapse
Affiliation(s)
- Tian-Tian Wang
- Department of Medical Imaging, The Second Affiliated Hospital of Shandong First Medical University, Taian 271000, Shandong Province, China
| | - Wei-Wei Liu
- Department of Rheumatology, The Second Affiliated Hospital of Shandong First Medical University, Taian 271000, Shandong Province, China
| | - Xian-Hai Liu
- Department of Network Information Center, The Second Affiliated Hospital of Shandong First Medical University, Taian 271000, Shandong Province, China
| | - Rong-Ji Gao
- Department of Medical Imaging, The Second Affiliated Hospital of Shandong First Medical University, Taian 271000, Shandong Province, China
| | - Chun-Yu Zhu
- Department of Medical Imaging, The Second Affiliated Hospital of Shandong First Medical University, Taian 271000, Shandong Province, China
| | - Qing Wang
- Department of Ultrasound, The Second Affiliated Hospital of Shandong First Medical University, Taian 271000, Shandong Province, China
| | - Lu-Ping Zhao
- Department of Medical Imaging, The Affiliated Hospital of Ji’ning Medical University, Jining 272000, Shandong Province, China
| | - Xiao-Ming Fan
- Department of Medical Imaging, The Second Affiliated Hospital of Shandong First Medical University, Taian 271000, Shandong Province, China
| | - Juan Li
- Department of Medical Imaging, The Second Affiliated Hospital of Shandong First Medical University, Taian 271000, Shandong Province, China
| |
Collapse
|
16
|
Xu JX, Chen TY, Liu YB, Xu XY, Chen WF, Li QL, Hu JW, Qin WZ, Cai MY, Zhang YQ, Zhou PH. Clinical outcomes of endoscopic resection for the treatment of esophageal gastrointestinal stromal tumors: a ten-year experience from a large tertiary center in China. Surg Endosc 2023:10.1007/s00464-023-10032-x. [PMID: 37069428 DOI: 10.1007/s00464-023-10032-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 03/12/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUNDS Esophageal gastrointestinal stromal tumors (E-GISTs) are extremely rare and surgical resection is the recommended approach. However, surgical resection usually causes severe trauma that may result in significant postoperative morbidity. Endoscopic resection (ER) has developed rapidly in recent years and has been widely used in gastrointestinal lesions. Nevertheless, the feasibility and efficacy of ER in the management of E-GISTs are unknown. METHODS Retrospective data were collected from January 2011 to December 2020 in a large tertiary center of China. Twenty-eight patients with E-GISTs treated by ER were included in the study. RESULTS Of the 28 patients, there were 21 males and 7 females, with a median age of 55 years (40-70 years). The median tumor size was 15 mm (5-80 mm). The technical success rate was 100% (28/28), while the en bloc resection rate was 96.4% (27/28). The median operation time was 35 min (10-410 min). Sixteen (57.2%) tumors were categorized into very low risk group, six (21.4%) into low risk group, and six (21.4%) into high risk group. Pathologists carefully examined margins of each lesion. There were 11 lesions (39.3%) determined as R0 resection and 17 lesions (60.7%) as R1 resection with positive margins. The median hospital stay was 2 days (range, 1-8 days). One patient suffered from hydrothorax and required drainage, leading to a major adverse event rate of 3.6% (1/28). There was no conversion to surgery, and no death occurred within 30 days after the procedure. Imatinib was given to two patients after ER under multidisciplinary team surveillance. During follow-up (median of 54 months, 9-122 months), no recurrences or metastasis were observed. CONCLUSION ER is safe and effective for E-GISTs and might become an optional choice in the future. Multicenter, prospective, large samples with long-term follow-up studies are still needed.
Collapse
Affiliation(s)
- Jia-Xin Xu
- Endoscopy Centre and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
- Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
| | - Tian-Yin Chen
- Endoscopy Centre and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
- Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
| | - Yan-Bo Liu
- Endoscopy Centre and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
- Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
| | - Xiao-Yue Xu
- Endoscopy Centre and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
- Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
| | - Wei-Feng Chen
- Endoscopy Centre and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
- Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
| | - Quan-Lin Li
- Endoscopy Centre and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
- Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
| | - Jian-Wei Hu
- Endoscopy Centre and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
- Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
| | - Wen-Zheng Qin
- Endoscopy Centre and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
- Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
| | - Ming-Yan Cai
- Endoscopy Centre and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
- Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
| | - Yi-Qun Zhang
- Endoscopy Centre and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
- Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China.
| | - Ping-Hong Zhou
- Endoscopy Centre and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
- Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China.
| |
Collapse
|
17
|
Campora M, Paudice M, Gambella A, Comandini D, Parente P, Sbaraglia M, Dei Tos AP, Grillo F, Mastracci L. Counting mitoses in gastrointestinal stromal tumours (GISTs): variable practices in the real-world setting and their clinical implications. Virchows Arch 2023; 482:589-594. [PMID: 36416965 PMCID: PMC10033612 DOI: 10.1007/s00428-022-03454-w] [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: 08/03/2022] [Revised: 08/03/2022] [Accepted: 11/08/2022] [Indexed: 11/24/2022]
Abstract
Mitotic count (MC) is an important prognostic indicator in gastrointestinal stromal tumours (GISTs). Though MC evaluation was initially proposed in 50 HPFs, recent international guidelines recommend that MC be performed on 5 mm2 because HPFs may have different areas depending on the ocular field number (FN) of the utilized light microscope. Performing MC on different areas leads to a non-standardized evaluation and erroneous risk stratification. The aim of the study was to audit real-life MC practices with special emphasis on possible risk stratification errors. A survey was administered to Italian pathologists to evaluate the following: method used for MC (5 mm2 versus 50 HPF); FN of the light microscope; prognostic scheme for risk stratification. Based on the results of the survey, 100 GISTs (25/risk class using Miettinen prognostic scheme) were retrieved and MC performed using 5 mm2 versus the corresponding mm2 area sizes of 50 HPFs with variable FNs (18, 20, 22). The survey demonstrated that the majority of pathologists (64.5%) use 50 HPFs with various FNs leading to excessive area size. The most frequently used prognostic scheme is that by Miettinen. Using this prognostic scheme and counting mitoses in 5 mm2 versus 50 HPFs with FNs 18, 20 and 22, a change in risk class was identified ranging from 10 to 41%, depending on FN. In conclusion, this study demonstrates that MC is still frequently performed on 50 HPF, with area sizes exceeding the specified 5 mm2 by far.
Collapse
Affiliation(s)
| | - Michele Paudice
- IRCCS Ospedale Policlinico San Martino, Largo Benzi 10, 16132, Genoa, Italy
- Pathology Unit, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | | | - Danila Comandini
- Oncology Unit, Department of Oncology and Haematology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Paola Parente
- Fondazione IRCCS Casa Sollievo della Sofferenza, Pathology Unit, San Giovanni Rotondo (FG), Italy
| | - Marta Sbaraglia
- Department of Pathology, Azienda Ospedale-Università Padova, Padua, Italy
| | - Angelo Paolo Dei Tos
- Department of Pathology, Azienda Ospedale-Università Padova, Padua, Italy
- Department of Medicine (DIMED), University of Padua School of Medicine, Padua, Italy
| | - Federica Grillo
- IRCCS Ospedale Policlinico San Martino, Largo Benzi 10, 16132, Genoa, Italy
- Pathology Unit, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Luca Mastracci
- IRCCS Ospedale Policlinico San Martino, Largo Benzi 10, 16132, Genoa, Italy.
- Pathology Unit, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy.
| |
Collapse
|
18
|
PITA ARAUJO FA, LOPES VNN, BARBOSA JPCDVL, MARTINS MRDF, BARBOSA J. LAPAROSCOPIC VERSUS OPEN SURGERY IN GASTRIC GASTROINTESTINAL STROMAL TUMORS LARGER THAN 5 CM: A SYSTEMATIC REVIEW AND META-ANALYSIS. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2023; 35:e1711. [PMID: 36629689 PMCID: PMC9831630 DOI: 10.1590/0102-672020220002e1711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/05/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Surgical resection represents the main treatment for resectable nonmetastatic gastric gastrointestinal stromal tumors. Despite the feasibility and safety of laparoscopic resection, its standard use in gastric tumors larger than 5 cm is yet to be established. AIMS This study aimed to compare the current evidence on laparoscopic resection with the classical open surgical approach in terms of perioperative, postoperative, and oncological outcomes. METHODS The PubMed, Scopus, and Web of Science databases were consulted. Articles comparing the approach to gastric gastric gastrointestinal stromal tumors larger than 5 cm by open and laparoscopic surgery were eligible. A post hoc subgroup analysis based on the extent of the surgery was performed to evaluate the operative time, blood loss, and length of hospital stay. RESULTS A total of nine studies met the eligibility criteria. In the study, 246 patients undergoing laparoscopic surgery and 301 patients undergoing open surgery were included. The laparoscopic approach had statistically significant lower intraoperative blood loss (p=0.01) and time to oral intake (p<0.01), time to first flatus (p<0.01), and length of hospital stay (0.01), compared to the open surgery approach. No significant differences were found when operative time (0.25), postoperative complications (0.08), R0 resection (0.76), and recurrence rate (0.09) were evaluated. The comparative subgroup analysis between studies could not explain the substantial heterogeneity obtained in the respective outcomes. CONCLUSION The laparoscopic approach in gastric gastrointestinal stromal tumors larger than 5 cm compared to the open surgical approach is a technically safe and feasible surgical method with similar oncological results.
Collapse
Affiliation(s)
| | - Vítor Nuno Neves LOPES
- Universidade do Porto, Faculty of Medicine – Porto,
Portugal;,Universidade do Porto, Faculty of Medicine, Department of
Surgery and Physiology – Porto, Portugal;,Department of General Surgery, São João University Hospital
Center – Porto, Portugal
| | - Jose Pedro Coimbra de Vargas Lobarinhas BARBOSA
- Universidade do Porto, Faculty of Medicine – Porto,
Portugal;,Universidade do Porto, Faculty of Medicine, São João University
Medical Center, Department of Community Medicine, Information and Decision in
Health – Porto, Portugal
| | | | - José BARBOSA
- Universidade do Porto, Faculty of Medicine – Porto,
Portugal;,Universidade do Porto, Faculty of Medicine, Department of
Surgery and Physiology – Porto, Portugal;,Department of General Surgery, São João University Hospital
Center – Porto, Portugal
| |
Collapse
|
19
|
Wu J, Zhuang M, Zhou Y, Zhan X, Xie W. The value of contrast-enhanced harmonic endoscopic ultrasound in differential diagnosis and evaluation of malignant risk of gastrointestinal stromal tumors (<50mm). Scand J Gastroenterol 2022; 58:542-548. [PMID: 36369879 DOI: 10.1080/00365521.2022.2144437] [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] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Contrast-enhanced harmonic endoscopic ultrasound (CEH-EUS) has been used in the differential diagnosis of benign and malignant tumors by visualization of tumor microcirculation and perfusion. However, its diagnostic role in submucosal tumors (SMTs), especially leiomyomas and gastric submucosal tumors (GISTs) was rarely studied. The aim of this study was to analyze the diagnostic role of CEH-EUS for SMTs (<50 mm) and the value of assessing the malignant potential of GISTs. MATERIALS AND METHODS We retrospectively included patients with tumors <50 mm in diameter who underwent preoperative EUS and CEH-EUS examination and had pathologically confirmed as leiomyomas and GISTs. To analyze the imaging features of CEH-EUS with pathological diagnosis as the gold standard and evaluate its diagnostic value. RESULTS This study included 10 cases of leiomyomas and 38 cases of GISTs. Under CEH-EUS detection, 86.9% of GISTs showed hyper-enhancement, 89.5% showed diffuse enhancement, 39.5% showed non-enhancing spots, and 97.4% showed obvious capsule enhancement. In contrast, the leiomyoma cases mostly showed hypo-enhancement (50.0%) or non-enhancement (30.0%) (p < 0.05). Then, the value of CEH-EUS in the differential diagnosis of benign and malignant tumors based on blood flow is significantly higher than that of B-EUS. Signal appearance time was significantly faster in the intermediate-high risk GISTs than in the very low-low risk group (5.1 s versus 15.5 s, p < 0.05), and the AUROC values predicted the risk at this time to be 0.903 (0.763-0.975). Heterogeneous perfusion and non-enhancing spots were also more common in the intermediate-high risk group. Univariate and multivariate analysis revealed that intratumoral irregularitie was an independent predictor of moderate to high risk (OR 3.99, 95%CI 1.04-90.95), with sensitivity, specificity and accuracy of 73.33%, 91.30% and 84.21%, respectively. CONCLUSIONS Through this study, CEH-EUS has a good differential diagnostic ability for leiomyomas and GISTs, and has a high value in predicting the risk of GISTs.
Collapse
Affiliation(s)
- Jiali Wu
- Department of Gastroenterology, The Second Hospital of Anhui Medical University, Hefei, China
| | - Mengqi Zhuang
- Department of Gastroenterology, The Second Hospital of Anhui Medical University, Hefei, China
| | - Yubao Zhou
- Department of Gastroenterology, The Second Hospital of Anhui Medical University, Hefei, China
| | - Xiang Zhan
- Department of Gastroenterology, The Second Hospital of Anhui Medical University, Hefei, China
| | - Weiwei Xie
- Department of Gastroenterology, The Second Hospital of Anhui Medical University, Hefei, China
| |
Collapse
|
20
|
Muacevic A, Adler JR, Owais M, Haseeb M, Kharal F. Schwannoma of the Ascending Colon in a 22-Year-Old Male: A Case Report. Cureus 2022; 14:e31946. [PMID: 36582566 PMCID: PMC9795079 DOI: 10.7759/cureus.31946] [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: 11/27/2022] [Indexed: 11/29/2022] Open
Abstract
Schwannoma of the ascending colon is an extremely rare neoplasm that is often discovered incidentally in the asymptomatic older population on surveillance colonoscopy. We present the case of a symptomatic 22-year-old male presenting with one month of discomfort in the right lower abdominal quadrant, abdominal bloating, and hematochezia. A sessile polyp measuring 0.5 cm was identified in the ascending colon on the colonoscopy. The polyp was completely resected using cold snare polypectomy. Histological examination of the resected polyp with hematoxylin-eosin staining revealed small nodules of bland spindle cells with focal nuclear condensation. The lesional cells tested positive for S-100 and SOX-10 on immunohistochemical analysis, establishing the diagnosis of benign schwannoma. Since this lesion was submucosal, its diagnosis required an endoscopic biopsy that could only be performed on the mucosa. It was difficult to distinguish it from other mesenchymal tumors (gastrointestinal stromal tumor or leiomyoma), and this makes the differential diagnosis exceedingly challenging. If the immunohistochemistry is positive for S-100 and negative for C-KIT, CD-34, actin, and desmin, it aids in diagnosis. These tumors have non-specific radiological features and are asymptomatic.
Collapse
|
21
|
Huang W, Yuan W, Ren L, Liang H, Du X, Sun X, Fang Y, Gao X, Fu M, Sun Y, Shen K, Hou Y. Clinicopathological and therapeutic analysis of PDGFRA mutated gastrointestinal stromal tumor. Pathol Res Pract 2022; 239:154138. [PMID: 36183438 DOI: 10.1016/j.prp.2022.154138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 09/04/2022] [Accepted: 09/16/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Platelet-Derived Growth Factor Receptor Alpha (PDGFRA) mutation has causes a rare subgroup of gastrointestinal stromal tumor (GIST) and not too much attention has been paid on it until the appearance of Avapritinib. This study aims to explore the clinicopathological features, therapy and prognosis of PDGFRA-mutant GIST for better understanding and clinical practice. METHOD 119 PDGFRA-mutant GIST patients were retrospectively collected from 2038 patients who underwent genetic testing. Kaplan-Meier method was used. RESULTS The incidence rate of PDGFRA-mutant GIST in our center was 5.8 %, with 79 males, 40 females, and a median age of 57 (25⁃80) years old. All the tumors were in the stomach, among which 60 were epithelioid type, 25 were spindle type and 34 were mixed type. There were 13 cases of exon 12 mutation and 106 cases of exon 18 mutation including 83 cases of D842V mutation (69.7 %). During a median follow⁃up of 49.6 (range, 1⁃154) months, progression could be observed in 12 patients with gene mutation at the codon 842 of exon 18, another case was V561D mutation in exon 12. The 5-year diseases⁃free survival (DFS) was 90.1 %, which was associated with the loss of CD34 expression (P<0.001). Patients in D842V group showed a marginal worse prognosis than those in non-D842V group (P = 0.163). According to the NIH criteria, high risk group showed a poorer prognosis than non-high risk group (P = 0.003), however, there were no significant differences among the three non-high risk groups (P = 0.495, P = 0.652). Among 13 advanced patients, 5 cases (treated with Avapritinib) achieved partial remission. CONCLUSION PDGFRA-mutant GIST mostly derived from stomach, with a relative indolent behavior. D842V mutation and lose of CD34 expression were adverse prognostic factors. Avapritinib can effectively control advanced patients in a certain period of time.
Collapse
Affiliation(s)
- Wen Huang
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei Yuan
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lei Ren
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Huaiyu Liang
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiangyang Du
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiangfei Sun
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yong Fang
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiaodong Gao
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Min Fu
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yihong Sun
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Kuntang Shen
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
| | - Yingyong Hou
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China.
| |
Collapse
|
22
|
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.
Collapse
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
| |
Collapse
|
23
|
Schaefer IM, DeMatteo RP, Serrano C. The GIST of Advances in Treatment of Advanced Gastrointestinal Stromal Tumor. Am Soc Clin Oncol Educ Book 2022; 42:1-15. [PMID: 35522913 DOI: 10.1200/edbk_351231] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Gastrointestinal stromal tumor (GIST) is the most common malignant neoplasm of mesenchymal origin and a compelling clinical and biologic model for the rational development of molecularly targeted agents. This is because the majority of GISTs are driven by gain-of-function mutations in KIT or PDGFRA receptor tyrosine kinases. Specific GIST mutations circumscribe well-defined molecular subgroups that must be determined during the diagnostic work-up to guide clinical management, including therapeutic decisions. Surgery is the cornerstone treatment in localized disease and can also be clinically relevant in the metastatic setting. The correct combination and sequence of targeted agents and surgical procedures improves outcomes for patients with GIST and should be discussed individually within multidisciplinary expert teams. All currently approved agents for the treatment of GIST are based on orally available tyrosine kinase inhibitors targeting KIT and PDGFRA oncogenic activation. Although first-line imatinib achieves remarkable prolonged disease control, the benefit of subsequent lines of treatment is more modest. Novel therapeutic strategies focus on overcoming the heterogeneity of KIT or PDGFRA secondary mutations and providing more potent inhibition of specific challenging mutations. This article reviews the current understanding and treatment of GIST, with an emphasis on recent advances.
Collapse
Affiliation(s)
- Inga-Marie Schaefer
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | - César Serrano
- Sarcoma Translational Research Program, Vall d'Hebron Institute of Oncology, Barcelona, Spain.,Medical Oncology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| |
Collapse
|
24
|
A Case of Metastatic Gastric Leiomyosarcoma With Bilateral Adrenal Involvement and Complications. ACG Case Rep J 2022; 9:e00764. [PMID: 35919667 PMCID: PMC9287273 DOI: 10.14309/crj.0000000000000764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 12/08/2021] [Indexed: 11/23/2022] Open
Abstract
Gastric leiomyosarcoma is a rare entity with only a handful of cases reported in the literature. Although this entity has been known to metastasize, there are currently no reported cases of metastatic leiomyosarcoma to the bilateral adrenal glands. We report a case of a 58-year-old woman with primary gastric leiomyosarcoma with bilateral metastasis to the adrenal gland. This case illustrates a presentation of gastric leiomyosarcoma with bilateral adrenal involvement, the challenges in its diagnosis, treatment, as well as a rare complication of primary adrenal insufficiency and adrenal crisis.
Collapse
|
25
|
Farraj KL, Kaliounji A, Desai J, Yeroushalmi K, Khan N. A Mass in the Thorax: A Rare Presentation of Gastrointestinal Stromal Tumor. Cureus 2022; 14:e22601. [PMID: 35355534 PMCID: PMC8957857 DOI: 10.7759/cureus.22601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2022] [Indexed: 11/23/2022] Open
Abstract
Gastrointestinal stromal tumors (GIST) can occur anywhere in the gastrointestinal tract, with the primary site being the stomach. GISTs are often discovered incidentally on imaging due to the non-specific symptoms they present at the presentation. They can be distinguished from other mesenchymal tumors by immunohistochemistry staining. These tumors can range from benign to highly malignant, with surgical resection as the main treatment modality. Here, we present a case of a large GIST found not in the stomach, but in the mediastinum, incidentally on imaging, in a middle-aged male.
Collapse
|
26
|
Starmans MPA, Timbergen MJM, Vos M, Renckens M, Grünhagen DJ, van Leenders GJLH, Dwarkasing RS, Willemssen FEJA, Niessen WJ, Verhoef C, Sleijfer S, Visser JJ, Klein S. Differential Diagnosis and Molecular Stratification of Gastrointestinal Stromal Tumors on CT Images Using a Radiomics Approach. J Digit Imaging 2022; 35:127-136. [PMID: 35088185 PMCID: PMC8921463 DOI: 10.1007/s10278-022-00590-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 01/05/2022] [Accepted: 01/14/2022] [Indexed: 12/21/2022] Open
Abstract
Treatment planning of gastrointestinal stromal tumors (GISTs) includes distinguishing GISTs from other intra-abdominal tumors and GISTs’ molecular analysis. The aim of this study was to evaluate radiomics for distinguishing GISTs from other intra-abdominal tumors, and in GISTs, predict the c-KIT, PDGFRA, BRAF mutational status, and mitotic index (MI). Patients diagnosed at the Erasmus MC between 2004 and 2017, with GIST or non-GIST intra-abdominal tumors and a contrast-enhanced venous-phase CT, were retrospectively included. Tumors were segmented, from which 564 image features were extracted. Prediction models were constructed using a combination of machine learning approaches. The evaluation was performed in a 100 × random-split cross-validation. Model performance was compared to that of three radiologists. One hundred twenty-five GISTs and 122 non-GISTs were included. The GIST vs. non-GIST radiomics model had a mean area under the curve (AUC) of 0.77. Three radiologists had an AUC of 0.69, 0.76, and 0.84, respectively. The radiomics model had an AUC of 0.52 for c-KIT, 0.56 for c-KIT exon 11, and 0.52 for the MI. The numbers of PDGFRA, BRAF, and other c-KIT mutations were too low for analysis. Our radiomics model was able to distinguish GISTs from non-GISTs with a performance similar to three radiologists, but less observer dependent. Therefore, it may aid in the early diagnosis of GIST, facilitating rapid referral to specialized treatment centers. As the model was not able to predict any genetic or molecular features, it cannot aid in treatment planning yet.
Collapse
Affiliation(s)
- Martijn P A Starmans
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.
- Department of Medical Informatics, Erasmus Medical Center, Rotterdam, The Netherlands.
| | - Milea J M Timbergen
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Melissa Vos
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Michel Renckens
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Dirk J Grünhagen
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Roy S Dwarkasing
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Wiro J Niessen
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Medical Informatics, Erasmus Medical Center, Rotterdam, The Netherlands
- Faculty of Applied Sciences, Delft University of Technology, Delft, The Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Stefan Sleijfer
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jacob J Visser
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Stefan Klein
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Medical Informatics, Erasmus Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
27
|
Extra gastrointestinal stromal tumor in the recto-vesical pouch: A case report and literature review. Ann Med Surg (Lond) 2022; 74:103283. [PMID: 35127068 PMCID: PMC8807970 DOI: 10.1016/j.amsu.2022.103283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 01/21/2022] [Accepted: 01/22/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Extra-gastrointestinal stromal tumors (EGISTs) are rare mesenchymal tumors located outside the gastrointestinal tract, and exhibit the same phenotypic and morphological profile of gastrointestinal stromal tumors (GISTs). Case report We report the case of a 20-year-old male patient consulted for chronic discomfort in the hypogastric region. Abdominal ultrasound and abdomino-pelvic CT scan identified a retro-vesical mass measuring 16 × 9 cm. He underwent an exploratory laparotomy and a total resection of the mass R0. The histopathological panel of the surgical specimen confirmed the diagnosis of EGIST. Clinical discussion The primary localization in the recto-vesical pouch of EGIST is a very rare entity. Their clinical and radiological presentations are unusual, and their definitive diagnosis is largely based on immunohistochemistry staining. Conclusion the origin of extra gastrointestinal stromal tumors EGIST can remain unclear. Extra gastrointestinal stromal tumors (EGISTs) are very rare primary entities that develop outside the digestive tract. Their primary localization in the recto-vesical pouch is a very rare entity. Their definitive diagnosis is largely based on immunohistochemistry staining. The only accepted treatment for non-metastatic EGISTs is a complete surgical resection.
Collapse
|
28
|
Kaiyasah H, Fardan H, Al Ozaibi L. Transvaginal Excision of Rectal Gastrointestinal Stromal Tumor: A Safe Minimally Invasive Approach. DUBAI MEDICAL JOURNAL 2021. [DOI: 10.1159/000520130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introduction: Gastrointestinal stromal tumors (GISTs), the specific kit-positive mesenchymal tumors, are rarely found in the anorectum and account for 5% of all GIST cases. Surgical excision remains the main treatment for anorectal GIST. The available techniques include enucleation transanal excision or sometimes an abdominoperineal resection for large or low tumors. Case Study: We present a middle-aged female with a complaint of intermittent rectal pain for 1 year. Diagnostic workup detected a mass in the rectovaginal septum. A transvaginal excision was performed. Final histopathology showed rectal GIST. On regular follow-up visits, there was no detectable recurrence, and her anal pain disappeared completely. Discussion: Colorectal GIST accounts for only 0.1% of all colorectal tumors; this infrequency has led to a controversy in its diagnosis and management. Nevertheless, surgery remains a cornerstone element in the management of rectal GISTs. Different resection methods have been described in the literature, ranging from less-invasive approach such as transanal excision to a more radical one like an abdominoperineal resection. As there is no standard approach, choosing which one to perform depends on the tumor size, its location, and the surgeon’s preference. Conclusion: Transvaginal excision could be considered a safe minimally invasive approach for low-lying rectal GISTs.
Collapse
|
29
|
Szczepaniak K, Nasierowska-Guttmejer A. The occurrence of gastrointestinal stromal tumors with second malignancies - Case series of a single institution experience. Pathol Res Pract 2021; 228:153662. [PMID: 34749214 DOI: 10.1016/j.prp.2021.153662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 10/17/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Gastrointestinal stromal tumors (GISTs) may coexist with different types of malignancies, either synchronously or metachronously. The aim of this study was to characterize the clinical and histopathological features of GIST coexisting with other neoplasms. METHODS A retrospective analysis of 76 GISTs cases diagnosed at our institution between January 2003 and March 2020 was performed. A subgroup of cases with concomitant second malignancy was selected. The clinical and pathologic records were reviewed. RESULTS 18 out of 76 patients (23.7%) with GISTs were diagnosed with the second neoplasms. In 11 cases GISTs were diagnosed metachronously to the second malignancy, whereas 7 cases of GIST were synchronous. The most common concomitant neoplasms were breast cancer and gastric cancer. The concomitant GIST were located mainly in small intestine (52.6%). 14 GISTs were classified as very low or low-risk (77.8%), 3 as moderate risk (16.7%) and 1 as high risk tumors (5.6%). CONCLUSION The coexistence of GIST with other malignancies may be more common, than it has been considered. As the most of concomitant GISTs occurs metachronously to the second malignancy, studying of this phenomenon requires a long-term follow-up.
Collapse
Affiliation(s)
- K Szczepaniak
- Department of Pathology, Central Clinical Hospital of the Ministry of Interior, Wołoska 137, 02-507 Warsaw, Poland
| | - A Nasierowska-Guttmejer
- Department of Pathology, Central Clinical Hospital of the Ministry of Interior, Wołoska 137, 02-507 Warsaw, Poland; Faculty of Medicine, Lazarski University in Warsaw, Świeradowska 43, 02-662 Warsaw, Poland.
| |
Collapse
|
30
|
Castillon M, Kammerer-Jacquet SF, Cariou M, Costa S, Conq G, Samaison L, Douet-Guilbert N, Marcorelles P, Doucet L, Uguen A. Fluorescent In Situ Hybridization Must be Preferred to pan-TRK Immunohistochemistry to Diagnose NTRK3-rearranged Gastrointestinal Stromal Tumors (GIST). Appl Immunohistochem Mol Morphol 2021; 29:626-634. [PMID: 33758144 DOI: 10.1097/pai.0000000000000933] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 02/12/2021] [Indexed: 12/30/2022]
Abstract
Tyrosine kinase inhibitors have revolutionized the treatment of patients with gastrointestinal stromal tumors (GISTs). Nevertheless, some GISTs do not contain any targetable KIT or PDGFRA mutations classically encountered in this field. Novel approved therapies targeting TRK chimeric proteins products of NTRK genes fusions consist in a promising approach to treat some patients with GISTs lacking any identified driver oncogenic mutation in KIT, PDGFRA or BRAF genes. Thus, an adequate testing strategy permitting to diagnose the rare NTRK-rearranged GISTs is required. In this work, we studied about the performances of pan-TRK immunohistochemistry (IHC) and NTRK1/2/3 fluorescent in situ hybridization in a series of 39 GISTs samples. Among 22 patients with GISTs lacking KIT or PDGFRA mutations, BRAFV600E IHC permitted to diagnose 2/22 (9%) BRAFV600E-mutated GISTs and, among the 20 KIT, PDGFRA, and BRAF wild type tumors, 1/20 (5%), NTRK3-rearranged tumor was diagnosed using NTRK3 fluorescent in situ hybridization. Pan-TRK IHC using EPR17341 and A7H6R clones was negative in this NTRK3-rearranged sample. Pan-TRK IHC was frequently positive in NTRK not rearranged tumors without (24 samples analyzed) or with (15 samples analyzed) KIT or PDGFRA mutations with major discrepancies between the 2 IHC clones (intraclass correlation coefficient of 0.3042). Given the new therapeutic opportunity offered by anti-TRK targeted therapies to treat patients with advanced cancers including GISTs, it is worth to extend molecular analysis to NTRK fusions testing in KIT, PDGFRA, and BRAF wild type GISTs. Pan-TRK IHC appears not relevant in this field but performing a simple NTRK3 fluorescent in situ hybridization test consists in a valuable approach to identify the rare NTRK3-rearranged GISTs treatable using anti-TRK therapies.
Collapse
Affiliation(s)
| | | | - Mélanie Cariou
- Registre des cancers digestifs du Finistère EA7479 SPURBO, Université de Bretagne Occidentale
| | | | | | | | | | | | | | - Arnaud Uguen
- Department of Pathology
- Univ Brest, Inserm, CHU de Brest, LBAI, Brest
| |
Collapse
|
31
|
Gheorghe G, Bacalbasa N, Ceobanu G, Ilie M, Enache V, Constantinescu G, Bungau S, Diaconu CC. Gastrointestinal Stromal Tumors-A Mini Review. J Pers Med 2021; 11:694. [PMID: 34442339 PMCID: PMC8400825 DOI: 10.3390/jpm11080694] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 07/17/2021] [Accepted: 07/20/2021] [Indexed: 02/07/2023] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract. They are potentially malignant, and have an unpredictable evolution. The origin of these tumors is in the interstitial cells of Cajal, which are cells that are interposed between the intramural neurons and the smooth muscle cells of the digestive tract. GISTs are characterized by mutations in the gene c-Kit, but also other mutations, such as those of the platelet-derived growth factor receptor alpha. The most common locations of these tumors are the stomach and small intestine, although they can occur at any level of the digestive tract and occasionally in the omentum, mesentery and peritoneum. Most cases of GISTs are sporadic, and about 5% of cases are part of family genetic syndromes. The correct diagnosis of GIST is determined by histopathological examination and immunohistochemistry. According to histopathology, there are three main types of GISTs: spindle cell type, epithelioid type and mixed type. The therapeutic management of GIST includes surgery, endoscopic treatment and chemotherapy. The prognosis of patients with GIST varies depending on a number of factors, such as risk category, GIST stage, treatment applied and recurrence after treatment.
Collapse
Affiliation(s)
- Gina Gheorghe
- Clinical Emergency Hospital of Bucharest, Department of Gastroenterology, University of Medicine and Pharmacy “Carol Davila“, 050474 Bucharest, Romania; (G.G.); (M.I.)
| | - Nicolae Bacalbasa
- Department of Visceral Surgery, “Fundeni” Clinical Institute, University of Medicine and Pharmacy “Carol Davila“, 050474 Bucharest, Romania;
| | - Gabriela Ceobanu
- “Sfanta Maria” Clinical Hospital, Department of Internal Medicine and Rheumatology, 011172 Bucharest, Romania;
| | - Madalina Ilie
- Clinical Emergency Hospital of Bucharest, Department of Gastroenterology, University of Medicine and Pharmacy “Carol Davila“, 050474 Bucharest, Romania; (G.G.); (M.I.)
| | - Valentin Enache
- Clinical Emergency Hospital of Bucharest, Department of Anatomical Pathology, 050474 Bucharest, Romania;
| | - Gabriel Constantinescu
- Clinical Emergency Hospital of Bucharest, Department of Gastroenterology, University of Medicine and Pharmacy “Carol Davila“, 050474 Bucharest, Romania; (G.G.); (M.I.)
| | - Simona Bungau
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania;
| | - Camelia Cristina Diaconu
- Clinical Emergency Hospital of Bucharest, Department of Internal Medicine, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania;
| |
Collapse
|
32
|
Nishiyama R, Ogasawara T, Mamuro N, Kamei Y, Yamada M, Furukawa D, Suzuki T, Nishi T, Shimada H. Coexistence of gastric cancer and gastric GIST with intra-tumor bleeding: successful embolization with subsequent total gastrectomy. Surg Case Rep 2021; 7:160. [PMID: 34241722 PMCID: PMC8271045 DOI: 10.1186/s40792-021-01244-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 07/03/2021] [Indexed: 12/31/2022] Open
Abstract
Background Gastrointestinal stromal tumor (GIST) is a rare tumor, however, simultaneous development of gastric cancer and gastric GIST has been documented more frequently in recent years. Rupture of gastric GIST is even more rare and occurred in 7% of all GISTs. Although ruptured GIST might be occasionally difficult to be managed by endoscopy, transcatheter arterial embolization (TAE) was reported to control bleeding from GIST effectively. We report herein a case of coexistence of gastric cancer and gastric GIST with progressing intra-tumor bleeding managed successfully by TAE and review the clinicopathological characteristics of this rare condition reported previously in the Japanese literature. Case presentation A 75-year-old woman with dyspnea and systemic edema was diagnosed as simultaneous occurrence of gastric cancer (histopathologically detected tubular adenocarcinoma pT2N1M0 fStageIIA) and gastric GIST (65 × 92 mm in diameter at the anterior wall of the fornix) with intra-tumor hemorrhage. Perceiving the progress of bleeding from tumor growth and exacerbating anemia, TAE of left gastric artery was performed. Then remission of anemia has been obtained, the patient underwent an elective radical surgery. Conclusions Simultaneous occurrence of gastric cancer and gastric GIST was speculated to be more common. TAE for ruptured GIST may be effective for hemostasis and reduction of tumor burden, which could facilitate minimal invasive surgery.
Collapse
Affiliation(s)
- Raisuke Nishiyama
- Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, Oiso Hospital, 21-1 Gakkyo, Oiso, Naka-Gun Kanagawa, 259-1198, Japan.
| | - Toshihito Ogasawara
- Department of Surgery, Tokai University School of Medicine, Oiso Hospital, 21-1 Gakkyo, Oiso, Naka-Gun Kanagawa, 259-1198, Japan
| | - Nana Mamuro
- Department of Surgery, Tokai University School of Medicine, Oiso Hospital, 21-1 Gakkyo, Oiso, Naka-Gun Kanagawa, 259-1198, Japan
| | - Yutarou Kamei
- Department of Surgery, Tokai University School of Medicine, Oiso Hospital, 21-1 Gakkyo, Oiso, Naka-Gun Kanagawa, 259-1198, Japan
| | - Misuzu Yamada
- Department of Surgery, Tokai University School of Medicine, Oiso Hospital, 21-1 Gakkyo, Oiso, Naka-Gun Kanagawa, 259-1198, Japan
| | - Daisuke Furukawa
- Department of Surgery, Tokai University School of Medicine, Oiso Hospital, 21-1 Gakkyo, Oiso, Naka-Gun Kanagawa, 259-1198, Japan
| | - Toshiyuki Suzuki
- Department of Surgery, Tokai University School of Medicine, Oiso Hospital, 21-1 Gakkyo, Oiso, Naka-Gun Kanagawa, 259-1198, Japan
| | - Takayuki Nishi
- Department of Surgery, Tokai University School of Medicine, Oiso Hospital, 21-1 Gakkyo, Oiso, Naka-Gun Kanagawa, 259-1198, Japan
| | - Hideo Shimada
- Department of Surgery, Tokai University School of Medicine, Oiso Hospital, 21-1 Gakkyo, Oiso, Naka-Gun Kanagawa, 259-1198, Japan
| |
Collapse
|
33
|
Chen ZM, Peng MS, Wang LS, Xu ZL. Efficacy and safety of endoscopic resection in treatment of small gastric stromal tumors: A state-of-the-art review. World J Gastrointest Oncol 2021; 13:462-471. [PMID: 34163567 PMCID: PMC8204354 DOI: 10.4251/wjgo.v13.i6.462] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/04/2021] [Accepted: 04/20/2021] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal stromal tumors can occur in any part of the gastrointestinal tract, but gastric stromal tumors (GSTs) are the most common. All GSTs have the potential to become malignant, and these can be divided into four different grades by risk from low to high: Very low risk, low risk, medium risk, and high risk. Current guidelines all recommend early complete excision of GSTs larger than 2 cm in diameter. However, it is not clear whether small GSTs (sGSTs, i.e., those smaller than 2 cm in diameter) should be treated as early as possible. The National Comprehensive Cancer Network recommends that endoscopic ultrasonography-guided (EUS-guided) fine-needle aspiration biopsy and imaging (computed tomography or magnetic-resonance imaging) be used to assess cancer risk for sGSTs detected by gastroscopy to determine treatment. When EUS indicates a higher risk of tumor, surgical resection is recommended. There are some questions on whether sGSTs also require early treatment. Many studies have shown that endoscopic treatment of GSTs with diameters of 2-5 cm is very effective. We here address whether endoscopic therapy is also suitable for sGSTs. In this paper, we try to explain three questions: (1) Does sGST require treatment? (2) Is digestive endoscopy a safe and effective means of treating sGST? and (3) When sGSTs are at different sites and depths, which endoscopic treatment method is more suitable?
Collapse
Affiliation(s)
- Ze-Ming Chen
- Department of Gastroenterology, Shenzhen People’s Hospital, The Second Clinical Medical College, Jinan University, Shenzhen 518000, Guangdong Province, China
| | - Min-Si Peng
- Department of Gastroenterology, Shenzhen People’s Hospital, The Second Clinical Medical College, Jinan University, Shenzhen 518000, Guangdong Province, China
| | - Li-Sheng Wang
- Department of Gastroenterology, Shenzhen People’s Hospital, The Second Clinical Medical College, Jinan University, Shenzhen 518000, Guangdong Province, China
| | - Zheng-Lei Xu
- Department of Gastroenterology, Shenzhen People’s Hospital, The Second Clinical Medical College, Jinan University, Shenzhen 518000, Guangdong Province, China
| |
Collapse
|
34
|
Kadel D, Bhuju S, Thapa BR, Chalise S, Kumar Sah S. Curative intent treatment of late presented extragastrointestinal stromal tumor: two identical case reports with literature review. J Surg Case Rep 2021; 2021:rjab220. [PMID: 34104404 PMCID: PMC8177904 DOI: 10.1093/jscr/rjab220] [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: 03/14/2021] [Revised: 05/05/2021] [Accepted: 05/08/2021] [Indexed: 12/24/2022] Open
Abstract
Gastrointestinal stromal tumors (GISTs) occurring outside the gastrointestinal tract are known as extragastrointestinal stromal tumors (EGIST). They share some common histopathologic and molecular characteristics. This report describes two female patients who were suspected of having a mesenteric GIST, but opted for surveillance rather than definitive treatment. Upon reassessment, both patients demonstrated increased tumor mass with no evidence of distant metastasis. The intraoperative findings confirmed the conclusion of clinical and imaging studies performed preoperatively and radical excisions were performed. Histopathological examination (spindle cell neoplasm) and immunohistochemistry (CD117) confirmed EGIST. Both patients underwent Imatinib therapy following surgery with no evidence of disease recurrence or metastasis upon follow up. Although sharing histologic features with GIST, EGIST frequently demonstrates distinct characteristics that facilitate the proper diagnosis and management of EGIST. Since it is a rare and aggressive disease with a poor outcome, early detection and curative surgical resection remains the mainstay of treatment.
Collapse
Affiliation(s)
- Dhruba Kadel
- Department of General Surgery, Scheer Memorial Adventist Hospital, Banepa, Nepal
| | - Shashinda Bhuju
- Department of General Surgery, Scheer Memorial Adventist Hospital, Banepa, Nepal
| | - Bikash Raj Thapa
- Department of Radiology, National Academy of Medical Sciences, National Trauma Center, Kathmandu, Nepal
| | - Sanat Chalise
- Department of Pathology, Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal
| | - Sandeep Kumar Sah
- Department of General Surgery, Scheer Memorial Adventist Hospital, Banepa, Nepal
| |
Collapse
|
35
|
Tustumi F, de Sousa JHB, Dornelas NM, Rosa GM, Steinman M, Bianchi ET. The Mechanisms for the Association of Cancer and Esophageal Dysmotility Disorders. Med Sci (Basel) 2021; 9:32. [PMID: 34064058 PMCID: PMC8163009 DOI: 10.3390/medsci9020032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/12/2021] [Accepted: 05/21/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Achalasia and other esophageal dysmotility disorders mimicking achalasia can be associated with cancer. This study aimed to review the main mechanisms for which cancer may develop in esophageal dysmotility disorder patients. METHODS A narrative review was performed. RESULTS The mechanism for developing squamous cell carcinoma and adenocarcinoma are discussed. Besides, achalasia-like syndromes related to familial KIT-gene mutation and pseudoachalasia are discussed. CONCLUSIONS Knowing the main mechanism for which achalasia can be related to cancer is essential for clinicians to conduct the proper investigation, surveillance, and treatment.
Collapse
Affiliation(s)
- Francisco Tustumi
- Hospital Israelita Albert Einstein, Sao Paulo 05652-900, Brazil; (J.H.B.d.S.); (N.M.D.); (G.M.R.); (M.S.); (E.T.B.)
- Department of Gastroenterology, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05403-000, Brazil
| | | | - Nicolas Medeiros Dornelas
- Hospital Israelita Albert Einstein, Sao Paulo 05652-900, Brazil; (J.H.B.d.S.); (N.M.D.); (G.M.R.); (M.S.); (E.T.B.)
| | - Guilherme Maganha Rosa
- Hospital Israelita Albert Einstein, Sao Paulo 05652-900, Brazil; (J.H.B.d.S.); (N.M.D.); (G.M.R.); (M.S.); (E.T.B.)
| | - Milton Steinman
- Hospital Israelita Albert Einstein, Sao Paulo 05652-900, Brazil; (J.H.B.d.S.); (N.M.D.); (G.M.R.); (M.S.); (E.T.B.)
| | - Edno Tales Bianchi
- Hospital Israelita Albert Einstein, Sao Paulo 05652-900, Brazil; (J.H.B.d.S.); (N.M.D.); (G.M.R.); (M.S.); (E.T.B.)
- Department of Gastroenterology, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05403-000, Brazil
| |
Collapse
|
36
|
Wu X, Dong D, Zhang L, Fang M, Zhu Y, He B, Ye Z, Zhang M, Zhang S, Tian J. Exploring the predictive value of additional peritumoral regions based on deep learning and radiomics: A multicenter study. Med Phys 2021; 48:2374-2385. [PMID: 33580497 DOI: 10.1002/mp.14767] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 01/06/2021] [Accepted: 02/04/2021] [Indexed: 12/18/2022] Open
Abstract
PURPOSE The present study assessed the predictive value of peritumoral regions on three tumor tasks, and further explored the influence of peritumors with different sizes. METHODS We retrospectively collected 333 samples of gastrointestinal stromal tumors from the Second Affiliated Hospital of Zhejiang University School of Medicine, and 183 samples of gastrointestinal stromal tumors from Tianjin Medical University Cancer Hospital. We also collected 211 samples of laryngeal carcinoma and 233 samples of nasopharyngeal carcinoma from the First Affiliated Hospital of Jinan University. The tasks of three tumor datasets were risk assessment (gastrointestinal stromal tumor), T3/T4 staging prediction (laryngeal carcinoma), and distant metastasis prediction (nasopharyngeal carcinoma), respectively. First, deep learning and radiomics were respectively used to construct peritumoral models, to study whether the peritumor had predictive value on three tumor datasets. Furthermore, we defined different sizes peritumors including fixed size (not considering tumor size) and adaptive size (according to average tumor radius) to explore the influence of peritumor of different sizes and types of tumors. Finally, we visualized the deep learning and radiomic models to observe the influence of the peritumor in three datasets. RESULTS The performance of intra-peritumors are better than intratumors alone in three datasets. Specifically, the comparisons of area under receiver operating characteristic curve in the testing set between intra-peritumoral and intratumoral models are: 0.908 vs 0.873 (P value: 0.037) in gastrointestinal stromal tumor datasets, 0.796 vs 0.756 (P value: 0.188) in laryngeal carcinoma datasets and 0.660 vs 0.579 (P value: 0.431) in nasopharyngeal carcinoma datasets. Furthermore, for gastrointestinal stromal tumor datasets, deep learning is more stable to learn peritumors with both fixed and adaptive size than radiomics. For laryngeal carcinoma datasets, the intra-peritumoral radiomic model could make model performance more balanced. For nasopharyngeal carcinoma datasets, radiomics is also more suitable for modeling peritumors than deep learning. The size of the peritumor is critical in this task, and only the performance of 1.5 mm-4.5 mm peritumors is stable. CONCLUSIONS Our results indicate that peritumors have additional predictive value in three tumor datasets through deep learning or radiomics. The definitions of the peritumoral region and artificial intelligence method also have great influence on the performance of the peritumor.
Collapse
Affiliation(s)
- Xiangjun Wu
- School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China.,CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Di Dong
- School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China.,CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Lu Zhang
- Department of Radiology, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Mengjie Fang
- School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China.,CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Yongbei Zhu
- School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China.,CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Bingxi He
- School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China.,CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Zhaoxiang Ye
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Minming Zhang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shuixing Zhang
- Department of Radiology, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Jie Tian
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China.,Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medicine and Engineering, Beihang University, Beijing, China
| |
Collapse
|
37
|
Lu G, Li J, Wu L, Shi Y, Zhang X, Xia Y, Li L. Establishment and Verification of a Nomogram for Predicting Survival in Patients with Small Intestinal Gastrointestinal Stromal Tumors. Dig Dis 2021; 40:50-61. [PMID: 33752202 DOI: 10.1159/000516022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 03/15/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND This study aimed to develop and validate nomograms for predicting overall survival (OS) and cancer-specific survival (CSS) in small intestinal gastrointestinal stromal tumors (SI GISTs). METHODS Patients diagnosed with SI GISTs were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database and further randomly divided into training and validating cohorts. Univariate and multivariate Cox analyses were conducted in the training set to determine independent prognostic factors to build nomograms for predicting 3- and 5-year OS and CSS. The performance of the nomograms was assessed by using the concordance index (C-index), calibration plot, and the area under the receiver operating characteristic curve (AUC). RESULTS Data of a total of 776 patients with SI GISTs were retrospectively collected from the SEER database. The OS nomogram was constructed based on age, surgery, imatinib treatment, and American Joint Committee for Cancer (AJCC) stage, while the CSS nomogram incorporated age, surgery, tumor grade, and AJCC stage. In the training set, the C-index for the OS nomogram was 0.773 (95% confidence interval [95% CI]: 0.722-0.824) and for the CSS nomogram 0.806 (95% CI: 0.757-0.855). In the internal validation cohort, the C-index for the OS nomogram was 0.741, while for the CSS nomogram, it was 0.819. Well-corresponded calibration plots both in OS and CSS nomogram models were noticed. The comparisons of AUC values showed that the established nomograms exhibited superior discrimination power than the 7th Tumor-Node-Metastasis staging system. CONCLUSION Our nomogram can effectively predict 3- and 5-year OS and CSS in patients with SI GISTs, and its use can help improve the accuracy of personalized survival prediction and facilitate to provide constructive therapeutic suggestions.
Collapse
Affiliation(s)
- Guangrong Lu
- Department of Gastroenterology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jiajia Li
- Department of Gastroenterology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Limin Wu
- Department of Gastroenterology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yuning Shi
- The Second Clinical Medical College of Wenzhou Medical University, Wenzhou, China
| | - Xuchao Zhang
- The Second Clinical Medical College of Wenzhou Medical University, Wenzhou, China
| | - Yushan Xia
- The Second Clinical Medical College of Wenzhou Medical University, Wenzhou, China
| | - Lili Li
- Departments of Medical Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| |
Collapse
|
38
|
Bi Y, Zeng DX, Ye W, Xiao M, Yang QL, Ling Y. LncRNA PVT1 promotes cells proliferation via PI3K–AKT–mTOR Pathway in gastrointestinal stromal tumor. ALL LIFE 2021. [DOI: 10.1080/26895293.2021.1889685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- YanZhi Bi
- Department of Medical Oncology, The Third Affiliated Hospital of Soochow University, Changzhou Tumor Hospital Affiliated to Soochow University, Changzhou, People’s Republic of China
| | - Dong Xiang Zeng
- Department of Medical Oncology, Changzhou Tumor Hospital Affiliated to Soochow University, Changzhou, People’s Republic of China
| | - Wei Ye
- Department of Medical Oncology, Changzhou Tumor Hospital Affiliated to Soochow University, Changzhou, People’s Republic of China
| | - Min Xiao
- Department of Medical Oncology, Changzhou Tumor Hospital Affiliated to Soochow University, Changzhou, People’s Republic of China
| | - Quan Liang Yang
- Department of Medical Oncology, Changzhou Tumor Hospital Affiliated to Soochow University, Changzhou, People’s Republic of China
| | - Yang Ling
- Department of Medical Oncology, Changzhou Tumor Hospital Affiliated to Soochow University, Changzhou, People’s Republic of China
| |
Collapse
|
39
|
Choi SJ, Lee KH, Yoo CK, Yoon JH, Jang KS, Kim YJ, Lee HL. Is There Pathological Uniformity between the Periphery and Center of a Gastrointestinal Stromal Tumor? J Clin Med 2021; 10:jcm10040687. [PMID: 33578901 PMCID: PMC7916709 DOI: 10.3390/jcm10040687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/08/2021] [Accepted: 02/08/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors and have some malignant potential. Mitotic count is important for predicting the malignant potential of GISTs. Proper treatment of GISTs requires accurate pathological diagnosis. In general, endoscopic ultrasound-guided fine-needle aspiration and deep biopsy are used for pathological diagnosis of GIST before making decisions about surgery. This study sought to evaluate the pathological uniformity of gastric GISTs for mitotic index of the center and periphery of the GIST. METHODS We retrospectively reviewed the data of 37 gastric GIST patients who underwent wedge resection at Hanyang University Hospital. We used Armed Forces Institute of Pathology criteria to classify gastric GISTs. To determine the pathological uniformity of gastric GISTs, we compared GIST risk stratification between the center and periphery of GISTs. RESULTS The mean size of GISTs was 3.56 ± 2.10 cm. Three lesions were located in the antrum, 11 in the fundus, 9 in the cardia, and 14 in the body. The mean age of patients was 58.65 ± 9.44 years; 18 patients were male and 19 were female. Thirty-five patients (94.6%) showed the same level of risk stratification between the center and periphery of gastric GISTs, while two patients (5.4%) presented different levels of risk between the two sites. No significant difference in mitotic count was observed between the two sites (kappa value = 0.863; p = 0.001). CONCLUSIONS Mitotic index category (either more than five mitoses per high-power field or five or fewer mitoses per high-power field) of GISTs showed good concurrence between the center and periphery.
Collapse
Affiliation(s)
- Seong Ji Choi
- Department of Gastroenterology, Hanyang University Hospital, Seoul 04763, Korea; (S.J.C.); (K.H.L.); (C.K.Y.); (J.H.Y.)
| | - Kwan Hong Lee
- Department of Gastroenterology, Hanyang University Hospital, Seoul 04763, Korea; (S.J.C.); (K.H.L.); (C.K.Y.); (J.H.Y.)
| | - Chan Kyoo Yoo
- Department of Gastroenterology, Hanyang University Hospital, Seoul 04763, Korea; (S.J.C.); (K.H.L.); (C.K.Y.); (J.H.Y.)
| | - Jai Hoon Yoon
- Department of Gastroenterology, Hanyang University Hospital, Seoul 04763, Korea; (S.J.C.); (K.H.L.); (C.K.Y.); (J.H.Y.)
| | - Ki Seok Jang
- Department of Pathology, College of Medicine, Hanyang University, Seoul 04763, Korea;
| | - Youn Jeong Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Incheon ST. Mary’s Hospital, Incheon 21431, Korea
- Correspondence: (Y.J.K.); (H.L.L.); Tel.: +82-32-280-5018 (Y.J.K.); +82-02-2290-8354 (H.L.L.)
| | - Hang Lak Lee
- Department of Gastroenterology, Hanyang University Hospital, Seoul 04763, Korea; (S.J.C.); (K.H.L.); (C.K.Y.); (J.H.Y.)
- Correspondence: (Y.J.K.); (H.L.L.); Tel.: +82-32-280-5018 (Y.J.K.); +82-02-2290-8354 (H.L.L.)
| |
Collapse
|
40
|
Brčić I, Argyropoulos A, Liegl-Atzwanger B. Update on Molecular Genetics of Gastrointestinal Stromal Tumors. Diagnostics (Basel) 2021; 11:diagnostics11020194. [PMID: 33525726 PMCID: PMC7912114 DOI: 10.3390/diagnostics11020194] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/21/2021] [Accepted: 01/23/2021] [Indexed: 12/14/2022] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. The majority are sporadic, solitary tumors that harbor mutually exclusive KIT or PDGFRA gain-of-function mutations. The type of mutation in addition to risk stratification corresponds to the biological behavior of GIST and response to treatment. Up to 85% of pediatric GISTs and 10–15% of adult GISTs are devoid of these (KIT/PDGFRA) mutations and are referred to as wild-type GISTs (wt-GIST). It has been shown that these wt-GISTs are a heterogeneous tumor group with regard to their clinical behavior and molecular profile. Recent advances in molecular pathology helped to further sub-classify the so-called “wt-GISTs”. Based on their significant clinical and molecular heterogeneity, wt-GISTs are divided into a syndromic and a non-syndromic (sporadic) subgroup. Recently, the use of succinate dehydrogenase B (SDHB) by immunohistochemistry has been used to stratify GIST into an SDHB-retained and an SDHB-deficient group. In this review, we focus on GIST sub-classification based on clinicopathologic, and molecular findings and discuss the known and yet emerging prognostic and predictive genetic alterations. We also give insights into the limitations of targeted therapy and highlight the mechanisms of secondary resistance.
Collapse
|
41
|
Mao X, Yang X, Chen X, Yu S, Yu S, Zhang B, Ji Y, Chen Y, Ouyang Y, Luo W. Single-cell transcriptome analysis revealed the heterogeneity and microenvironment of gastrointestinal stromal tumors. Cancer Sci 2021; 112:1262-1274. [PMID: 33393143 PMCID: PMC7935798 DOI: 10.1111/cas.14795] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/15/2020] [Accepted: 12/31/2020] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of the human gastrointestinal tract. In this study, we performed single-cell RNA sequencing (RNA-seq) on intra- and peri-tumor tissues from GIST patients with the aim of discovering the heterogeneity of tumor cells in GIST and their interactions with other cells. We found four predominating cell types in GIST tumor tissue, including T cells, macrophages, tumor cells, and NK cells. Tumor cells could be clustered into two groups: one was highly proliferating and associated with high risk of metastasis, the other seemed "resting" and associated with low risk. Their clinical relevance and prognostic values were confirmed by RNA-seq of 65 GIST samples. T cells were the largest cell type in our single-cell data. Two groups of CD8+ effector memory (EM) cells were in the highest clonal expansion and performed the highest cytotoxicity but were also the most exhausted among all T cells. A group of macrophages were found polarized to possess both M1 and M2 signatures, and increased along with tumor progression. Cell-to-cell interaction analysis revealed that adipose endothelial cells had high interactions with tumor cells to facilitate their progression. Macrophages were at the center of the tumor microenvironment, recruiting immune cells to the tumor site and having most interactions with both tumor and nontumor cells. In conclusion, we obtained an overview of the GIST microenvironment and revealed the heterogeneity of each cell type and their relevance to risk classifications, which provided a novel theoretical basis for learning and curing GISTs.
Collapse
Affiliation(s)
- Xiaofan Mao
- Clinical Research Institute, The First People's Hospital of Foshan & Sun Yat-Sen University Foshan Hospital, Foshan, China.,Medical Engineering Technology Research and Development Center of Immune Repertoire in Foshan, The First People's Hospital of Foshan & Sun Yat-Sen University Foshan Hospital, Foshan, China
| | - Xuezhu Yang
- Gastroenterology, The First People's Hospital of Foshan & Sun Yat-Sen University Foshan Hospital, Foshan, China
| | - Xiangping Chen
- Clinical Research Institute, The First People's Hospital of Foshan & Sun Yat-Sen University Foshan Hospital, Foshan, China.,Medical Engineering Technology Research and Development Center of Immune Repertoire in Foshan, The First People's Hospital of Foshan & Sun Yat-Sen University Foshan Hospital, Foshan, China
| | - Sifei Yu
- Clinical Research Institute, The First People's Hospital of Foshan & Sun Yat-Sen University Foshan Hospital, Foshan, China.,Medical Engineering Technology Research and Development Center of Immune Repertoire in Foshan, The First People's Hospital of Foshan & Sun Yat-Sen University Foshan Hospital, Foshan, China
| | - Si Yu
- Gastroenterology, The First People's Hospital of Foshan & Sun Yat-Sen University Foshan Hospital, Foshan, China
| | - Beiying Zhang
- Clinical Research Institute, The First People's Hospital of Foshan & Sun Yat-Sen University Foshan Hospital, Foshan, China.,Medical Engineering Technology Research and Development Center of Immune Repertoire in Foshan, The First People's Hospital of Foshan & Sun Yat-Sen University Foshan Hospital, Foshan, China
| | - Yong Ji
- Gastroenterology, The First People's Hospital of Foshan & Sun Yat-Sen University Foshan Hospital, Foshan, China
| | - Yihao Chen
- Clinical Research Institute, The First People's Hospital of Foshan & Sun Yat-Sen University Foshan Hospital, Foshan, China.,Medical Engineering Technology Research and Development Center of Immune Repertoire in Foshan, The First People's Hospital of Foshan & Sun Yat-Sen University Foshan Hospital, Foshan, China
| | - Ying Ouyang
- Clinical Research Institute, The First People's Hospital of Foshan & Sun Yat-Sen University Foshan Hospital, Foshan, China.,Medical Engineering Technology Research and Development Center of Immune Repertoire in Foshan, The First People's Hospital of Foshan & Sun Yat-Sen University Foshan Hospital, Foshan, China
| | - Wei Luo
- Clinical Research Institute, The First People's Hospital of Foshan & Sun Yat-Sen University Foshan Hospital, Foshan, China.,Medical Engineering Technology Research and Development Center of Immune Repertoire in Foshan, The First People's Hospital of Foshan & Sun Yat-Sen University Foshan Hospital, Foshan, China
| |
Collapse
|
42
|
Do IG, Jung KU, Koo DH, Lee YG, Oh S, Kim K, Kim DH, Sohn JH, Son BH, Lee SR, Shin JH, Kim HO, Kim H, Chun HK, Serrero G, Yoo CH. Clinicopathological characteristics and outcomes of gastrointestinal stromal tumors with high progranulin expression. PLoS One 2021; 16:e0245153. [PMID: 33411849 PMCID: PMC7790380 DOI: 10.1371/journal.pone.0245153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 12/22/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND & AIMS Progranulin (PGRN) is known to promote tumorigenesis and proliferation of several types of cancer cells. However, little is known about the clinicopathological features of patients with gastrointestinal stromal tumors (GISTs) with regard to PGRN expression. METHODS A retrospective analysis was performed on patients with GISTs who underwent curative surgical resection between 2007 and 2017. PGRN expression was evaluated by immunohistochemical (IHC) analysis and semi-quantitatively categorized (no expression, 0; weak, 1+; moderate, 2+; strong, 3+). Tumors with a staining intensity of 2+ or 3+ were considered high PGRN expression. RESULTS Fifty-four patients were analyzed; 31 patients (57%) were male. The median age at surgery was 60 years (range, 33-79), and the most common primary site was the stomach (67%). Thirty-five patients (65%) had spindle histology; 42 patients (78%) were separated as a high-risk group according to the modified National Institutes of Health (NIH) classification. High PGRN-expressing tumors were observed in 27 patients (50%), had more epithelioid/mixed histology (68% vs. 32%; p = 0.046), and KIT exon 11 mutations (76% vs. 24%; p = 0.037). Patients with high PGRN-expressing tumors had a worse recurrence-free survival (RFS) (36% of 5-year RFS) compared to those with low PGRN-expressing tumors (96%; p<0.001). Multivariate analysis showed that high PGRN expression and old age (>60 years) were independent prognostic factors for poor RFS. CONCLUSIONS High PGRN-expressing GISTs showed more epithelioid/mixed histology and KIT exon 11 mutations. PGRN overexpression was significantly associated with poor RFS in patients with GISTs who underwent curative resection.
Collapse
Affiliation(s)
- In-Gu Do
- Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyung Uk Jung
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong-Hoe Koo
- Division of Hematology/Oncology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- * E-mail: (DHK); (CHY)
| | - Yun-Gyoo Lee
- Division of Hematology/Oncology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sukjoong Oh
- Division of Hematology/Oncology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyungeun Kim
- Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong-Hoon Kim
- Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jin Hee Sohn
- Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Byung Ho Son
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung Ryol Lee
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jun Ho Shin
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyung Ook Kim
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hungdai Kim
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ho-Kyung Chun
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ginette Serrero
- A&G Pharmaceutical Inc., Columbia, Maryland, United States of America
- Greenebaum Cancer Center, University of Maryland, Baltimore, Maryland, United States of America
| | - Chang Hak Yoo
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- * E-mail: (DHK); (CHY)
| |
Collapse
|
43
|
Immunohistochemistry in Bone and Soft Tissue Tumours. Sarcoma 2021. [DOI: 10.1007/978-981-15-9414-4_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
|
44
|
Laparoscopic Local Resection through Subserosal Dissection with Endoscopic Air-Insufflation for Submucosal Tumors Located Near the Esophagogastric Junction. THE JOURNAL OF MINIMALLY INVASIVE SURGERY 2020; 23:172-178. [PMID: 35601640 PMCID: PMC8985622 DOI: 10.7602/jmis.2020.23.4.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/26/2020] [Accepted: 11/10/2020] [Indexed: 11/25/2022]
Abstract
Purpose A novel resection method, namely, laparoscopic local resection through subserosal dissection with endoscopic air-insuff lation (LRSDEA) was used for submucosal tumors located near the esophagogastric junction (SMT-EGJ) to avoid major gastric resection. Methods A total of 9 cases underwent LRSDEA. We sequentially performed: laparoscopic dissections around EGJ, subserosal dissections around SMTs using laparoscopic electrocautery and ultrasonic shears, and finally, enucleation of SMTs. During these procedures, intraoperative endoscopic tumor localization, as well as endoscopic air-insufflation allowed for safe resection. These procedures are shown in the supplementary video clip. The clinicopathological characteristics and surgical results were analyzed. Results All laparoscopic procedures were successfully performed without requiring a major gastrectomy. The mean operation time was 126.1 minutes, and estimated blood loss was 12.0 ml. There were no postoperative complications. Pathological diagnoses were 6 leiomyomas, 2 gastrointestinal stromal tumors, and 1 gastric duplication. Conclusion LRSDEA is an effective and safe treatment option for SMT-EGJ, as major resection of the stomach is avoided.
Collapse
|
45
|
Oliveira Santos P, Cunha TM, Lemos MM. An unusual presentation of an extragastrointestinal stromal tumour: a case report. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00297-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Gastrointestinal stromal tumours (GISTs) account for most mesenchymal gastrointestinal tumours, which in turn represent 1% of all gastrointestinal cancers. They mainly affect older adults, with a slight male preponderance. These lesions can be found along the digestive tract and most frequently in the stomach. Extragastrointestinal stromal tumours (EGISTs) are even rarer lesions, with few cases or series reported.
Case presentation
A 51-year-old woman was referred to our hospital due to progressive abdominal volume increase. Evaluation by multidetector computed tomography (MDCT) revealed a large intraperitoneal mixed tumour with few solid components, measuring up to 30 cm and compressing the surrounding structures, thought to be an ovarian tumour. Diagnostic laparotomy showed that the lesion was adherent to the greater gastric curvature and the vesical peritoneum. The lesion was removed without complications.
Conclusions
Imaging plays an essential role in the diagnosis of large intraperitoneal tumours. MDCT is the preferred technique to stage and to follow-up EGISTs.
Collapse
|
46
|
Gastrointestinal Stromal Tumors in Saudi Arabia: a Comprehensive Review in the Light of Recent Literature. Indian J Surg 2020. [DOI: 10.1007/s12262-020-02141-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
47
|
Xu JJ, Taudorf M, Ulriksen PS, Achiam MP, Resch TA, Nielsen MB, Lönn LB, Hansen KL. Gastrointestinal Applications of Iodine Quantification Using Dual-Energy CT: A Systematic Review. Diagnostics (Basel) 2020; 10:diagnostics10100814. [PMID: 33066281 PMCID: PMC7602017 DOI: 10.3390/diagnostics10100814] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/04/2020] [Accepted: 10/07/2020] [Indexed: 12/15/2022] Open
Abstract
Dual-energy computed tomography (DECT) can estimate tissue vascularity and perfusion via iodine quantification. The aim of this systematic review was to outline current and emerging clinical applications of iodine quantification within the gastrointestinal tract using DECT. The search was conducted with three databases: EMBASE, Pubmed and The Cochrane Library. This identified 449 studies after duplicate removal. From a total of 570 selected studies, 30 studies were enrolled for the systematic review. The studies were categorized into four main topics: gastric tumors (12 studies), colorectal tumors (8 studies), Crohn’s disease (4 studies) and miscellaneous applications (6 studies). Findings included a significant difference in iodine concentration (IC) measurements in perigastric fat between T1–3 vs. T4 stage gastric cancer, poorly and well differentiated gastric and colorectal cancer, responders vs. non-responders following chemo- or chemoradiotherapy treatment among cancer patients, and a positive correlation between IC and Crohn’s disease activity. In conclusion, iodine quantification with DECT may be used preoperatively in cancer imaging as well as for monitoring treatment response. Future studies are warranted to evaluate the capabilities and limitations of DECT in splanchnic flow.
Collapse
Affiliation(s)
- Jack Junchi Xu
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.B.N.); (L.B.L.); (K.L.H.)
- Department of Surgical Gastroenterology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.T.); (P.S.U.); (M.P.A.); (T.A.R.)
- Correspondence:
| | - Mikkel Taudorf
- Department of Surgical Gastroenterology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.T.); (P.S.U.); (M.P.A.); (T.A.R.)
| | - Peter Sommer Ulriksen
- Department of Surgical Gastroenterology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.T.); (P.S.U.); (M.P.A.); (T.A.R.)
| | - Michael Patrick Achiam
- Department of Surgical Gastroenterology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.T.); (P.S.U.); (M.P.A.); (T.A.R.)
- Department of Vascular Surgery, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Timothy Andrew Resch
- Department of Surgical Gastroenterology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.T.); (P.S.U.); (M.P.A.); (T.A.R.)
- Department of Clinical Medicine, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Michael Bachmann Nielsen
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.B.N.); (L.B.L.); (K.L.H.)
- Department of Surgical Gastroenterology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.T.); (P.S.U.); (M.P.A.); (T.A.R.)
| | - Lars Birger Lönn
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.B.N.); (L.B.L.); (K.L.H.)
- Department of Surgical Gastroenterology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.T.); (P.S.U.); (M.P.A.); (T.A.R.)
| | - Kristoffer Lindskov Hansen
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.B.N.); (L.B.L.); (K.L.H.)
- Department of Surgical Gastroenterology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.T.); (P.S.U.); (M.P.A.); (T.A.R.)
| |
Collapse
|
48
|
Seven G, Kochan K, Caglar E, Kiremitci S, Koker IH, Senturk H. Evaluation of Ki67 Index in Endoscopic Ultrasound-Guided Fine Needle Aspiration Samples for the Assessment of Malignancy Risk in Gastric Gastrointestinal Stromal Tumors. Dig Dis 2020; 39:407-414. [PMID: 33017820 DOI: 10.1159/000511994] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 10/05/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND The risk of malignancy in resected gastrointestinal stromal tumors (GISTs) depends on tumor size, location, and mitotic index. Reportedly, the Ki67 index has a prognostic value in resected GISTs. We aimed to analyze the accuracy of endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) samples with reference to Ki67 index, using surgical specimens as the gold standard. METHODS Fifty-five patients who underwent EUS-FNA followed by surgical resection for gastric GISTs were retrospectively analyzed. Patients' age and sex; tumors' size and location; mitotic index, cell type, cellularity, pleomorphism, presence of ulceration, hemorrhage, necrosis, mucosal or serosal invasion, growth pattern, and Ki67 index based on pathology were investigated. RESULTS Location in fundus, ulceration, hemorrhage, mucosal invasion, and Ki67 index in surgical specimens were significant in predicting high-risk groups (p < 0.05) on univariate analysis. Frequency of bleeding (p = 0.034) and the Ki67 index (p = 0.018) were the only independent significant factors in multivariate analysis. The optimal cutoff level of Ki67 was 5%, with 88.2% sensitivity and 52.8% specificity (p = 0.021). The mean Ki67 index was lower in EUS-FNA samples than in surgical specimens (2% [1-15] versus 10% [1-70], p = 0.001). The rank correlation coefficient value of Ki67 was 0.199 (p = 0.362) between EUS-FNA and surgical samples and showed no reliability for EUS-FNA samples. CONCLUSION The Ki67 index in resected specimens correlated with high-risk GISTs, although it had no additive value to the current criteria. The Ki67 index in EUS-guided FNA samples is not a reliable marker of proliferation in GISTs.
Collapse
Affiliation(s)
- Gulseren Seven
- Division of Gastroenterology, Bezmialem Vakif University, Istanbul, Turkey
| | - Koray Kochan
- Division of Gastroenterology, Bezmialem Vakif University, Istanbul, Turkey
| | - Erkan Caglar
- Division of Gastroenterology, Balikesir University School of Medicine, Balikesir, Turkey
| | - Sercan Kiremitci
- Division of Gastroenterology, Bezmialem Vakif University, Istanbul, Turkey
| | | | - Hakan Senturk
- Division of Gastroenterology, Bezmialem Vakif University, Istanbul, Turkey
| |
Collapse
|
49
|
Liu P, Tan F, Liu H, Ge J, Liu S, Lei T, Zhao X. Skin Metastasis of Gastrointestinal Stromal Tumors: A Case Series and Literature Review. Cancer Manag Res 2020; 12:7681-7690. [PMID: 32904396 PMCID: PMC7455533 DOI: 10.2147/cmar.s261823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/04/2020] [Indexed: 12/12/2022] Open
Abstract
Background Gastrointestinal stromal tumors (GISTs) extremely and rarely metastasize to the skin, and such metastases have not been well characterized. Methods Retrospective analysis of clinicopathological data of patients with skin metastasis of a GIST (SM-GIST) admitted to Xiangya Hospital (Changsha, Hunan, China) and literature review were conducted. Results Including our 4 cases, a total of 17 cases have been reported to date. The mean age of the patients was 55.4 years (29~70 years) and there was not sex predominance (male 10 and female 7). Primary tumors were often located in the stomach (n=9), duodenum (n=2) and small bowel (n=2). Meanwhile, SM-GIST mainly occurred in head and face (n=6), extremities (n=6), followed by abdomen wall (n=5), back (n=3) and chest (n=2). Mutation analysis revealed that the frequency of wild-type GIST (WT-GIST), exon 9, 11 and 13 mutations was 6, 1, 4 and 1, respectively. The average time to SM-GIST was 4.22 years, specifically 4.59 years in gastric and 3.8 years in non-gastric. Moreover, for the resection only group (including chemotherapy), such average time was 3.63 years, while for the combined group (resection and tyrosine kinase inhibitors (TKIs)), it was about 4.74 years. The mean survival was approximately 6.2 years. However, after the diagnosis of SM-GIST, survival was only about 1.69 years. Conclusion SM-GIST is a rare malignant condition. Non-gastric GIST, surgery without TKIs, high invasiveness and tumor burden, and molecular subtype (mutation in exon 9, 11 and wild-type) may be conducive to the development of SM-GIST. Additionally, it is also a sign of poor prognosis.
Collapse
Affiliation(s)
- Peng Liu
- Department of Gastrointestinal Surgery, Xiangya Hospital, Central South University, Changsha 410008, Hunan, People's Republic of China
| | - Fengbo Tan
- Department of Gastrointestinal Surgery, Xiangya Hospital, Central South University, Changsha 410008, Hunan, People's Republic of China
| | - Heli Liu
- Department of Gastrointestinal Surgery, Xiangya Hospital, Central South University, Changsha 410008, Hunan, People's Republic of China
| | - Jie Ge
- Department of Gastrointestinal Surgery, Xiangya Hospital, Central South University, Changsha 410008, Hunan, People's Republic of China
| | - Sheng Liu
- Department of Gastrointestinal Surgery, Xiangya Hospital, Central South University, Changsha 410008, Hunan, People's Republic of China
| | - Tianxiang Lei
- Department of Gastrointestinal Surgery, Xiangya Hospital, Central South University, Changsha 410008, Hunan, People's Republic of China
| | - Xianhui Zhao
- Department of Gastrointestinal Surgery, Xiangya Hospital, Central South University, Changsha 410008, Hunan, People's Republic of China
| |
Collapse
|
50
|
Al-Maghrabi H, Alahmadi S, Falemban AH. Primary Gastrointestinal Stromal Tumor of the Prostate: Unexpected Guest. Cureus 2020; 12:e10244. [PMID: 33042684 PMCID: PMC7535941 DOI: 10.7759/cureus.10244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Primary mesenchymal lesions of the prostate are exceptionally rare. They comprise 1% of all prostatic neoplasms. Despite its rare location, the diagnosis of primary gastrointestinal stromal tumors (GISTs) of the prostate gland should never be missed. Such a diagnosis can be made after the rolling out of direct extension from adjacent organs, especially the rectum. GIST diagnosis has a clinical impact on patient treatment and clinical outcomes. They harbor a certain KIT activation mutation that responds to pharmacologic therapy inhibitors. The objective of the current study was to provide a thorough review of GIST arising primarily in the prostate gland along with a comprehensive study of GIST pathogenesis, histologic morphology, immunohistochemistry, and molecular studies’ findings, and their importance in differentiating GIST from other prostate mesenchymal tumors. This will emphasize the role of careful spindle cell lesion diagnosis in the prostate gland that can influence the prognostic stratification of clinical management, future follow-up, and disease outcome. Thirteen cases were collected after an extensive and detailed review of the English literature through PubMed, Medknow, Google Scholar, as well as personal experience. The anatomic location of this lesion plays a significant role in the differential diagnosis. It is difficult to establish the accurate primary origin of GIST on core needle tissue biopsy. Thus, clinical, and radiological examinations play a crucial role in rolling out the possibility of rectal GIST secondarily invading and involving the prostate gland. To conclude, primary prostatic GIST is a rare diagnosis. Extraintestinal, particularly rectal, GIST can clinically and radiologically mimic the impression of the prostatic lesion. Before diagnosing primary prostatic spindle cell lesions, such as solitary fibrous tumor (SFT), inflammatory myofibroblastic tumor (IMT), leiomyoma, leiomyosarcoma, or prostatic stromal tumors, one should include CD117/c-Kit in the workup of a prostatic spindle cell lesion. GIST has distinct pathogenesis, and its diagnosis can have a clinical impact on the patient's management plan and clinical outcome.
Collapse
Affiliation(s)
- Haneen Al-Maghrabi
- Pathology, King Faisal Specialist Hospital and Research Centre, Jeddah, SAU
| | | | | |
Collapse
|