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Wu Q, Jiang J, Li Z, Ling X, Qiao Z, Ma Y. Long-term survival outcomes of endoscopic therapy vs. surgical resection in patients with cardia gastrointestinal stromal tumor. PLoS One 2024; 19:e0306598. [PMID: 38968220 DOI: 10.1371/journal.pone.0306598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 06/19/2024] [Indexed: 07/07/2024] Open
Abstract
The ideal surgical approach for treating cardia gastrointestinal stromal tumor (GIST) is not clearly established. This study aimed to assess the long-term survival results among patients who received endoscopic therapy (ET) or surgical resection (SR) for cardia GIST. Cardia GIST patients from 2000 to 2019 were selected from the surveillance, epidemiology, and end result (SEER) database. Multiple imputation (MI) was applied to handle missing data, and propensity score matching (PSM) was carried out to mitigate selection bias during comparisons. Demographic and clinical characteristics' effects on overall survival (OS) and cancer-specific survival (CSS) were assessed using Kaplan-Meier analyses and multivariate Cox proportional hazard models. A total of 330 patients with cardia GIST were enrolled, including 47 (14.2%) patients with ET and 283 (85.8%) patients with SR. The 5-year OS and CSS rates in the ET and SR groups were comparable [before PSM, (OS) (76.1% vs. 81.2%, P = 0.722), (CSS) (95.0% vs. 89.3%, P = 0.186); after PSM, (OS) (75.4% vs. 85.4%, P = 0.540), (CSS) (94.9% vs. 92.0%, P = 0.099)]. Moreover, there was no significant difference between ET and SR in terms of long-term OS (hazard ratio [HR] 0.735, 95% confidence interval [CI] 0.422-1.282) and CSS (HR 1.560, 95% CI 0.543-4.481). Our study found no significant disparity in long-term survival outcomes between ET and SR in cardia GIST patients, implying that ET could be a valid surgical strategy for treating cardia GIST.
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Affiliation(s)
- Qiong Wu
- Department of Gastroenterology, Suzhou Ninth People's Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, China
| | - Jun Jiang
- Department of Public Health and Preventive Medicine, Anhui Medical College, Hefei, China
| | - Zhuofan Li
- Suzhou Medical College of Soochow University, Suzhou, China
| | - Xin Ling
- Department of Gastroenterology, Suzhou Ninth People's Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, China
| | - Zhenguo Qiao
- Department of Gastroenterology, Suzhou Ninth People's Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, China
| | - Yimin Ma
- Departments of Gastroenterology, Gaochun People's Hospital of Nanjing, Nanjing, China
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Olivera-Salazar R, Salcedo Cabañas G, Vega-Clemente L, Alonso-Martín D, Castellano Megías VM, Volward P, García-Olmo D, García-Arranz M. Pilot Study by Liquid Biopsy in Gastrointestinal Stromal Tumors: Analysis of PDGFRA D842V Mutation and Hypermethylation of SEPT9 Presence by Digital Droplet PCR. Int J Mol Sci 2024; 25:6783. [PMID: 38928487 PMCID: PMC11203410 DOI: 10.3390/ijms25126783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 06/15/2024] [Accepted: 06/17/2024] [Indexed: 06/28/2024] Open
Abstract
Tissue biopsy remains the standard for diagnosing gastrointestinal stromal tumors (GISTs), although liquid biopsy is emerging as a promising alternative in oncology. In this pilot study, we advocate for droplet digital PCR (ddPCR) to diagnose GIST in tissue samples and explore its potential for early diagnosis via liquid biopsy, focusing on the PDGFRA D842V mutation and SEPT9 hypermethylated gene. We utilized ddPCR to analyze the predominant PDGFRA mutation (D842V) in surgical tissue samples from 15 GIST patients, correlating with pathologists' diagnoses. We expanded our analysis to plasma samples to compare DNA alterations between tumor tissue and plasma, also investigating SEPT9 gene hypermethylation. We successfully detected the PDGFRA D842V mutation in GIST tissues by ddPCR. Despite various protocols to enhance mutation detection in early-stage disease, it remained challenging, likely due to the low concentration of DNA in plasma samples. Additionally, the results of Area Under the Curve (AUC) for the hypermethylated SEPT9 gene, analyzing concentration, ratio, and abundance were 0.74 (95% Confidence Interval (CI): 0.52 to 0.97), 0.77 (95% CI: 0.56 to 0.98), and 0.79 (95% CI: 0.59 to 0.99), respectively. As a rare disease, the early detection of GIST through such biomarkers is particularly crucial, offering significant potential to improve patient outcomes.
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Affiliation(s)
- Rocío Olivera-Salazar
- New Therapies Laboratory, Health Research Institute-Fundación Jiménez Díaz University Hospital (IIS-FJD), Avda. Reyes Católicos, 2, 28040 Madrid, Spain; (L.V.-C.); (D.A.-M.); (D.G.-O.); (M.G.-A.)
| | - Gabriel Salcedo Cabañas
- Surgeon Esophagogastric Unit, Hospital Fundación Jiménez Díaz, Avda. Reyes Católicos, 2, 28040 Madrid, Spain; (G.S.C.); (P.V.)
| | - Luz Vega-Clemente
- New Therapies Laboratory, Health Research Institute-Fundación Jiménez Díaz University Hospital (IIS-FJD), Avda. Reyes Católicos, 2, 28040 Madrid, Spain; (L.V.-C.); (D.A.-M.); (D.G.-O.); (M.G.-A.)
| | - David Alonso-Martín
- New Therapies Laboratory, Health Research Institute-Fundación Jiménez Díaz University Hospital (IIS-FJD), Avda. Reyes Católicos, 2, 28040 Madrid, Spain; (L.V.-C.); (D.A.-M.); (D.G.-O.); (M.G.-A.)
| | | | - Peter Volward
- Surgeon Esophagogastric Unit, Hospital Fundación Jiménez Díaz, Avda. Reyes Católicos, 2, 28040 Madrid, Spain; (G.S.C.); (P.V.)
| | - Damián García-Olmo
- New Therapies Laboratory, Health Research Institute-Fundación Jiménez Díaz University Hospital (IIS-FJD), Avda. Reyes Católicos, 2, 28040 Madrid, Spain; (L.V.-C.); (D.A.-M.); (D.G.-O.); (M.G.-A.)
- Department of Surgery, Fundación Jiménez Díaz University Hospital (FJD), 28040 Madrid, Spain
- Department of Surgery, Universidad Autónoma de Madrid, 28034 Madrid, Spain
| | - Mariano García-Arranz
- New Therapies Laboratory, Health Research Institute-Fundación Jiménez Díaz University Hospital (IIS-FJD), Avda. Reyes Católicos, 2, 28040 Madrid, Spain; (L.V.-C.); (D.A.-M.); (D.G.-O.); (M.G.-A.)
- Department of Surgery, Universidad Autónoma de Madrid, 28034 Madrid, Spain
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3
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Singh A, Chitti B, Aguiar C, Wernicke AG, Devoe CE, Rahman H, Sison C, Parashar B. Comparing gastrointestinal stromal tumor outcomes between geriatric and non-geriatric patients: A population-based analysis. World J Surg 2024; 48:1424-1432. [PMID: 38647223 DOI: 10.1002/wjs.12170] [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: 01/01/2024] [Accepted: 03/22/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Gastrointestinal Stromal Tumors (GISTs) are the most common mesenchymal tumors of the GI tract. SEER is an extensive cancer database which proves useful in analyzing population trends. This analysis investigated GIST outcomes between geriatric & non-geriatric patients. METHODS SEER*STAT 8.4.0.1 was used to extract relevant GIST data from 2000 to 2019. Geriatric age was defined as ≥70 years. Variables included age, sex, surgery, cancer-specific death, and overall survival. Statistical tests included univariate analysis using KM survival estimate (95% confidence interval) to calculate 5-year survival (5YS). Log-Rank tests determined statistical significance. Multivariable Cox's PH regression estimated the geriatric hazard death ratio adjusted for sex, stage, and surgery. RESULTS The number of patients included was 13,579, yielding overall 5YS of 68.6% (95% CI 67.7-69.5). Cancer-specific death was 39.11% in 2000 & 3.33% in 2019. Non-geriatric & geriatric patient data yielded 5YS of 77.4% (76.4%-78.3%) and 53.3% (51.7%-54.8%) respectively (p < 0.0001). For no surgery/surgery, younger patient data yielded 5YS of 48.7% (45.8%-51.4%) and 83.7% (82.7%-84.7%) respectively (p < 0.0001); geriatric data yielded 5YS of 29.3% (26.5%-32.1%) and 62.8% (60.8%-64.6%) respectively (p < 0.0001). Multivariable analysis yielded a geriatric hazard death of 2.56 (2.42-2.70) (p < 0.0001). CONCLUSIONS Cancer-specific death decreased since 2000, indicating an improvement in survival & treatment methods. Observed lower survival rates overall in the geriatric group. Surgery appeared to enhance survival rates in both groups, suggesting that surgery is an important factor in GIST survival regardless of age. Large prospective studies will help define clinical management for geriatric patients.
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Affiliation(s)
- Abhiram Singh
- Department of Radiation Oncology, Northwell, New Hyde Park, New York, USA
- Department of Chemistry and Biochemistry, University of California-Los Angeles, Los Angeles, California, USA
| | - Bhargava Chitti
- Department of Radiation Oncology, Northwell, New Hyde Park, New York, USA
| | | | | | - Craig E Devoe
- Department of Medical Oncology, Northwell, New Hyde Park, New York, USA
| | - Husneara Rahman
- Biostatistics Unit, Office of Academic Affairs, Northwell Health, New Hyde Park, New York, USA
| | - Cristina Sison
- Biostatistics Unit, Office of Academic Affairs, Northwell Health, New Hyde Park, New York, USA
| | - Bhupesh Parashar
- Department of Radiation Oncology, Northwell, New Hyde Park, New York, USA
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Xu E, Shi Q, Qi Z, Li B, Sun H, Ren Z, Cai S, He D, Lv Z, Chen Z, Zhong L, Xu L, Li X, Xu S, Zhou P, Zhong Y. Clinical outcomes of endoscopic resection for the treatment of intermediate- or high-risk gastric small gastrointestinal stromal tumors: a multicenter retrospective study. Surg Endosc 2024; 38:3353-3360. [PMID: 38698259 DOI: 10.1007/s00464-024-10753-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 02/14/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND AND AIMS Many studies of gastric gastrointestinal stromal tumors (g-GISTs) following endoscopic resection (ER) have typically focused on tumor size, with most tumors at low risk of aggressiveness after risk stratification. There have been few systematic studies on the oncologic outcomes of intermediate- or high-risk g-GISTs after ER. METHODS From January 2014 to January 2020, we retrospectively collected patients considered at intermediate- or high-risk of g-GISTs according to the modified NIH consensus classification system. The primary outcome was overall survival (OS). RESULTS Six hundred and seventy nine (679) consecutive patients were diagnosed with g-GISTs and treated by ER between January 2014 and January 2020 in three hospitals in Shanghai, China. 43 patients (20 males and 23 females) were confirmed at intermediate-or high-risk. The mean size of tumors was 2.23 ± 1.01 cm. The median follow-up period was 62.02 ± 15.34 months, with a range of 28 to 105 months. There were no recurrences or metastases, even among patients having R1 resections. The 5-year OS rate was 97.4% (42/43). CONCLUSION ER for intermediate- or high-risk gastric small GISTs is a feasible and safe method, which allows for a wait-and-see approach before determining the necessity for imatinib adjuvant or surgical treatment. This approach to g-GISTs does require that patients undergo close follow-up.
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Affiliation(s)
- Enpan Xu
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qiang Shi
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhipeng Qi
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Bing Li
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Huihui Sun
- Tongji Hospital Affiliated to Tongji University, Shanghai Tongji Hospital, Shanghai, China
| | - Zhong Ren
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shilun Cai
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Dongli He
- Shanghai Xuhui Central Hospital, Fudan University, Shanghai, China
| | - Zhengtao Lv
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhanghan Chen
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Liang Zhong
- Huashan Hospital, Fudan University, Shanghai, China
| | - Leiming Xu
- Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai Jiaotong University School of Medicine Xinhua Hospital, Shanghai, China
| | - Xiaobo Li
- Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, Shanghai, China
| | - Shuchang Xu
- Tongji Hospital Affiliated to Tongji University, Shanghai Tongji Hospital, Shanghai, China
| | - Pinghong Zhou
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yunshi Zhong
- Zhongshan Hospital, Fudan University, Shanghai, China.
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Ben Yehuda A, Hammerschlag J, Jeroukhimov I, Markman O, Lavy R, Hershkovitz Y. Should Advanced Age Preclude Surgical Treatment of Gastrointestinal Stromal Tumor? J Laparoendosc Adv Surg Tech A 2024; 34:461-463. [PMID: 38354293 DOI: 10.1089/lap.2023.0503] [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: 02/16/2024] Open
Abstract
Introduction: Surgical resection is a gold standard treatment for gastrointestinal stromal tumors (GISTs). It can be performed by minimally invasive surgery approach in most of the patients. It has been shown that advanced age is not a clear poor prognostic factor in patients who underwent surgery for GIST. We hypothesized that elderly patients undergo elective surgery less often compared to younger population. We aim to evaluate the safety, efficacy and oncological results of GIST treatment in the elderly population in our Medical Center. Materials and Methods: All patients who underwent surgery for GIST in Shamir Medical Center from January 1, 2016, to July 31, 2023, were included in the study. The patients were divided into 2 groups. Group 1 included patients younger than 75 years, while patients older than 75 years were included in Group 2. The groups were compared according to demographics, clinical and surgical parameters, complications, and pathology results. Results: Overall, 49 patients were included in the study. Group 1 included 28 patients and Group 2 included 21 patients. Group 2 patients more often underwent emergency surgery (52.4% versus 14.3%, P < .05) and had increased open surgery rate (19% versus 0%, P < .05). No difference between the groups was noted in surgical parameters, complications, and length of hospital stay. Tumor size, number of mitoses, level of ki67%, and involvement of surgical margins were not significantly different. However, in Group 2 patients, tumor size was larger and there was a trend toward higher rate of ki67 > 5%. Conclusion: Elderly patients with GIST are less frequently undergoing electively surgery and relatively often undergo open surgery. Frequency of complications is similar in elderly patients compares to younger patients group.
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Affiliation(s)
- Amir Ben Yehuda
- Division of Surgery, Shamir Medical Center Affiliated with University Tel Aviv, Zerifin, Israel
| | - Jonathan Hammerschlag
- Division of Surgery, Shamir Medical Center Affiliated with University Tel Aviv, Zerifin, Israel
| | - Igor Jeroukhimov
- Trauma Unit, Shamir Medical Center Affiliated with University Tel Aviv, Zerifin, Israel
| | - Olena Markman
- Department of Surgery, Barzilai Medical Center, Ashkelon, Israel
| | - Ron Lavy
- Division of Surgery, Shamir Medical Center Affiliated with University Tel Aviv, Zerifin, Israel
| | - Yehuda Hershkovitz
- Trauma Unit, Shamir Medical Center Affiliated with University Tel Aviv, Zerifin, Israel
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Liu L, Zhang R, Shi Y, Sun J, Xu X. Automated machine learning for predicting liver metastasis in patients with gastrointestinal stromal tumor: a SEER-based analysis. Sci Rep 2024; 14:12415. [PMID: 38816560 PMCID: PMC11139903 DOI: 10.1038/s41598-024-62311-9] [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: 05/08/2024] [Accepted: 05/15/2024] [Indexed: 06/01/2024] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are a rare type of tumor that can develop liver metastasis (LIM), significantly impacting the patient's prognosis. This study aimed to predict LIM in GIST patients by constructing machine learning (ML) algorithms to assist clinicians in the decision-making process for treatment. Retrospective analysis was performed using the Surveillance, Epidemiology, and End Results (SEER) database, and cases from 2010 to 2015 were assigned to the developing sets, while cases from 2016 to 2017 were assigned to the testing set. Missing values were addressed using the multiple imputation technique. Four algorithms were utilized to construct the models, comprising traditional logistic regression (LR) and automated machine learning (AutoML) analysis such as gradient boost machine (GBM), deep neural net (DL), and generalized linear model (GLM). We evaluated the models' performance using LR-based metrics, including the area under the receiver operating characteristic curve (AUC), calibration curve, and decision curve analysis (DCA), as well as AutoML-based metrics, such as feature importance, SHapley Additive exPlanation (SHAP) Plots, and Local Interpretable Model Agnostic Explanation (LIME). A total of 6207 patients were included in this study, with 2683, 1780, and 1744 patients allocated to the training, validation, and test sets, respectively. Among the different models evaluated, the GBM model demonstrated the highest performance in the training, validation, and test cohorts, with respective AUC values of 0.805, 0.780, and 0.795. Furthermore, the GBM model outperformed other AutoML models in terms of accuracy, achieving 0.747, 0.700, and 0.706 in the training, validation, and test cohorts, respectively. Additionally, the study revealed that tumor size and tumor location were the most significant predictors influencing the AutoML model's ability to accurately predict LIM. The AutoML model utilizing the GBM algorithm for GIST patients can effectively predict the risk of LIM and provide clinicians with a reference for developing individualized treatment plans.
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Affiliation(s)
- Luojie Liu
- Department of Gastroenterology, Changshu Hospital Affiliated to Soochow University, Suzhou, China
| | - Rufa Zhang
- Department of Gastroenterology, Changshu Hospital Affiliated to Soochow University, Suzhou, China
| | - Ying Shi
- Department of Gastroenterology, Changshu Hospital Affiliated to Soochow University, Suzhou, China
| | - Jinbing Sun
- Department of General Surgery, Changshu Hospital Affiliated to Soochow University, Suzhou, China.
| | - Xiaodan Xu
- Department of Gastroenterology, Changshu Hospital Affiliated to Soochow University, Suzhou, China.
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Sadeghi A, Moghadam PK, Mangeli F, Mohammadi M, Ghadirzadeh E, Rajabnia M. Rectal gastrointestinal stromal tumor (GIST) in a patient with Crohn's disease: a rare coincidence case report and brief literature review. Oxf Med Case Reports 2024; 2024:omae039. [PMID: 38784781 PMCID: PMC11110859 DOI: 10.1093/omcr/omae039] [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: 11/28/2023] [Revised: 01/26/2024] [Indexed: 05/25/2024] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are the most common type of gastrointestinal mesenchymal tumors. The most common site for developing these neoplasms is the stomach and small intestine. In contrast, anorectal GISTs are very rare. Population-based studies have shown an increased risk of colorectal cancers (CRC) in patients with Crohn's disease (CD). As in sporadic CRC, adenocarcinomas are the most commonly observed tumor. Accordingly, it is expected that rectal mass in CD patients to be an adenocarcinoma. Some reports have presented CD cases with GISTs along the gastrointestinal tract; however, to the best of our knowledge, a rectal GIST has not been reported in CD. Herein, we report a 41-year-old woman with CD who presented with 8 weeks of constipation and was diagnosed with rectal GIST and briefly review existing reports regarding GIST in IBD.
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Affiliation(s)
- Amir Sadeghi
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran province, Tehran, Iran
| | - Pardis Ketabi Moghadam
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran province, Tehran, Iran
| | - Forough Mangeli
- Clinical Pathologist, Department of Pathology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran province, Tehran, Iran
| | - Mahsa Mohammadi
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran province, Tehran, Iran
| | - Erfan Ghadirzadeh
- Gut and Liver Research Center, Non-communicable Diseases Institute, Mazandaran University of Medical Sciences, Mazandaran province, Sari, Iran
| | - Mohsen Rajabnia
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Alborz province, Karaj, Iran
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Akahoshi K, Tamura S, Akahoshi K, Shiratsuchi Y, Koga H, Oya M, Ohishi Y, Koga T. Efficacy and histologic frequencies of endoscopic ultrasonography-guided tissue acquisition using conventional fine-needle aspiration needles for gastric subepithelial hypoechoic mass. Australas J Ultrasound Med 2024; 27:89-96. [PMID: 38784701 PMCID: PMC11109998 DOI: 10.1002/ajum.12382] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
Introduction/Purpose For gastric subepithelial lesions (GSELs) showing a hypoechoic mass (HM) on endoscopic ultrasonography (EUS) imaging, the utility of EUS-guided tissue acquisition using conventional fine-needle aspiration needles (EUS-TA-CFNAN) and the frequency of histological types remain unclear. This study aimed to examine this issue. Methods This prospective observational study enrolled 291 consecutive patients who underwent EUS-TA-CFNAN for GSELs showing an HM (GSELHM) on EUS imaging. Immunohistochemical analysis was performed for all EUS-TA-CFNAN and surgically resected specimens. The main outcome measures were the technical results of EUS-TA-CFNAN and the frequency of histological types in GSELHM. Results The endoscopic ultrasound-guided tissue acquisition using conventional fine-needle aspiration needle diagnosis rate for GSELHM was 80.1% (95% confidence interval [CI]: 75.0-84.5, 233/291). It was significantly lower for antrum (P = 0.004) and lesions smaller than 2 cm (P = 0.003). There were no adverse events. The immunohistochemical diagnoses of EUS-TA-CFNAN included 149 cases of gastrointestinal stromal tumour (GIST) (51.2%), 48 cases of leiomyoma (16.5%), 11 cases of schwannoma (3.8%), 8 cases of the ectopic pancreas (2.7%), 5 cases of subepithelial lesion like cancer (1.7%), 12 cases of other lesions (4.1%), and 58 cases of undiagnosable lesions (19.9%). The frequency of malignant or potentially malignant tumour in GSELHM was 55.0% (95% CI: 49.1-60.8, 160/291). Surgery was performed in 149 patients according to the conclusive EUS-TA-CFNAN results, in which the diagnostic accuracy of EUS-TA-CFNAN was 97.3% (95% CI: 94.7-99.9, 145/149). Conclusion The use of EUS-TA-CFNAN for GSELHMs is safe and accurate. Gastric subepithelial lesions showing a hypoechoic mass have a reasonably high possibility of containing malignant or potentially malignant tumours, including GISTs.
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Affiliation(s)
| | | | | | | | - Hidenobu Koga
- Clinical Research Support OfficeAso Iizuka HospitalIizukaJapan
| | - Masafumi Oya
- Department of PathologyAso Iizuka HospitalIizukaJapan
| | | | - Tadashi Koga
- Department of SurgeryAso Iizuka HospitalIizukaJapan
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Cai M, Song B, Deng Y, Gao P, Cai S, Yalikong A, Xu E, Zhong Y, Yu J, Zhou P. Automatically optimized radiomics modeling system for small gastric submucosal tumor (<2 cm) discrimination based on EUS images. Gastrointest Endosc 2024; 99:537-547.e4. [PMID: 37956896 DOI: 10.1016/j.gie.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 10/14/2023] [Accepted: 11/06/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND AND AIMS The clinical management of small gastric submucosal tumors (SMTs) (<2 cm) faces a non-negligible challenge because of the lack of guideline consensus and effective diagnostic tools. This article develops an automatically optimized radiomics modeling system (AORMS) based on EUS images to diagnose and evaluate SMTs. METHODS A total of 205 patients with EUS images of small gastric SMTs (<2 cm) were retrospectively enrolled in the development phase of AORMS for the diagnosis and the risk stratification of GI stromal tumor (GIST). A total of 178 patients with images from different centers were prospectively enrolled in the independent testing phase. The performance of AORMS was compared to that of endoscopists in the development set and evaluated in the independent testing set. RESULTS AORMS demonstrated an area under the curve (AUC) of 0.762 for the diagnosis of GIST and 0.734 for the risk stratification of GIST, respectively. In the independent testing set, AORMS achieved an AUC of 0.770 and 0.750 for the diagnosis and risk stratification of small GISTs, respectively. In comparison, the AUCs of 5 experienced endoscopists ranged from 0.501 to 0.608 for diagnosing GIST and from 0.562 to 0.748 for risk stratification. AORMS outperformed experienced endoscopists by more than 20% in diagnosing GIST. CONCLUSIONS AORMS implements automatic parameter selection, which enhances its robustness and clinical applicability. It has demonstrated good performance in the diagnosis and risk stratification of GISTs, which could aid endoscopists in the diagnosis of small gastric SMTs (<2 cm).
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Affiliation(s)
- Mingyan Cai
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Endoscopic Minimally Invasive Collaborative Innovation Center, Shanghai, China
| | - Baohui Song
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Endoscopic Minimally Invasive Collaborative Innovation Center, Shanghai, China
| | - Yinhui Deng
- MingGe Research, Fudan University Science Park, Shanghai, China; Biomedical Engineering Center, School of Information Science and Technology, Fudan University, Shanghai, China
| | - Pingting Gao
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Endoscopic Minimally Invasive Collaborative Innovation Center, Shanghai, China
| | - Shilun Cai
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Endoscopic Minimally Invasive Collaborative Innovation Center, Shanghai, China
| | - Ayimukedisi Yalikong
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Endoscopic Minimally Invasive Collaborative Innovation Center, Shanghai, China
| | - Enpan Xu
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Endoscopic Minimally Invasive Collaborative Innovation Center, Shanghai, China
| | - Yunshi Zhong
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Endoscopic Minimally Invasive Collaborative Innovation Center, Shanghai, China; Department of Endoscopy, Zhongshan Hospital Xuhui Branch, Fudan University, Shanghai, China.
| | - Jinhua Yu
- Biomedical Engineering Center, School of Information Science and Technology, Fudan University, Shanghai, China.
| | - Pinghong Zhou
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Endoscopic Minimally Invasive Collaborative Innovation Center, Shanghai, China.
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10
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Shionoya K, Tonozuka R, Mukai S, Tsuchiya T, Tanaka R, Yamamoto K, Nagai K, Mastunami Y, Kojima H, Itoi T. Endoscopic ultrasound-guided biopsy using a three-prong asymmetry tip needle for pancreatic tumors and peridigestive tract lesions: Retrospective single-center study. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2024; 31:294-304. [PMID: 38212938 DOI: 10.1002/jhbp.1403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
BACKGROUND Endoscopic ultrasound-guided tissue acquisition is vital for diagnosing pancreatic and peridigestive tract lesions. A new three-prong asymmetry tip needle has been developed for this procedure. In this study, we retrospectively assessed the diagnostic ability, tissue collection volume, and procedural adverse events of the three-prong asymmetry tip needle for solid pancreatic, subepithelial, and other organ lesions. METHODS We analyzed the data of 58 consecutive patients who underwent endoscopic ultrasound-guided tissue acquisition using a three-prong asymmetry tip needle between August 2022 and April 2023 at a single care center. RESULTS The tissue collection rate was 91.4% with 89.7% accuracy, 89.3% sensitivity, 100% specificity, 100% positive predictive value, and 25% negative predictive value. No significant differences in collection rates or diagnostic performance were observed based on the target organ, puncture route, or lesion size. Using our original assessment method, the average histological core tissue score was 3.1 ± 0.8, whereas the blood contamination volume was 2.5 ± 0.8. Only one of 58 patients (1.7%) developed a pancreatic fistula of moderate severity as an adverse event. CONCLUSIONS The three-prong asymmetry tip needle demonstrated good diagnostic capability and adequate sample volume with safety for pancreatic, subepithelial, and other organ lesions.
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Affiliation(s)
| | | | | | - Takayoshi Tsuchiya
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
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11
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Khaled I, Hafez Mousa A, Yasir Nukaly H, Mohammed Zubair MT, Alsharif MH, Abujamai JZ, Ahmed RA, Alklani T, Ennab F. Hybrid surgical approach excision of gastrointestinal stromal tumor (GIST): A case report of GIST at an unusual location and review of the literature. Clin Case Rep 2024; 12:e8778. [PMID: 38659501 PMCID: PMC11039485 DOI: 10.1002/ccr3.8778] [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: 09/09/2023] [Revised: 02/02/2024] [Accepted: 03/27/2024] [Indexed: 04/26/2024] Open
Abstract
Gastrointestinal stromal tumors are the most common malignant subepithelial lesions involving the gastrointestinal tract. Surgical techniques have been the mainstay of treatment, however, in recent times hybrid surgeries are being introduced yielding better clinical outcomes.
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Affiliation(s)
- Islam Khaled
- Department of SurgerySaudi German HospitalsJeddahSaudi Arabia
- Department of Surgery, Faculty of MedicineSuez Canal University HospitalsIsmailiaEgypt
| | - Ahmed Hafez Mousa
- Department of SurgerySaudi German HospitalsJeddahSaudi Arabia
- College of Medicine and SurgeryBatterjee Medical CollegeJeddahSaudi Arabia
| | | | | | | | | | - Ruqayyah Ali Ahmed
- College of Medicine and SurgeryBatterjee Medical CollegeJeddahSaudi Arabia
| | | | - Farah Ennab
- College of MedicineMohammed Bin Rashid University of Medicine and Health SciencesDubaiUnited Arab Emirates
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12
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Rashwan HH, Taher AM, Hassan HA, Awaji AA, Kiriacos CJ, Assal RA, Youness RA. Harnessing the supremacy of MEG3 LncRNA to defeat gastrointestinal malignancies. Pathol Res Pract 2024; 256:155223. [PMID: 38452587 DOI: 10.1016/j.prp.2024.155223] [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: 01/05/2024] [Revised: 02/16/2024] [Accepted: 02/21/2024] [Indexed: 03/09/2024]
Abstract
Evidence suggests that long non-coding RNAs (lncRNAs) play a pivotal role in the carcinogenesis and progression of various human malignancies including gastrointestinal malignancies. This comprehensive review reports the functions and mechanisms of the lncRNA maternally expressed gene 3 (MEG3) involved in gastrointestinal malignancies. It summarizes its roles in mediating the regulation of cellular proliferation, apoptosis, migration, invasiveness, epithelial-to-mesenchymal transition, and drug resistance in several gastrointestinal cancers such as colorectal cancer, gall bladder cancer, pancreatic cancer, gastric cancer, esophageal cancer, cholangiocarcinoma, gastrointestinal stromal tumors and most importantly, hepatocellular carcinoma. In addition, the authors briefly highlight its implicated mechanistic role and interactions with different non-coding RNAs and oncogenic signaling cascades. This review presents the rationale for developing non coding RNA-based anticancer therapy via harnessing the power of MEG3 in gastrointestinal malignancies.
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Affiliation(s)
- H H Rashwan
- Molecular Genetics and Biochemistry Department, Molecular Genetics Research Team (MGRT), Faculty of Biotechnology, German International University (GIU), Cairo 11835, Egypt; Bioinformatics Group, Center for Informatics Science (CIS), School of Information Technology and Computer Science (ITCS), Nile University, 12677, Giza, Egypt
| | - A M Taher
- Molecular Genetics and Biochemistry Department, Molecular Genetics Research Team (MGRT), Faculty of Biotechnology, German International University (GIU), Cairo 11835, Egypt
| | - H A Hassan
- Molecular Genetics and Biochemistry Department, Molecular Genetics Research Team (MGRT), Faculty of Biotechnology, German International University (GIU), Cairo 11835, Egypt
| | - A A Awaji
- Department of Biology, Faculty of Science, University College of Taymaa, University of Tabuk, Tabuk 71491, Saudi Arabia
| | - C J Kiriacos
- Molecular Genetics and Biochemistry Department, Molecular Genetics Research Team (MGRT), Faculty of Biotechnology, German International University (GIU), Cairo 11835, Egypt
| | - R A Assal
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Heliopolis University for Sustainable Development, Cairo, Egypt
| | - R A Youness
- Molecular Genetics and Biochemistry Department, Molecular Genetics Research Team (MGRT), Faculty of Biotechnology, German International University (GIU), Cairo 11835, Egypt.
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13
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Nudotor R, Ali AMM, Weltz A, Park A, Gibson G. Metachronous Gastrointestinal Stromal Tumors of Different Histologies: An Unusual Case. Cureus 2024; 16:e59159. [PMID: 38803754 PMCID: PMC11129840 DOI: 10.7759/cureus.59159] [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: 04/27/2024] [Indexed: 05/29/2024] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors accounting for only a small fraction of all primary malignant tumors of the gastrointestinal tract. Histologically, GISTs are classified as epithelioid, spindle type, or mixed. We present a case of a 66-year-old male incidentally noted to have a pedunculated gastric mass along the lesser curvature of the stomach during a laparoscopic Nissen fundoplication and hiatal hernia repair. A wedge resection was performed and the pathology demonstrated a 3.7 cm GIST of epithelioid type. Four years after the initial surgery, a jejunal mass was identified via CT enterography as part of a workup for ongoing iron deficiency anemia. A laparoscopic small bowel resection was performed, and the pathology revealed a new primary 3.2 cm GIST of the spindle cell subtype. Three years after surgery, surveillance imaging is negative for any recurrence. This appears to be the first report of the occurrence of metachronous primary GISTs of different histologic subtypes, separated by location.
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Affiliation(s)
| | | | - Adam Weltz
- Surgery, Anne Arundel Medical Center, Annapolis, USA
| | - Adrian Park
- Surgery, Anne Arundel Medical Center, Annapolis, USA
| | - Glen Gibson
- Surgery, Anne Arundel Medical Center, Annapolis, USA
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14
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Liu X, Yu J, Li Y, Shi H, Jiao X, Liu X, Guo D, Li Z, Tian Y, Dai F, Niu Z, Zhou Y. Deciphering the tumor immune microenvironment of imatinib-resistance in advanced gastrointestinal stromal tumors at single-cell resolution. Cell Death Dis 2024; 15:190. [PMID: 38443340 PMCID: PMC10914684 DOI: 10.1038/s41419-024-06571-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/16/2024] [Accepted: 02/21/2024] [Indexed: 03/07/2024]
Abstract
The heterogeneous nature of tumors presents a considerable obstacle in addressing imatinib resistance in advanced cases of gastrointestinal stromal tumors (GIST). To address this issue, we conducted single-cell RNA-sequencing in primary tumors as well as peritoneal and liver metastases from patients diagnosed with locally advanced or advanced GIST. Single-cell transcriptomic signatures of tumor microenvironment (TME) were analyzed. Immunohistochemistry and multiplex immunofluorescence staining were used to further validate it. This analysis revealed unique tumor evolutionary patterns, transcriptome features, dynamic cell-state changes, and different metabolic reprogramming. The findings indicate that in imatinib-resistant TME, tumor cells with activated immune and cytokine-mediated immune responses interacted with a higher proportion of Treg cells via the TIGIT-NECTIN2 axis. Future immunotherapeutic strategies targeting Treg may provide new directions for the treatment of imatinib-resistant patients. In addition, IDO1+ dendritic cells (DC) were highly enriched in imatinib-resistant TME, interacting with various myeloid cells via the BTLA-TNFRSF14 axis, while the interaction was not significant in imatinib-sensitive TME. Our study highlights the transcriptional heterogeneity and distinct immunosuppressive microenvironment of advanced GIST, which provides novel therapeutic strategies and innovative immunotherapeutic agents for imatinib resistance.
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Affiliation(s)
- Xuechao Liu
- Department of General Surgery, Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, Shandong, China
| | - Jing Yu
- School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Yi Li
- Department of General Surgery, Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, Shandong, China
| | - Hailei Shi
- Pathology Department, Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, Shandong, China
| | - Xuelong Jiao
- Department of General Surgery, Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, Shandong, China
| | - Xiaodong Liu
- Department of General Surgery, Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, Shandong, China
| | - Dong Guo
- Department of General Surgery, Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, Shandong, China
| | - Zequn Li
- Department of General Surgery, Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, Shandong, China
| | - Yulong Tian
- Department of General Surgery, Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, Shandong, China
| | - Fan Dai
- Zhejiang Provincial Key Laboratory of Crop Genetic Resources, Institute of Crop Science, Plant Precision Breeding Academy, College of Agriculture and Biotechnology, Zhejiang University, Hangzhou, 310058, Zhejiang, China.
| | - Zhaojian Niu
- Department of General Surgery, Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, Shandong, China.
| | - Yanbing Zhou
- Department of General Surgery, Affiliated Hospital of Qingdao University, 16# Jiangsu Road, Qingdao, Shandong, China.
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15
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Wang C, Niu Y. Knowledge and awareness of early gastrointestinal cancer screening in Sunan Yugur Autonomous County in Gansu, China. J Int Med Res 2024; 52:3000605241233935. [PMID: 38483133 PMCID: PMC10943729 DOI: 10.1177/03000605241233935] [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: 10/04/2023] [Accepted: 01/29/2024] [Indexed: 03/18/2024] Open
Abstract
OBJECTIVE We aimed to assess the level of knowledge and awareness regarding the need for screening of early gastrointestinal cancer among residents of Sunan Yugur Autonomous County in China. METHODS In this cross-sectional study, we conducted a survey among permanent residents of Sunan Yugur Autonomous County from January 2020 to January 2023 using a questionnaire to obtain data on knowledge regarding early gastrointestinal cancer screening. RESULTS The survey included 12,000 residents. Among participants, 62.30% (7476/12,000) were aware of the need for early gastrointestinal cancer screening. Awareness about the need for early gastrointestinal cancer screening differed significantly based on participants' sex, age, level of education, area of residence, and ethnicity. CONCLUSION The level of awareness regarding the need for early gastrointestinal cancer screening was relatively low in our study population. The government and medical institutions should provide information and promote early gastrointestinal cancer screening in the region to improve the health status and quality of life among the Yugur people.
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Affiliation(s)
- Caihong Wang
- Nursing Department, Hexi University Affiliated Zhangye People’s Hospital, Zhangye, Gansu, China
| | - Yumei Niu
- Nursing Department, Hexi University Affiliated Zhangye People’s Hospital, Zhangye, Gansu, China
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16
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Zidan M, Hassan E, Refaie M. A Successful Central Gastrectomy and Gastro-Gastric Anastomosis for a Large Gastric GIST. J Gastrointest Cancer 2024; 55:202-206. [PMID: 38008873 DOI: 10.1007/s12029-023-00992-7] [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] [Accepted: 11/19/2023] [Indexed: 11/28/2023]
Abstract
PURPOSE Partial gastrectomy is always the preferred technique for GIST resection. Central gastrectomy is a practical technique that can be employed in many situations during the resection of both subepithelial stromal tumors and gastric tumors. CASE PRESENTATION A 53-year-old Egyptian female patient with a 15 × 19 cm large fungating gastric GIST managed by central gastrectomy. Central gastrectomy and gastro-gastric anastomosis were performed with negative resection margins, and the patient received post-operative imatinib, achieving disease control throughout an 8-month post-operative follow-up. CONCLUSION Central gastrectomy is an effective method of partial gastrectomy that can be considered in GIST resection; however, more studies are needed to evaluate the efficiency of central gastrectomy in terms of long-term follow-up and terms of R0 respectability in gastric cancer.
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Affiliation(s)
- Mohamed Zidan
- Department of Surgery, Alexandria University Hospital, Alexandria, 21568, Egypt.
- Alexandria Endoscopy Association, Alexandria, Egypt.
| | - Eslam Hassan
- Department of Surgery, Borg El Arab General Hospital, Alexandria, Egypt
| | - Mostafa Refaie
- Department of Surgery, Alexandria University Hospital, Alexandria, 21568, Egypt
- Faculty of Medicine, Alexandria University, Alexandria, 21568, Egypt
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17
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Wang J, Shao M, Hu H, Xiao W, Cheng G, Yang G, Ji H, Yu S, Wan J, Xie Z, Xu M. Convolutional neural network applied to preoperative venous-phase CT images predicts risk category in patients with gastric gastrointestinal stromal tumors. BMC Cancer 2024; 24:280. [PMID: 38429653 PMCID: PMC10908217 DOI: 10.1186/s12885-024-11962-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 02/05/2024] [Indexed: 03/03/2024] Open
Abstract
OBJECTIVE The risk category of gastric gastrointestinal stromal tumors (GISTs) are closely related to the surgical method, the scope of resection, and the need for preoperative chemotherapy. We aimed to develop and validate convolutional neural network (CNN) models based on preoperative venous-phase CT images to predict the risk category of gastric GISTs. METHOD A total of 425 patients pathologically diagnosed with gastric GISTs at the authors' medical centers between January 2012 and July 2021 were split into a training set (154, 84, and 59 with very low/low, intermediate, and high-risk, respectively) and a validation set (67, 35, and 26, respectively). Three CNN models were constructed by obtaining the upper and lower 1, 4, and 7 layers of the maximum tumour mask slice based on venous-phase CT Images and models of CNN_layer3, CNN_layer9, and CNN_layer15 established, respectively. The area under the receiver operating characteristics curve (AUROC) and the Obuchowski index were calculated to compare the diagnostic performance of the CNN models. RESULTS In the validation set, CNN_layer3, CNN_layer9, and CNN_layer15 had AUROCs of 0.89, 0.90, and 0.90, respectively, for low-risk gastric GISTs; 0.82, 0.83, and 0.83 for intermediate-risk gastric GISTs; and 0.86, 0.86, and 0.85 for high-risk gastric GISTs. In the validation dataset, CNN_layer3 (Obuchowski index, 0.871) provided similar performance than CNN_layer9 and CNN_layer15 (Obuchowski index, 0.875 and 0.873, respectively) in prediction of the gastric GIST risk category (All P >.05). CONCLUSIONS The CNN based on preoperative venous-phase CT images showed good performance for predicting the risk category of gastric GISTs.
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Affiliation(s)
- Jian Wang
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
- Department of radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, Zhejiang, China
| | - Meihua Shao
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Hongjie Hu
- Department of Radiology, The Sir Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Wenbo Xiao
- Department of radiology,The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | | | - Guangzhao Yang
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Hongli Ji
- Jianpei Technology, Hangzhou, Zhejiang, China
| | - Susu Yu
- Department of radiology,The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jie Wan
- Jianpei Technology, Hangzhou, Zhejiang, China
| | - Zongyu Xie
- Department of Radiology, The First Affliated Hospital of Bengbu Medical University, Bengbu, Anhui, China
| | - Maosheng Xu
- Department of radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, Zhejiang, China.
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18
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Liu L, Zhang R, Qiao Z, Ye Y, Xia K, Feng Y, Xu X. Prognostic factors for liver metastasis in patients with small intestinal stromal tumor: A retrospective analysis of surveillance, epidemiology, and end results. World J Surg 2024; 48:598-609. [PMID: 38501551 DOI: 10.1002/wjs.12073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/19/2023] [Accepted: 12/27/2023] [Indexed: 03/20/2024]
Abstract
BACKGROUND Liver metastasis (LIM) is the most common distant site of metastasis in small intestinal stromal tumors (SISTs). The aim of this study was to determine the risk and prognostic factors associated with LIM in patients with SISTs. METHODS Patients diagnosed with gastrointestinal stromal tumors between 2010 and 2019 were selected from the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariate logistic regression models, as well as a Cox regression model were used to explore the risk factors associated with the development and prognosis of LIM. Additionally, the overall survival (OS) of patients with LIM was analyzed using the Kaplan-Meier method. Furthermore, a predictive nomogram was constructed, and the model's performance was evaluated using receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA). RESULTS A total of 1582 eligible patients with SISTs were included, among whom 146 (9.2%) were diagnosed with LIM. Poor tumor grade, absence of surgery, later T-stage, and no chemotherapy were associated with an increased risk of developing LIM. The nomogram prediction model achieved an AUC of 0.810, 95% Confidence Interval (CI) 0.773-0.846, indicating good performance, and the calibration curve showed excellent accuracy in predicting LIM. The OS rate of patients with LIM was significantly lower than that of patients without LIM (p < 0.001). CONCLUSIONS Patients with SISTs who are at high risk of developing LIM deserve more attention during follow-up, as LIM can significantly affect patient prognosis. The nomogram demonstrated good calibration and discrimination for predicting LIM.
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Affiliation(s)
- Luojie Liu
- Department of Gastroenterology, Changshu Hospital Affiliated to Soochow University, Suzhou, China
| | - Rufa Zhang
- Department of Gastroenterology, Changshu Hospital Affiliated to Soochow University, Suzhou, China
| | - Zhenguo Qiao
- Department of Gastroenterology, Suzhou Ninth People's Hospital, Suzhou, China
| | - Ye Ye
- Department of Gastroenterology, Changshu Hospital Affiliated to Soochow University, Suzhou, China
| | - Kaijian Xia
- Department of Scientific Research, Changshu Hospital Affiliated to Soochow University, Suzhou, China
| | - Yunfu Feng
- Department of Endoscopy Center, The First People's Hospital of Kunshan, Suzhou, China
| | - Xiaodan Xu
- Department of Gastroenterology, Changshu Hospital Affiliated to Soochow University, Suzhou, China
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19
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He Z, Du C, Cheng B, Feng J, Wang N, Ma Y, Li L, Zhang B, Wang H, Tang P, Chai N, Linghu E. Endoscopic resection for the treatment of gastric gastrointestinal stromal tumors: a retrospective study from a large tertiary hospital in China. Surg Endosc 2024; 38:1398-1405. [PMID: 38148402 DOI: 10.1007/s00464-023-10619-4] [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: 10/15/2023] [Accepted: 11/28/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND AND AIMS With the continuous development of endoscopic technology, endoscopic resection (ER) has gradually become an optional method for the treatment of gastric gastrointestinal stromal tumors (GISTs). However, studies with a large sample or a long follow-up are lacking. Therefore, this research aims to evaluate the efficacy and safety of ER for gastric GISTs in the real-world setting with more than 300 enrolled patients and a follow-up period longer than 45 months. METHODS From January 2013 to February 2023, 409 patients with a pathological diagnosis of GISTs after ER were retrospectively enrolled in this study. After excluding 86 patients with non-gastric GISTs, we assessed 323 patients with gastric GISTs. The main outcome measures were en bloc resection, complete resection, residual disease, recurrence, and complications. RESULTS There were 194 (60.06%) females and 129 (39.94%) males, and the median age of the included patients was 58 years (51, 63). The median tumor size was 15.0 (10.0, 20.0) mm. According to the modified NIH criteria, 246 (75.85%) patients were classified as very low risk, 62 (19.20%) were classified as low risk, 12 (3.72%) were classified as moderate risk, and 3 (0.93%) were classified as high risk. A total of 287 (88.85%) patients achieved en bloc resection, and 287 (88.85%) also achieved complete resection. Only one patient showed residual and no recurrent lesions were noted during the follow-up. Regarding complications, three patients had complications, with a complication rate of 0.93%, and no severe complications requiring surgical intervention occurred. CONCLUSION ER is an appropriate alternative method for the treatment of gastric GISTs, with an en bloc resection rate of 88.85% and a complication rate of 0.93%. No recurrence was noted during follow-up, even for GISTs with piecemeal resection.
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Affiliation(s)
- Zhengting He
- Senior Department of Gastroenterology, The First Medical Center of PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
| | - Chen Du
- Senior Department of Gastroenterology, The First Medical Center of PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
| | - Bingqian Cheng
- Senior Department of Gastroenterology, The First Medical Center of PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
| | - Jiancong Feng
- Senior Department of Gastroenterology, The First Medical Center of PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
| | - Nanjun Wang
- Senior Department of Gastroenterology, The First Medical Center of PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
| | - Yan Ma
- Senior Department of Gastroenterology, The First Medical Center of PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
| | - Longsong Li
- Senior Department of Gastroenterology, The First Medical Center of PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
| | - Bo Zhang
- Senior Department of Gastroenterology, The First Medical Center of PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
| | - Hongbin Wang
- Senior Department of Gastroenterology, The First Medical Center of PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
| | - Ping Tang
- Senior Department of Gastroenterology, The First Medical Center of PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
| | - Ningli Chai
- Senior Department of Gastroenterology, The First Medical Center of PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China.
| | - Enqiang Linghu
- Senior Department of Gastroenterology, The First Medical Center of PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China.
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20
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Khouchoua S, Imrani K, Bourekba I, Guelzim Y, Moatassim Billah N, Nassar I. Chronic abdominal pain revealing a gastrointestinal stromal tumor. Radiol Case Rep 2024; 19:961-965. [PMID: 38204938 PMCID: PMC10776905 DOI: 10.1016/j.radcr.2023.11.053] [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: 10/09/2023] [Revised: 11/18/2023] [Accepted: 11/22/2023] [Indexed: 01/12/2024] Open
Abstract
Gastrointestinal stromal tumors (GIST) are mesenchymal neoplasms most frequently seen in the stomach and small intestine, arising in the muscularis propria of the intestinal wall. Given its nonspecific clinical presentation, it can represent a diagnostic challenge, especially in abdominopelvic locations. Lesion evaluation of abdominopelvic tumors can be difficult and lead to misinterpretation in assessing their origin. We report the case of an 84-year-old woman with a voluminous small bowel GIST mimicking a uterine neoplasm.
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Affiliation(s)
- Selma Khouchoua
- Central Radiology Department, Ibn Sina University Hospital Center, Mohamed V University, Ave Abderrahim Bouabid, 10000, Rabat, Morocco
| | - Kaoutar Imrani
- Central Radiology Department, Ibn Sina University Hospital Center, Mohamed V University, Ave Abderrahim Bouabid, 10000, Rabat, Morocco
| | - Iliass Bourekba
- Central Radiology Department, Ibn Sina University Hospital Center, Mohamed V University, Ave Abderrahim Bouabid, 10000, Rabat, Morocco
| | - Yousra Guelzim
- Central Radiology Department, Ibn Sina University Hospital Center, Mohamed V University, Ave Abderrahim Bouabid, 10000, Rabat, Morocco
| | - Nabil Moatassim Billah
- Central Radiology Department, Ibn Sina University Hospital Center, Mohamed V University, Ave Abderrahim Bouabid, 10000, Rabat, Morocco
| | - Ittimade Nassar
- Central Radiology Department, Ibn Sina University Hospital Center, Mohamed V University, Ave Abderrahim Bouabid, 10000, Rabat, Morocco
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21
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Lu HF, Li JJ, Zhu DB, Mao LQ, Xu LF, Yu J, Yao LH. Postoperative encapsulated hemoperitoneum in a patient with gastric stromal tumor treated by exposed endoscopic full-thickness resection: A case report. World J Gastrointest Surg 2024; 16:601-608. [PMID: 38463350 PMCID: PMC10921194 DOI: 10.4240/wjgs.v16.i2.601] [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: 10/03/2023] [Revised: 12/28/2023] [Accepted: 01/16/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Gastric stromal tumors, originating from mesenchymal tissues, are one of the most common tumors of the digestive tract. For stromal tumors originating from the muscularis propria, compared with conventional endoscopic submucosal dissection (ESD), endoscopic full-thickness resection (EFTR) can remove deep lesions and digestive tract wall tumors completely. However, this technique has major limitations such as perforation, postoperative bleeding, and post-polypectomy syndrome. Herein, we report a case of postoperative serous surface bleeding which formed an encapsulated hemoperitoneum in a patient with gastric stromal tumor that was treated with exposed EFTR. Feasible treatment options to address this complication are described. CASE SUMMARY A 47-year-old male patient had a hemispherical protrusion found during gastric endoscopic ultrasonography, located at the upper gastric curvature adjacent to the stomach fundus, with a smooth surface mucosa and poor mobility. The lesion was 19.3 mm × 16.1 mm in size and originated from the fourth ultrasound layer. Computed tomography (CT) revealed no significant evidence of lymph node enlargement or distant metastasis. Using conventional ESD technology for mucosal pre-resection, exposed EFTR was performed to resect the intact tumor in order to achieve a definitive histopathological diagnosis. Based on its morphology and immunohistochemical expression of CD117 and DOG-1, the lesion was proven to be consistent with a gastric stromal tumor. Six days after exposed EFTR, CT showed a large amount of encapsulated fluid and gas accumulation around the stomach. In addition, gastroscopy suggested intracavitary bleeding and abdominal puncture drainage indicated serosal bleeding. Based on these findings, the patient was diagnosed with serosal bleeding resulting in encapsulated abdominal hemorrhage after exposed EFTR for a gastric stromal tumor. The patient received combined treatments, such as hemostasis under gastroscopy, gastrointestinal decompression, and abdominal drainage. All examinations were normal within six months of follow-up. CONCLUSION This patient developed serous surface bleeding in the gastric cavity following exposed EFTR. Serosal bleeding resulting in an encapsulated hemoperitoneum is rare in clinical practice. The combined treatment may replace certain surgical techniques.
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Affiliation(s)
- Hui-Fei Lu
- Department of Gastroenterology, the First People’s Hospital of Huzhou, Huzhou 313000, Zhejiang Province, China
| | - Jing-Jing Li
- Department of Gastroenterology, the First People’s Hospital of Huzhou, Huzhou 313000, Zhejiang Province, China
| | - De-Bin Zhu
- Department of Gastroenterology, the First People’s Hospital of Huzhou, Huzhou 313000, Zhejiang Province, China
| | - Li-Qi Mao
- Department of Gastroenterology, the First People’s Hospital of Huzhou, Huzhou 313000, Zhejiang Province, China
| | - Li-Fen Xu
- Department of Gastroenterology, the First People’s Hospital of Huzhou, Huzhou 313000, Zhejiang Province, China
| | - Jing Yu
- Department of Gastroenterology, the First People’s Hospital of Huzhou, Huzhou 313000, Zhejiang Province, China
| | - Lin-Hua Yao
- Department of Gastroenterology, the First People’s Hospital of Huzhou, Huzhou 313000, Zhejiang Province, China
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22
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Le P, Monika F, Sabri A, Kovar J, Dietz N. Recurrent Gastrointestinal Stromal Tumor With Chondroid Differentiation After Imatinib Therapy: An Unusual Case and Literature Review. Cureus 2024; 16:e54842. [PMID: 38533168 PMCID: PMC10963660 DOI: 10.7759/cureus.54842] [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: 02/24/2024] [Indexed: 03/28/2024] Open
Abstract
Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor in the gastrointestinal tract and is most commonly seen in the stomach. The standard treatment for patients with advanced GISTs include both surgical resection and imatinib therapy. There have been cases that document the alterations of patients' GIST histomorphology both with primary GIST prior to imatinib therapy and with recurrent GIST after imatinib therapy. However, there has been no documented case of a patient who has recurrent GIST with chondroid differentiation at the primary site after imatinib therapy. In this article, we report an incidental finding of a 58-year-old patient who had two treatments of imatinib therapy prior to surgical resection of her recurrent GIST in her stomach. We also explore through a mini-literature review the various cases of GIST with chondroid differentiation that have been reported to compare the histomorphology, immunophenotype, and patient demographic of these cases. This article is significant for reporting a rare finding of GIST after imatinib therapy and highlights the various presentations that GIST could acquire after imatinib therapy that exclude another malignant process, such as chondrosarcoma.
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Affiliation(s)
- Patricia Le
- Pathology, Creighton University School of Medicine, Omaha, USA
| | - Fnu Monika
- Pathology, Creighton University School of Medicine, Omaha, USA
| | - Ahmed Sabri
- Pathology, Creighton University School of Medicine, Omaha, USA
| | - Joyce Kovar
- Pathology, Creighton University School of Medicine, Omaha, USA
| | - Nicholas Dietz
- Pathology, Creighton University School of Medicine, Omaha, USA
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23
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Wu J, Wang C, Cui X, Liu L, Wang L, Wang J, Xue X, Dang T. MicroRNA-128 acts as a suppressor in the progression of gastrointestinal stromal tumor by targeting B-lymphoma Mo-MLV insertion region 1. Clin Transl Oncol 2024; 26:363-374. [PMID: 38103120 DOI: 10.1007/s12094-023-03354-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 01/11/2023] [Indexed: 12/17/2023]
Abstract
INTRODUCTION The critical role of microRNA-128 (miR-128) in gastrointestinal-related diseases has been documented. In the current study, we tried to clarify the specific role miR-128 in gastrointestinal stromal tumor (GIST) and the underlying mechanism. METHODS Differentially expressed genes in GIST were identified following bioinformatics analysis. Then, expression patterns of miR-128 and B-lymphoma Mo-MLV insertion region 1 (BMI-1) in clinical tissue samples and cell lines were characterized, followed by validation of their correlation. GIST-T1 cells were selected and transfected with different mimic, inhibitor, or siRNA plasmids, after which the biological functions were assayed. RESULTS We identified low miR-128 and high BMI-1 expression in GIST tissues of 78 patients and 4 GIST cell lines. Ectopic expression of miR-128 or silencing of BMI-1 suppressed the malignant potentials of GIST-T1 cells. As a target of miR-128, BMI-1 re-expression could partly counteract the suppressive effect of miR-128 on the malignancy of GIST-T1 cells. CONCLUSION Our study provided evidence that miR-128-mediated silencing of BMI-1 could prevent malignant progression of GIST, highlighting a promising anti-tumor target for combating GIST.
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Affiliation(s)
- Jinbao Wu
- Inner Mongolia Institute of Digestive Diseases, The Second Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, No. 30, Hudemulin Street, Qingshan District, Baotou, 014030, Inner Mongolia Autonomous Region, People's Republic of China
| | - Changjuan Wang
- Inner Mongolia Institute of Digestive Diseases, The Second Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, No. 30, Hudemulin Street, Qingshan District, Baotou, 014030, Inner Mongolia Autonomous Region, People's Republic of China
| | - Xia Cui
- Inner Mongolia Institute of Digestive Diseases, The Second Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, No. 30, Hudemulin Street, Qingshan District, Baotou, 014030, Inner Mongolia Autonomous Region, People's Republic of China
| | - Lin Liu
- Inner Mongolia Institute of Digestive Diseases, The Second Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, No. 30, Hudemulin Street, Qingshan District, Baotou, 014030, Inner Mongolia Autonomous Region, People's Republic of China
| | - Lu Wang
- Inner Mongolia Institute of Digestive Diseases, The Second Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, No. 30, Hudemulin Street, Qingshan District, Baotou, 014030, Inner Mongolia Autonomous Region, People's Republic of China
| | - Jing Wang
- Inner Mongolia Institute of Digestive Diseases, The Second Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, No. 30, Hudemulin Street, Qingshan District, Baotou, 014030, Inner Mongolia Autonomous Region, People's Republic of China
| | - Xiaohui Xue
- Inner Mongolia Institute of Digestive Diseases, The Second Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, No. 30, Hudemulin Street, Qingshan District, Baotou, 014030, Inner Mongolia Autonomous Region, People's Republic of China
| | - Tong Dang
- Inner Mongolia Institute of Digestive Diseases, The Second Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology, No. 30, Hudemulin Street, Qingshan District, Baotou, 014030, Inner Mongolia Autonomous Region, People's Republic of China.
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24
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Yoshinaga S. Endoscopic ultrasound-based application for determining the management of subepithelial lesions: Do androids dream of endoscopic ultrasound? Dig Endosc 2024; 36:152-153. [PMID: 37469303 DOI: 10.1111/den.14629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 06/30/2023] [Indexed: 07/21/2023]
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25
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Hashemi M, Nazdari N, Gholamiyan G, Paskeh MDA, Jafari AM, Nemati F, Khodaei E, Abyari G, Behdadfar N, Raei B, Raesi R, Nabavi N, Hu P, Rashidi M, Taheriazam A, Entezari M. EZH2 as a potential therapeutic target for gastrointestinal cancers. Pathol Res Pract 2024; 253:154988. [PMID: 38118215 DOI: 10.1016/j.prp.2023.154988] [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: 08/15/2023] [Revised: 11/18/2023] [Accepted: 11/27/2023] [Indexed: 12/22/2023]
Abstract
Gastrointestinal (GI) cancers continue to be a major cause of mortality and morbidity globally. Understanding the molecular pathways associated with cancer progression and severity is essential for creating effective cancer treatments. In cancer research, there is a notable emphasis on Enhancer of zeste homolog 2 (EZH2), a key player in gene expression influenced by its irregular expression and capacity to attach to promoters and alter methylation status. This review explores the impact of EZH2 signaling on various GI cancers, such as colorectal, gastric, pancreatic, hepatocellular, esophageal, and cholangiocarcinoma. The primary function of EZH2 signaling is to facilitate the accelerated progression of cancer cells. Additionally, EZH2 has the capacity to modulate the reaction of GI cancers to chemotherapy and radiotherapy. Numerous pathways, including long non-coding RNAs and microRNAs, serve as upstream regulators of EZH2 in these types of cancer. EZH2's enzymatic activity enables it to attach to target gene promoters, resulting in methylation that modifies their expression. EZH2 could be considered as an independent prognostic factor, with increased expression correlating with a worse disease prognosis. Additionally, a range of gene therapies including small interfering RNA, and anti-tumor agents are being explored to target EZH2 for cancer treatment. This comprehensive review underscores the current insights into EZH2 signaling in gastrointestinal cancers and examines the prospect of therapies targeting EZH2 to enhance patient outcomes.
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Affiliation(s)
- Mehrdad Hashemi
- Department of Genetics, Faculty of Advanced Science and Technology, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran; Farhikhtegan Medical Convergence sciences Research Center, Farhikhtegan Hospital Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Naghmeh Nazdari
- Farhikhtegan Medical Convergence sciences Research Center, Farhikhtegan Hospital Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Ghazaleh Gholamiyan
- Farhikhtegan Medical Convergence sciences Research Center, Farhikhtegan Hospital Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Mahshid Deldar Abad Paskeh
- Department of Genetics, Faculty of Advanced Science and Technology, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran; Farhikhtegan Medical Convergence sciences Research Center, Farhikhtegan Hospital Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Ali Moghadas Jafari
- Farhikhtegan Medical Convergence sciences Research Center, Farhikhtegan Hospital Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Fateme Nemati
- Farhikhtegan Medical Convergence sciences Research Center, Farhikhtegan Hospital Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Elaheh Khodaei
- Department of Dermatology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ghazal Abyari
- Farhikhtegan Medical Convergence sciences Research Center, Farhikhtegan Hospital Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Nazanin Behdadfar
- Young Researchers and Elite Club, Buinzahra Branch, Islamic Azad University, Buinzahra, Iran
| | - Behnaz Raei
- Farhikhtegan Medical Convergence sciences Research Center, Farhikhtegan Hospital Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Rasoul Raesi
- Department of Health Services Management, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Medical-Surgical Nursing, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Noushin Nabavi
- Department of Urologic Sciences and Vancouver Prostate Centre, University of British Columbia, V6H3Z6 Vancouver, BC, Canada
| | - Peng Hu
- Department of Emergency, Shanghai Tenth People's Hospital, Tongji University, Shanghai 200072, China
| | - Mohsen Rashidi
- Department Pharmacology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran; The Health of Plant and Livestock Products Research Center, Mazandaran University of Medical Sciences, Sari, Iran.
| | - Afshin Taheriazam
- Farhikhtegan Medical Convergence sciences Research Center, Farhikhtegan Hospital Tehran Medical Sciences, Islamic Azad University, Tehran, Iran; Department of Orthopedics, Faculty of medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran.
| | - Maliheh Entezari
- Department of Genetics, Faculty of Advanced Science and Technology, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran; Farhikhtegan Medical Convergence sciences Research Center, Farhikhtegan Hospital Tehran Medical Sciences, Islamic Azad University, Tehran, Iran.
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26
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Schroder PM, Biesterveld BE, Al-Adra DP. Premalignant Lesions in the Kidney Transplant Candidate. Semin Nephrol 2024; 44:151495. [PMID: 38490902 DOI: 10.1016/j.semnephrol.2024.151495] [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: 03/17/2024]
Abstract
End-stage kidney disease patients who are referred for transplant undergo an extensive evaluation process to ensure their health prior to transplant due in part to the shortage of available organs. Although management and surveillance guidelines exist for malignancies identified in the transplant and waitlist populations, less is written about the management of premalignant lesions in this population. This review covers the less common premalignant lesions (intraductal papillary mucinous neoplasm, gastrointestinal stromal tumor, thymoma, and pancreatic neuroendocrine tumor) that can be found in the transplant candidate population. High-level evidence for the management of these rarer premalignant lesions in the transplant population is lacking, and this review extrapolates evidence from the general population and should not be a substitute for a multidisciplinary discussion with medical and surgical oncologists.
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Affiliation(s)
- Paul M Schroder
- Department of Surgery, Division of Transplantation, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Ben E Biesterveld
- Department of Surgery, Division of Transplantation, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - David P Al-Adra
- Department of Surgery, Division of Transplantation, University of Wisconsin School of Medicine and Public Health, Madison, WI.
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27
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Xu EP, Qi ZP, Li B, Ren Z, Cai MY, Cai SL, Lyv ZT, Chen ZH, Liu JY, Shi Q, Zhong YS. The efficacy of full-thickness endoscopic resection of subepithelial tumors in the gastric cardia. World J Gastrointest Oncol 2023; 15:2111-2119. [PMID: 38173428 PMCID: PMC10758656 DOI: 10.4251/wjgo.v15.i12.2111] [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: 09/10/2023] [Revised: 10/18/2023] [Accepted: 10/30/2023] [Indexed: 12/14/2023] Open
Abstract
BACKGROUND Gastric subepithelial tumors (SETs) may harbor potential malignancy. Although it is well recognized that large SETs should be resected, the precise treatment strategy remains controversial. Compared to surgical resection, endoscopic resection (ER) has many advantages; however, ER of SETs in the cardia is challenging. AIM To evaluate the safety and efficacy of endoscopic full-thickness resection (EFTR) for the treatment of gastric cardia SETs. METHODS We retrospectively reviewed data from all patients with SETs originating from the muscularis propria layer in the gastric cardia that were treated by EFTR or submucosal tunneling ER (STER) at Zhongshan Hospital Fudan University between November 2014 and May 2022. Baseline characteristics and clinical outcomes, including procedure times and complications rates, were compared between groups of patients receiving EFTR and STER. RESULTS A total of 171 tumors were successfully removed [71 (41.5%) tumors in the EFTR and 100 (58.5%) tumors in the STER group]. Gastrointestinal stromal tumors (GISTs) were the most common SET. The en bloc resection rate was 100% in the EFTR group vs 97.0% in STER group (P > 0.05). Overall, the EFTR group had a higher complete resection rate than the STER group (98.6% vs 91.0%, P < 0.05). The procedure time was also shorter in the EFTR group (44.63 ± 28.66 min vs 53.36 ± 27.34, P < 0.05). The most common major complication in both groups was electrocoagulation syndrome. There was no significant difference in total complications between the two groups (21.1% vs 22.0%, P = 0.89). CONCLUSION EFTR of gastric cardia SETs is a very promising method to facilitate complete resection with similar complications and reduced operative times compared to STER. In cases of suspected GISTs or an unclear diagnosis, EFTR should be recommended to ensure complete resection.
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Affiliation(s)
- En-Pan Xu
- Endoscopy Center, Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - Zhi-Peng Qi
- Endoscopy Center, Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - Bing Li
- Endoscopy Center, Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - Zhong Ren
- Endoscopy Center, Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - Ming-Yan Cai
- Endoscopy Center, Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - Shi-Lun Cai
- Endoscopy Center, Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - Zhen-Tao Lyv
- Endoscopy Center, Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - Zhang-Han Chen
- Endoscopy Center, Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - Jing-Yi Liu
- Endoscopy Center, Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - Qiang Shi
- Endoscopy Center, Zhongshan Hospital Fudan University, Shanghai 200032, China
| | - Yun-Shi Zhong
- Endoscopy Center, Zhongshan Hospital Fudan University, Shanghai 200032, China
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28
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Xuefen Z, Yuanyuan B, Qin L, Xiaoyang W. Nutritional care in patients undergoing laparoscopic/minimally invasive surgeries for gastrointestinal tumours. Wideochir Inne Tech Maloinwazyjne 2023; 18:625-638. [PMID: 38239578 PMCID: PMC10793145 DOI: 10.5114/wiitm.2023.130468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 07/24/2023] [Indexed: 01/22/2024] Open
Abstract
The introduction of minimally invasive surgeries for gastrointestinal tumours has been associated with many favourable postoperative outcomes and a reduced impact on nutritional status. The literature review begins by discussing the impact of minimally invasive procedures on the nutritional status of patients with gastrointestinal tumours, followed by indications for enteral nutrition (EN) in this population, including preoperative nutritional support and postoperative nutritional support. The review then examines the evidence that favours the use of EN in this population, including studies demonstrating improved outcomes with preoperative EN and reduced postoperative complications with postoperative EN. It also discusses potential strategies for improving outcomes with EN, such as early initiation of feeding and individualized nutrition plans. Overall, current evidence shows that EN improves outcomes, reduces complications, and enhances the quality of life. However, the optimal timing, composition of EN, and long-term outcomes are still unclear, indicating the need for future investigations.
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Affiliation(s)
- Zhou Xuefen
- Department of Gastrointestinal Surgery, Affiliated Kunshan Hospital to Jiangsu University, Suzhou Jiangsu, China
| | - Bian Yuanyuan
- Department of Gastrointestinal Surgery, Affiliated Kunshan Hospital to Jiangsu University, Suzhou Jiangsu, China
| | - Li Qin
- Department of Gastrointestinal Surgery, Affiliated Kunshan Hospital to Jiangsu University, Suzhou Jiangsu, China
| | - Wu Xiaoyang
- Department of Gastrointestinal Surgery, Affiliated Kunshan Hospital to Jiangsu University, Suzhou Jiangsu, China
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Tsurumaru D, Nishimuta Y, Kai S, Oki E, Minoda Y, Ishigami K. Clinical significance of dual-energy dual-layer CT parameters in differentiating small-sized gastrointestinal stromal tumors from leiomyomas. Jpn J Radiol 2023; 41:1389-1396. [PMID: 37464171 PMCID: PMC10687125 DOI: 10.1007/s11604-023-01473-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/12/2023] [Indexed: 07/20/2023]
Abstract
PURPOSE Small gastrointestinal stromal tumors (GISTs) can generally have nonspecific CT findings similar to those with benign submucosal tumors of the stomach. The purpose of this study was to explore the potential dual-layer dual-energy CT (dlDECT) parameters to differentiate small-sized (≤ 4 cm) GISTs from leiomyomas of the stomach. MATERIALS AND METHODS This retrospective study included 26 SMTs ≤ 4 cm in diameter with pathological confirmation of either GIST (n = 17) or leiomyoma (n = 9) from May 2018 to January 2022. All patients received contrast-enhanced CT. The normalized iodine concentration (NIC) and spectral slope (λHU) were compared between GIST and leiomyoma. Receiver-operating characteristic (ROC) curves were plotted and the areas under the curve (AUCs) were calculated to estimate the diagnostic performance of these markers for differentiating GISTs from leiomyomas. RESULTS NIC was significantly higher in GIST than in leiomyoma in the portal (P = 0.0019) and delayed phases (P = 0.0011). λHU was significantly higher in GIST than in leiomyoma in the portal (P = 0.0006) and delayed phases (P = 0.0009). AUC of the ROC curves using NIC to differentiate between GIST and leiomyoma were 0.875 and 0.895 in the portal and delayed phase; using λHU, they were 0.918 and 0.902 in the portal and delayed phase. CONCLUSION dlDECT parameters including NIC and λHU show promise as indicators for differentiating small-sized GISTs from leiomyomas.
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Affiliation(s)
- Daisuke Tsurumaru
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, Japan.
| | - Yusuke Nishimuta
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, Japan
| | - Satohiro Kai
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, Japan
| | - Eiji Oki
- Department of Surgery and Sciences, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, Japan
| | - Yosuke Minoda
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, Japan
| | - Kousei Ishigami
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, Japan
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30
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Nakamura N, Suzuki R, Takahashi Y, Uwamori A, Masuda M, Fukui T, Noda Y, Tsuta K, Naganuma M. Primary Gastric Rhabdomyosarcoma. Intern Med 2023; 62:3483-3488. [PMID: 37081684 PMCID: PMC10749818 DOI: 10.2169/internalmedicine.1645-23] [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: 01/18/2023] [Accepted: 03/09/2023] [Indexed: 04/22/2023] Open
Abstract
Primary gastric rhabdomyosarcoma is extremely rare. An 87-year-old man visited our clinic with a chief complaint of abdominal pain. Computed tomography (CT) and 18F-fluorodeoxyglucose positron emission tomography-CT revealed a massive tumor originating from the muscularis propria of the stomach along with splenic vein tumor thrombosis. We diagnosed the patient with primary gastric rhabdomyosarcoma by an endoscopic ultrasound-guided fine-needle aspiration/biopsy.
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Affiliation(s)
- Naohiro Nakamura
- Department of Gastroenterology, Kansai Medical University, Japan
| | - Ryo Suzuki
- Department of Gastroenterology, Kansai Medical University, Japan
| | - Yu Takahashi
- Department of Gastroenterology, Kansai Medical University, Japan
| | - Atsushi Uwamori
- Department of Gastroenterology, Kansai Medical University, Japan
| | - Masataka Masuda
- Department of Gastroenterology, Kansai Medical University, Japan
| | - Toshiro Fukui
- Department of Gastroenterology, Kansai Medical University, Japan
| | - Yuri Noda
- Department of Pathology, Kansai Medical University, Japan
| | - Koji Tsuta
- Department of Pathology, Kansai Medical University, Japan
| | - Makoto Naganuma
- Department of Gastroenterology, Kansai Medical University, Japan
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31
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Hori M, Maki K, Okuno Y, Mikami K, Takeuchi T. A radiation-related second primary gastrointestinal stromal tumor in the bladder. Curr Urol 2023; 17:268-270. [PMID: 37994336 PMCID: PMC10662837 DOI: 10.1097/cu9.0000000000000186] [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: 04/21/2022] [Accepted: 08/09/2022] [Indexed: 03/06/2023] Open
Abstract
A 69-year-old man underwent 78 Gy/39 Fr of intensity-modulated radiation therapy for prostate cancer. Seven years after radiotherapy, a nonpapillary bladder tumor was identified. Transurethral resection of the bladder tumor was performed, and the pathological diagnosis was spindle cell sarcoma. Immunostaining revealed KIT-, DOG1++, CD34-, Actin++, Cytokeratin-, Desmin-, S100 protein-, and Vimentin++. No tumor recurrence was observed until 17 months after tumor resection. DOG1 is strongly and specifically expressed in gastrointestinal stromal tumors. This was a rare case of bladder gastrointestinal stromal tumor as a radiation-related second primary tumor.
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Affiliation(s)
| | | | | | | | - Takumi Takeuchi
- Department of Urology, Japan Organization of Occupational Health and Safety, Kanto Rosai Hospital, Kawasaki, Japan
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32
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Liu L, Xu X, You W, Shi D, Li R, Ma C. Learning curve for endoscopic resection of gastric gastrointestinal stromal tumors: a single-center experience. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2023; 115:601-607. [PMID: 37170590 DOI: 10.17235/reed.2023.9441/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND endoscopic resection (ER) is widely used in the treatment of gastric gastrointestinal stromal tumors (gGISTs). However, no studies have previously described the learning curve (LC) for ER of gGISTs. This study aimed to evaluate the LC based on multifarious operative outcomes. METHODS one hundred consecutive patients who underwent ER of gGISTs by a single endoscopist from January 2017 to December 2022 were included. Patients were analyzed in groups of ten to minimize demographic differences, and operative time (OT), conversion rate, intraoperative and postoperative complication were assessed to evaluate the LC. Meanwhile, for the OT, the LC was further analyzed using the cumulative sum (CUSUM) method and patients were organized chronologically in three phases. RESULT there was a statistically significant decrease in OT, conversion to laparoscopic surgery, and postoperative complication after 30 cases (median 80.0 min vs 56.0 min, p < 0.001; 10.0 % vs 0 %, p = 0.025; 33.3 % vs 10.0 %, p = 0.004), rate of intraoperative complications after 20 cases (15.0 % vs 1.3 %, p = 0.025). CUSUM chart demonstrated that OT increased dramatically before around 30 cases (phase 1) and decreased after 60 cases (phase 3), with a plateau phase in the middle 30 cases (phase 2). Among the three phases, the R0 resection and conversion rate were not significantly different. However, OT, intraoperative and postoperative complications were gradually decreased (p < 0.05). CONCLUSIONS the LC of ER of gGISTs is approximately 60 cases. However, about 30 cases were sufficient to acquire skills to reduce complications and conversion rate during the ER procedure.
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Affiliation(s)
- Luojie Liu
- Gastroenterology, The First Affiliated Hospital of Soochow University, China
| | - Xiaodan Xu
- Gastroenterology, Changshu Hospital Affiliated to Soochow University
| | - Wendao You
- Gastroenterology, The First Affiliated Hospital of Soochow University
| | - Dongtao Shi
- Gastroenterology, The First Affiliated Hospital of Soochow University
| | - Rui Li
- Gastroenterology, The First Affiliated Hospital of Soochow University
| | - Chao Ma
- Gastroenterology, The First Affiliated Hospital of Soochow University
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Akahoshi K, Akahoshi K, Shiratsuchi Y, Tamura S, Uemura K, Sashihara R, Ohishi Y, Inoue K, Koga T, Koga H. Endoscopic Ultrasonography-Guided Fine-Needle Aspiration for Duodenal Subepithelial Lesions Showing a Hypoechoic Mass on Endoscopic Ultrasound Imaging. THE TURKISH JOURNAL OF GASTROENTEROLOGY : THE OFFICIAL JOURNAL OF TURKISH SOCIETY OF GASTROENTEROLOGY 2023; 34:1156-1162. [PMID: 37681269 PMCID: PMC10724752 DOI: 10.5152/tjg.2023.22696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/16/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND/AIMS For duodenal subepithelial lesions showing a hypoechoic mass on endoscopic ultrasound imaging, the utility of endoscopic ultrasound-guided fine-needle aspiration and the frequency of histological types have not been the focus of previous literature. This study aimed to clarify this. MATERIALS AND METHODS This prospective observational study enrolled 22 consecutive patients who underwent endoscopic ultrasoundguided fine-needle aspiration for duodenal subepithelial lesions with hypoechoic mass on endoscopic ultrasound. Immunohistochemical analysis was performed for all endoscopic ultrasound-guided fine-needle aspiration and surgically resected specimens. The main outcome measures were the technical results of endoscopic ultrasound-guided fine-needle aspiration and the frequency of histological types of duodenal subepithelial lesions with hypoechoic mass. RESULTS Thirteen fine-needle aspiration specimens were obtained from the duodenal bulb and eight from the descending duodenal region. The puncture was not performed because of intervening vessels in one patient. The diagnostic rate was 81% (95% confidence interval: 58.1-94.6, 17/21 patients). In 12 patients receiving surgical resection (excluding one cancellation of endoscopic ultrasoundguided fine-needle aspiration), the diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration was 75% (95% confidence interval: 42.8-94.5, 9/12 patients). No complications were observed. The histopathological diagnoses included 11 cases of gastrointestinal stromal tumor (50%), 2 cases of leiomyoma (9%), 2 cases of metastatic cancer (9%), 2 cases of benign inconclusive, and 1 case each of carcinoid, malignant lymphoma, leiomyosarcoma, gauzeoma, and aberrant pancreas (4.5% each). The frequency of malignant tumors in the duodenal subepithelial lesions with hypoechoic mass group was 73% (16/22 patients). CONCLUSIONS Endoscopic ultrasound-guided fine-needle aspiration for duodenal subepithelial lesions with hypoechoic mass was safe and accurate. As duodenal subepithelial lesion with hypoechoic mass has a reasonably high possibility of containing malignant tumors, it is desirable to perform endoscopic ultrasound-guided fine-needle aspiration.
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Affiliation(s)
| | - Kazuya Akahoshi
- Endoscopy Center, Aso Iizuka Hospital, Iizuka, Japan
- Department of Medical Research Promotion, Aso Iizuka Hospital, Iizuka, Japan
| | | | | | - Kento Uemura
- Endoscopy Center, Aso Iizuka Hospital, Iizuka, Japan
| | | | | | - Kanako Inoue
- Division of Central Laboratory, Aso Iizuka Hospital, Iizuka, Japan
| | - Tadashi Koga
- Department of Surgery, Aso Iizuka Hospital, Iizuka, Japan
| | - Hidenobu Koga
- Department of Medical Research Promotion, Aso Iizuka Hospital, Iizuka, Japan
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Sacerdoţianu VM, Mirea CS, Popa P, Gheonea DI, Foarfă MC, Matei M, Săndulescu DL, Lungulescu CV, Ciurea T, Ungureanu BS. Giant exophytic gastrointestinal stromal tumor (GIST) causing gastric outlet obstruction: case report and review of literature. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY = REVUE ROUMAINE DE MORPHOLOGIE ET EMBRYOLOGIE 2023; 64:595-601. [PMID: 38184841 PMCID: PMC10863695 DOI: 10.47162/rjme.64.4.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/08/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Gastrointestinal stromal tumors (GISTs) are rare mesenchymal tumors, mostly located within the stomach. About 30% of GISTs are incidentally diagnosed and as they become symptomatic may be associated with bleeding, bowel obstruction or spontaneous rupture. CASE PRESENTATION We present the case of a middle-aged patient diagnosed with a giant gastric GIST, which presented for intermittent gastric outlet obstruction symptoms, and emphasize the major imagistic, histopathological, and therapeutic challenges that may be encountered. There are only several cases of gastric exophytic gastric GIST provoking intermittent gastric outlet obstruction. Tumor resection should be adapted to every patient's status, focused on en bloc extraction, with preservation of invaded organs as much as possible.
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Affiliation(s)
- Victor-Mihai Sacerdoţianu
- Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, Romania
| | - Cecil Sorin Mirea
- Department of Surgery, University of Medicine and Pharmacy of Craiova, Romania
| | - Petrică Popa
- Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, Romania
| | - Dan Ionuţ Gheonea
- Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, Romania
| | - Maria Camelia Foarfă
- Department of Pathology, University of Medicine and Pharmacy of Craiova, Romania
| | - Marius Matei
- Department of Histology, University of Medicine and Pharmacy of Craiova, Romania
| | - Daniela Larisa Săndulescu
- Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, Romania
| | | | - Tudorel Ciurea
- Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, Romania
| | - Bogdan Silviu Ungureanu
- Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, Romania
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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.
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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
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Nie WJ, Jing Z, Hua M. Value of enhanced computed tomography in differentiating small mesenchymal tumours of the gastrointestinal from smooth muscle tumours. World J Gastrointest Surg 2023; 15:2012-2020. [PMID: 37901731 PMCID: PMC10600775 DOI: 10.4240/wjgs.v15.i9.2012] [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: 06/30/2023] [Revised: 07/24/2023] [Accepted: 08/04/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Computed tomography (CT) technology has been gradually used in the differentiation of small mesenchymal tumors of the stomach and intestines from smooth muscle tumours. AIM To explore the value of enhanced CT in the differentiation of small mesenchymal tumors of the stomach and intestines from smooth muscle tumours. METHODS Clinical data of patients with gastric mesenchymal or gastric smooth muscle tumours who were treated in our hospital from May 2018 to April 2023 were retrospectively analysed. Patients were divided into the gastric mesenchymal tumor group and the gastric smooth muscle tumor group respectively (n = 50 cases per group). Clinical data of 50 healthy volunteers who received physical examinations in our hospital during the same period were selected and included in the control group. Serum levels of carcinoembryonic antigen (CEA), alpha-fetoprotein (AFP), carbohydrate antigen 19-9 (CA19-9), CA-125 and cytokeratin 19 fragment antigen 21-1 were compared among the three groups. The value of CEA and CA19-9 in the identification of gastric mesenchymal tumours was analysed using the receiver operating characteristic (ROC) curve. The Kappa statistic was used to analyse the consistency of the combined CEA and CA19-9 test in identifying gastric mesenchymal tumours. RESULTS CEA levels varied among the three groups in the following order: The gastric mesenchymal tumour group > the control group > the gastric smooth muscle tumour group. CA19-9 levels varied among the three groups in the following order: The gastric mesenchymal group > the gastric smooth muscle group > the control group, the difference was statistically significant (P < 0.05). ROC analysis showed that the area under the curve of CEA and CA19-9 was 0. 879 and 0. 782, respectively. CONCLUSION Enhanced CT has shown value in differentiating small mesenchymal tumors of the stomach and intestines from smooth muscle tumors.
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Affiliation(s)
- Wen-Jun Nie
- Department of Radiology, Changzhou Geriatric Hospital Affiliated to Soochow University, Changzhou No. 7 People’s Hospital Radiology Department, Changzhou 213011, Jiangsu Province, China
| | - Zhao Jing
- Medical Area, Eastern Theater General Hospital, Qinhuai District Medical Area, Nanjing 210000, Jiangsu Province, China
| | - Mo Hua
- Department of Radiology, Changzhou Geriatric Hospital Affiliated to Soochow University, Changzhou No. 7 People’s Hospital Radiology Department, Changzhou 213011, Jiangsu Province, China
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Feng N, Chen HY, Wang XJ, Lu YF, Zhou JP, Zhou QM, Wang XB, Yu JN, Yu RS, Xu JX. A CT-based nomogram established for differentiating gastrointestinal heterotopic pancreas from gastrointestinal stromal tumor: compared with a machine-learning model. BMC Med Imaging 2023; 23:131. [PMID: 37715139 PMCID: PMC10504714 DOI: 10.1186/s12880-023-01094-3] [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: 05/02/2023] [Accepted: 09/01/2023] [Indexed: 09/17/2023] Open
Abstract
OBJECTIVE To identify CT features and establish a nomogram, compared with a machine learning-based model for distinguishing gastrointestinal heterotopic pancreas (HP) from gastrointestinal stromal tumor (GIST). MATERIALS AND METHODS This retrospective study included 148 patients with pathologically confirmed HP (n = 48) and GIST (n = 100) in the stomach or small intestine that were less than 3 cm in size. Clinical information and CT characteristics were collected. A nomogram on account of lasso regression and multivariate logistic regression, and a RandomForest (RF) model based on significant variables in univariate analyses were established. Receiver operating characteristic (ROC) curve, mean area under the curve (AUC), calibration curve and decision curve analysis (DCA) were carried out to evaluate and compare the diagnostic ability of models. RESULTS The nomogram identified five CT features as independent predictors of HP diagnosis: age, location, LD/SD ratio, duct-like structure, and HU lesion/pancreas A. Five features were included in RF model and ranked according to their relevance to the differential diagnosis: LD/SD ratio, HU lesion/pancreas A, location, peritumoral hypodensity line and age. The nomogram and RF model yielded AUC of 0.951 (95% CI: 0.842-0.993) and 0.894 (95% CI: 0.766-0.966), respectively. The DeLong test found no statistically significant difference in diagnostic performance (p > 0.05), but DCA revealed that the nomogram surpassed the RF model in clinical usefulness. CONCLUSION Two diagnostic prediction models based on a nomogram as well as RF method were reliable and easy-to-use for distinguishing between HP and GIST, which might also assist treatment planning.
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Affiliation(s)
- Na Feng
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Jiefang Road 88#, 310009, Hangzhou, China
| | - Hai-Yan Chen
- Department of Radiology, Zhejiang Cancer Hospital, Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, 310022, Hangzhou, Zhejiang, China
| | - Xiao-Jie Wang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Jiefang Road 88#, 310009, Hangzhou, China
| | - Yuan-Fei Lu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Jiefang Road 88#, 310009, Hangzhou, China
| | - Jia-Ping Zhou
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Jiefang Road 88#, 310009, Hangzhou, China
| | - Qiao-Mei Zhou
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Jiefang Road 88#, 310009, Hangzhou, China
| | - Xin-Bin Wang
- Department of Radiology, The First People's Hospital of Xiaoshan District, Hangzhou, China
| | - Jie-Ni Yu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Jiefang Road 88#, 310009, Hangzhou, China
| | - Ri-Sheng Yu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Jiefang Road 88#, 310009, Hangzhou, China.
| | - Jian-Xia Xu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang Chinese Medical University, Chaowang Road 318#, 310005, Hangzhou, China.
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Park EY, Baek DH, Hong SM, Lee BE, Lee MW, Kim GH, Song GA. Feasibility of endoscopic resection and impact of endoscopic ultrasound-based surveillance on colorectal subepithelial tumors. Surg Endosc 2023; 37:6867-6876. [PMID: 37311889 DOI: 10.1007/s00464-023-10195-7] [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: 02/12/2023] [Accepted: 06/02/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND Owing to the rising number of screening endoscopies and instrumental advances in endoscopic ultrasound (EUS), colorectal subepithelial tumors (SETs) are being increasingly detected. We aimed to determine the feasibility of endoscopic resection (ER) and the impact of EUS-based surveillance on colorectal SETs. METHODS The medical records of 984 patients with incidentally detected colorectal SETs between 2010 and 2019 were retrospectively reviewed. Overall, 577 colorectal SETs underwent ER, and 71 colorectal SETs underwent serial colonoscopy for > 12 months. RESULTS The mean tumor size (± standard deviation) of 577 colorectal SETs for which ER was performed was 7.0 ± 5.7 (median, 55; range, 1-50) mm; 475 tumors were located in the rectum and 102, in the colon. En bloc resection was achieved in 560/577 treated lesions (97.1%), and complete resection was achieved in 516/577 (89.4%). ER-related adverse events occurred in 15/577 (2.6%) patients. SETs originating from the muscularis propria showed a higher risk of ER-related adverse events and perforation than SETs arising from the mucosal or submucosal layer (odds ratio [OR] 19.786, 95% confidence interval [CI] 4.556-85.919; P = 0.002 and OR 141.250, 95% CI 11.596-1720.492; P = 0.046, respectively). Seventy-one patients were followed up after EUS without any treatment for > 12 months, during which three showed progression; eight, regression; and sixty, no changes. CONCLUSIONS ER for colorectal SETs showed excellent efficacy and safety. Additionally, colorectal SETs without high-risk features in surveillance with colonoscopy showed an excellent prognosis.
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Affiliation(s)
- Eun Young Park
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, 179, Gudeok-Ro, Seo-Gu, Busan, 49421, South Korea
- Department of Internal Medicine, Dong-Eui Medical Center, Busan, South Korea
| | - Dong Hoon Baek
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, 179, Gudeok-Ro, Seo-Gu, Busan, 49421, South Korea.
| | - Seung Min Hong
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, 179, Gudeok-Ro, Seo-Gu, Busan, 49421, South Korea
| | - Bong Eun Lee
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, 179, Gudeok-Ro, Seo-Gu, Busan, 49421, South Korea
| | - Moon Won Lee
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, 179, Gudeok-Ro, Seo-Gu, Busan, 49421, South Korea
| | - Gwang Ha Kim
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, 179, Gudeok-Ro, Seo-Gu, Busan, 49421, South Korea
| | - Geun Am Song
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, 179, Gudeok-Ro, Seo-Gu, Busan, 49421, South Korea
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Liu L, Ye Y, Wang Q, Feng Y, Shi D, Li R, Lu F, He B, Xu X. Risk factors for postoperative complications in endoscopic resection of gastric gastrointestinal stromal tumors: a multi-center analysis. Surg Endosc 2023; 37:6844-6851. [PMID: 37308766 DOI: 10.1007/s00464-023-10177-9] [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: 02/15/2023] [Accepted: 05/30/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Endoscopic resection (ER) is widely used in treating gastric gastrointestinal stromal tumors (gGISTs); however, complications occur frequently after resection. We aimed to determine factors associated with postoperative complications for ER of gGISTs. METHODS This was a retrospective, multi-center, observational study. Consecutive patients who underwent ER of gGISTs at five institutes from January 2013 to December 2022 were analyzed. The risk factors for delayed bleeding and postoperative infection were assessed. RESULTS A total of 513 cases were finally analyzed. Of 513 patients, 27 (5.3%) had delayed bleeding and 69 (13.4%) had a postoperative infection. Multivariate analysis indicated that risk factors for delayed bleeding were long operative time (OR = 50.655; 95% CI, 13.777-186.252; P < 0.001) and severe intraoperative bleeding (OR = 4.731, 95% CI, 1.139-19.658; P = 0.032), and risk factors for postoperative infection were long operative time (OR = 13.749, 95% CI, 6.884-27.461; P < 0.001) and perforation (OR = 4.339, 95% CI, 2.178-8.644; P < 0.001). CONCLUSIONS Our study indicated the risk factors for postoperative complications in ER of gGISTs. Long operation time is a common risk factor for delayed bleeding and postoperative infection. Patients with these risk factors should be given careful observation postoperatively.
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Affiliation(s)
- Luojie Liu
- Department of Gastroenterology, Changshu Hospital Affiliated to Soochow University, Suzhou, China
| | - Ye Ye
- Department of Gastroenterology, Changshu Hospital Affiliated to Soochow University, Suzhou, China
| | - Qinghua Wang
- Department of Gastroenterology, No.1 People's Hospital of Kunshan, Suzhou, China
| | - Yunfu Feng
- Department of Gastroenterology, No.1 People's Hospital of Kunshan, Suzhou, China
| | - Dongtao Shi
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Rui Li
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Fenying Lu
- Department of Gastroenterology, No.2 People's Hospital of Changshu, Suzhou, China
| | - Bin He
- Department of Gastroenterology, Zhangjiagang Hospital Affiliated to Soochow University, Suzhou, China
| | - Xiaodan Xu
- Department of Gastroenterology, Changshu Hospital Affiliated to Soochow University, Suzhou, China.
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Townsend H. Surgical Management of Gastrointestinal Stromal Tumors. J Adv Pract Oncol 2023; 14:541-547. [PMID: 37808075 PMCID: PMC10558015 DOI: 10.6004/jadpro.2023.14.6.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are considered rare, but they are one of the most common malignant mesenchymal tumors within the gastrointestinal tract, affecting 4,000 to 6,000 adults in the United States each year. Because gastrointestinal bleeding is often the initial symptom, a thorough and timely diagnostic workup is imperative to accurately diagnose a potentially deadly tumor. Endoscopic ultrasound is helpful when working through a differential diagnosis of subepithelial lesions and can help identify which mucosal layer the lesion originates from, as well as the density of the lesion; however, surgical resection is the standard of care for the treatment of a resectable nonmetastatic GIST. For recurrent GISTs, metastatic disease, or GISTs not amendable to resection, tyrosine kinase inhibitors are frequently used, with imatinib being used in the first-line setting. A multimodal treatment approach is often necessary to increase the chances of a permanent cure.
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Affiliation(s)
- Heather Townsend
- From Atrium Health Carolinas Medical Center, Charlotte, North Carolina
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Huang J, Fan X, Liu W. Applications and Prospects of Artificial Intelligence-Assisted Endoscopic Ultrasound in Digestive System Diseases. Diagnostics (Basel) 2023; 13:2815. [PMID: 37685350 PMCID: PMC10487217 DOI: 10.3390/diagnostics13172815] [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: 08/01/2023] [Revised: 08/22/2023] [Accepted: 08/27/2023] [Indexed: 09/10/2023] Open
Abstract
Endoscopic ultrasound (EUS) has emerged as a widely utilized tool in the diagnosis of digestive diseases. In recent years, the potential of artificial intelligence (AI) in healthcare has been gradually recognized, and its superiority in the field of EUS is becoming apparent. Machine learning (ML) and deep learning (DL) are the two main AI algorithms. This paper aims to outline the applications and prospects of artificial intelligence-assisted endoscopic ultrasound (EUS-AI) in digestive diseases over the past decade. The results demonstrated that EUS-AI has shown superiority or at least equivalence to traditional methods in the diagnosis, prognosis, and quality control of subepithelial lesions, early esophageal cancer, early gastric cancer, and pancreatic diseases including pancreatic cystic lesions, autoimmune pancreatitis, and pancreatic cancer. The implementation of EUS-AI has opened up new avenues for individualized precision medicine and has introduced novel diagnostic and treatment approaches for digestive diseases.
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Affiliation(s)
| | | | - Wentian Liu
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin 300052, China; (J.H.); (X.F.)
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Gomes RSA, de Oliveira GHP, de Moura DTH, Kotinda APST, Matsubayashi CO, Hirsch BS, Veras MDO, Ribeiro Jordão Sasso JG, Trasolini RP, Bernardo WM, de Moura EGH. Endoscopic ultrasound artificial intelligence-assisted for prediction of gastrointestinal stromal tumors diagnosis: A systematic review and meta-analysis. World J Gastrointest Endosc 2023; 15:528-539. [PMID: 37663113 PMCID: PMC10473903 DOI: 10.4253/wjge.v15.i8.528] [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: 03/16/2023] [Revised: 06/15/2023] [Accepted: 07/24/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Subepithelial lesions (SELs) are gastrointestinal tumors with heterogeneous malignant potential. Endoscopic ultrasonography (EUS) is the leading method for evaluation, but without histopathological analysis, precise differentiation of SEL risk is limited. Artificial intelligence (AI) is a promising aid for the diagnosis of gastrointestinal lesions in the absence of histopathology. AIM To determine the diagnostic accuracy of AI-assisted EUS in diagnosing SELs, especially lesions originating from the muscularis propria layer. METHODS Electronic databases including PubMed, EMBASE, and Cochrane Library were searched. Patients of any sex and > 18 years, with SELs assessed by EUS AI-assisted, with previous histopathological diagnosis, and presented sufficient data values which were extracted to construct a 2 × 2 table. The reference standard was histopathology. The primary outcome was the accuracy of AI for gastrointestinal stromal tumor (GIST). Secondary outcomes were AI-assisted EUS diagnosis for GIST vs gastrointestinal leiomyoma (GIL), the diagnostic performance of experienced endoscopists for GIST, and GIST vs GIL. Pooled sensitivity, specificity, positive, and negative predictive values were calculated. The corresponding summary receiver operating characteristic curve and post-test probability were also analyzed. RESULTS Eight retrospective studies with a total of 2355 patients and 44154 images were included in this meta-analysis. The AI-assisted EUS for GIST diagnosis showed a sensitivity of 92% [95% confidence interval (CI): 0.89-0.95; P < 0.01), specificity of 80% (95%CI: 0.75-0.85; P < 0.01), and area under the curve (AUC) of 0.949. For diagnosis of GIST vs GIL by AI-assisted EUS, specificity was 90% (95%CI: 0.88-0.95; P = 0.02) and AUC of 0.966. The experienced endoscopists' values were sensitivity of 72% (95%CI: 0.67-0.76; P < 0.01), specificity of 70% (95%CI: 0.64-0.76; P < 0.01), and AUC of 0.777 for GIST. Evaluating GIST vs GIL, the experts achieved a sensitivity of 73% (95%CI: 0.65-0.80; P < 0.01) and an AUC of 0.819. CONCLUSION AI-assisted EUS has high diagnostic accuracy for fourth-layer SELs, especially for GIST, demonstrating superiority compared to experienced endoscopists' and improving their diagnostic performance in the absence of invasive procedures.
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Affiliation(s)
- Rômulo Sérgio Araújo Gomes
- Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-010, Brazil
| | | | - Diogo Turiani Hourneaux de Moura
- Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-010, Brazil
| | - Ana Paula Samy Tanaka Kotinda
- Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-010, Brazil
| | - Carolina Ogawa Matsubayashi
- Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-010, Brazil
| | - Bruno Salomão Hirsch
- Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-010, Brazil
| | - Matheus de Oliveira Veras
- Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-010, Brazil
| | | | - Roberto Paolo Trasolini
- Division of Hepatology and Endoscopy, Department of Gastroenterology, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA 02115, United States
| | - Wanderley Marques Bernardo
- Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-010, Brazil
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Du C, He Z, Li L, Ning B, Zhang B, Zhai Y, Ma Y, Han K, Wang H, Tang P, Chai N, Linghu E. Endoscopic resection for the treatment of non-gastric gastrointestinal stromal tumors: A retrospective study from a large tertiary hospital in China. Clin Res Hepatol Gastroenterol 2023; 47:102152. [PMID: 37257690 DOI: 10.1016/j.clinre.2023.102152] [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: 03/28/2023] [Revised: 05/14/2023] [Accepted: 05/29/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND AND AIMS Few studies on endoscopic resection (ER) for the treatment of non-gastric gastrointestinal (GI) stromal tumors (GISTs) have been conducted, and most have been case reports or case series. The aim of this study was to evaluate the effectiveness and safety of ER for non-gastric GISTs. METHODS From January 2010 to December 2022, 329 patients who were diagnosed with GISTs underwent ER. After excluding 302 patients with gastric GISTs, we retrospectively assessed the data of 27 patients with non-gastric GISTs. The main outcome measures were en bloc resection, complete resection, residual disease, recurrence, and complications. RESULTS A total of 15(55.6%) females and 12(44.4%) males with a mean age of 53.8 ± 11.0 years were assessed. There were 19 (70.4%) GISTs in the esophagus, 2 (7.4%) in the duodenum, 3 (11.1%) in the colon and 3 (11.1%) in the rectum. The median tumor size was 12.0 mm (range 4.0-35.0 mm). Most of the GISTs (20, 74.1%) were very low risk, and the remaining 7(25.9%) were low risk. Both en bloc resection and complete resection were achieved in 25(92.6%) patients. Piecemeal resection mainly resulted from a larger tumor size, an irregular shape, and an extraluminal growth pattern. No residual disease or recurrence was noted during the follow-up period. The median operation time was 23 min (range 2-125 min). After excluding the operation time of EER, the operation time was prolonged to 37 min (range 12-125 min). Only one patient experienced mild abdominal pain, leading to a complication rate of 3.7%. No severe complications requiring for surgical interventions occurred. CONCLUSION ER was an effective and safe method for non-gastric GISTs in selected cases. GISTs of a small size and regular shape with an intraluminal growth pattern require complete resection.
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Affiliation(s)
- Chen Du
- Senior Department of Gastroenterology, the First Medical Center of PLA General Hospital, Fuxing Road 28. Haidian District, Beijing 100853, China
| | - Zhengting He
- Senior Department of Gastroenterology, the First Medical Center of PLA General Hospital, Fuxing Road 28. Haidian District, Beijing 100853, China
| | - Longsong Li
- Senior Department of Gastroenterology, the First Medical Center of PLA General Hospital, Fuxing Road 28. Haidian District, Beijing 100853, China
| | - Bo Ning
- Senior Department of Gastroenterology, the First Medical Center of PLA General Hospital, Fuxing Road 28. Haidian District, Beijing 100853, China
| | - Bo Zhang
- Senior Department of Gastroenterology, the First Medical Center of PLA General Hospital, Fuxing Road 28. Haidian District, Beijing 100853, China
| | - Yaqi Zhai
- Senior Department of Gastroenterology, the First Medical Center of PLA General Hospital, Fuxing Road 28. Haidian District, Beijing 100853, China
| | - Yan Ma
- Senior Department of Gastroenterology, the First Medical Center of PLA General Hospital, Fuxing Road 28. Haidian District, Beijing 100853, China
| | - Ke Han
- Senior Department of Gastroenterology, the First Medical Center of PLA General Hospital, Fuxing Road 28. Haidian District, Beijing 100853, China
| | - Hongbin Wang
- Senior Department of Gastroenterology, the First Medical Center of PLA General Hospital, Fuxing Road 28. Haidian District, Beijing 100853, China
| | - Ping Tang
- Senior Department of Gastroenterology, the First Medical Center of PLA General Hospital, Fuxing Road 28. Haidian District, Beijing 100853, China
| | - Ningli Chai
- Senior Department of Gastroenterology, the First Medical Center of PLA General Hospital, Fuxing Road 28. Haidian District, Beijing 100853, China.
| | - Enqiang Linghu
- Senior Department of Gastroenterology, the First Medical Center of PLA General Hospital, Fuxing Road 28. Haidian District, Beijing 100853, China.
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Obri MS, Nimri F, Kamran W, Nimri R, Pompa R, Zuchelli T. Gastrointestinal Stromal Tumor Presenting as Food Impaction and Pseudo-Achalasia. ACG Case Rep J 2023; 10:e01116. [PMID: 37583506 PMCID: PMC10424890 DOI: 10.14309/crj.0000000000001116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 07/06/2023] [Indexed: 08/17/2023] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are one of the most common mesenchymal tumors of the gastrointestinal tract. Studies report the incidence of GIST to be 14.5 per million, with 18% being diagnosed incidentally. The most common location is the stomach while the esophagus is the rarest, representing only 0.7% of cases. The clinical manifestations of GISTs vary. Most patients present with bleeding and gastric discomfort. Some may present with life-threatening hematemesis or melena. We present a unique case of a GIST presenting as pseudo-achalasia and food impaction.
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Affiliation(s)
- Mark S. Obri
- Division of Internal Medicine, Henry Ford Health, Detroit, MI
| | - Faisal Nimri
- Division of Gastroenterology and Hepatology, Henry Ford Health, Detroit, MI
| | - Wasih Kamran
- Division of Internal Medicine, Henry Ford Health, Detroit, MI
| | - Rund Nimri
- Jordan University of Science and Technology, School of Medicine, Irbid, Jordan
| | - Robert Pompa
- Division of Gastroenterology and Hepatology, Henry Ford Health, Detroit, MI
| | - Tobias Zuchelli
- Division of Gastroenterology and Hepatology, Henry Ford Health, Detroit, MI
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Pawlak KM, Khalaf K, Mönkemüller K, Kurek K. Systemic multiple myeloma and colonic abnormalities. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2023; 8:328-329. [PMID: 37575143 PMCID: PMC10422100 DOI: 10.1016/j.vgie.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Video 1Colonic abnormalities observed in the course of systemic multiple myeloma.
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Affiliation(s)
- Katarzyna M Pawlak
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Kareem Khalaf
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
- Humanitas Research Hospital-IRCCS, Department of Gastroenterology, Endoscopy Unit, Rozzano, Italy
| | - Klaus Mönkemüller
- University of Belgrade, Belgrade, Serbia
- Department of Gastroenterology, Ameos Teaching University Hospital (Otto-von-Guericke University-Magdeburg), Halberstadt, Germany
- Department of Gastroenterology, Helios Frankenwaldklinik, Kronach, Germany
| | - Krzysztof Kurek
- Department of Gastroenterology and Internal Medicine, Medicał University of Bialystok, Bialystok, Poland
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Zhu H, Yang G, Ma Y, Huo Q, Wan D, Yang Q. Update of epidemiology, survival and initial treatment in patients with gastrointestinal stromal tumour in the USA: a retrospective study based on SEER database. BMJ Open 2023; 13:e072945. [PMID: 37419634 PMCID: PMC10335486 DOI: 10.1136/bmjopen-2023-072945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 06/22/2023] [Indexed: 07/09/2023] Open
Abstract
OBJECTIVES An updated epidemiological analysis of gastrointestinal stromal tumour (GIST), the change of cancer-specific survival (CSS) and patterns of initial treatment are of interest. DESIGN A retrospective study using data from the Surveillance, Epidemiology and End Results (SEER) database. SETTING AND PARTICIPANTS A total of 5625 patients with GIST diagnosed between 2010 and 2019 were identified. PRIMARY OUTCOME MEASURES Age-standardised incidence rate (ASIR) and annual prevalence rate were calculated. SEER combined stage, period CSS rate and initial treatment were summarised. All the data were calculated by SEER*Stat software. RESULTS From 2010 to 2019, the ASIR of GIST increased from 0.79 to 1.02 per 100 000 person-years, with an increase of 2.4% annually. The increase was across age and sex subgroups. The prevalence trend was similar with the ASIR trend in each subgroup. The stage distributions were similar between different age groups, but varied among different primary tumour sites. More importantly, a stage shift from regional stage to localized stage at diagnosis was found, which may result in the improvement of CSS over years. Overall, the 5-year CSS rate of GIST was approximately 81.3%. Even for metastatic GIST, the rate exceeded 50%. Surgery was the most common treatment regimen for GIST, followed by surgery and systemic treatment. Whereas approximately 7.0% patients were undertreated, which was more pronounced among patients with distant and unknown stages. CONCLUSIONS The findings of this study suggest an improving early detection of GIST and an improving ability of accurate staging. Though most patients are effectively treated and perform good survivals, approximate 7.0% patients may be undertreated.
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Affiliation(s)
- Haizhen Zhu
- Department of Oncology, Guizhou Provincial People's Hospital, Medical School of Guizhou University, Guizhou Cancer Center, Guiyang, Guizhou, China
| | - Guangrong Yang
- Department of Oncology, The People's Hospital of Qijiang District, Chongqing, Chongqing, China
| | - Ying Ma
- Department of Gastroenterology, The 941st Hospital of the PLA Joint Logistic Support Force, Xining, Qinghai, China
| | - Qianwen Huo
- The 941st Hospital of the PLA Joint Logistic Support Force, Xining, Qinghai, China
| | - Deli Wan
- Department of Gastroenterology, The People's Hospital of Qijiang District, Chongqing, Chongqing, China
| | - Qiao Yang
- Department of Ultrasound, The 941st Hospital of the PLA Joint Logistic Support Force, Xining, Qinghai, China
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Wu H, Ding P, Wu J, Sun C, Guo H, Chen S, Lowe S, Yang P, Tian Y, Liu Y, Zhao Q. A New Online Dynamic Nomogram: Construction and Validation of a Predictive Model for Distant Metastasis Risk and Prognosis in Patients with Gastrointestinal Stromal Tumors. J Gastrointest Surg 2023; 27:1429-1444. [PMID: 37231240 DOI: 10.1007/s11605-023-05706-9] [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: 01/09/2023] [Accepted: 04/28/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Gastrointestinal stromal tumor (GIST) is the most common sarcoma of the digestive tract, among which patients with distant metastases tend to have a poor prognosis. This study aimed to develop a model for predicting distant metastasis in GIST patients and to develop two models for monitoring overall survival (OS) and cancer-specific survival (CSS) in GIST patients with metastasis. This would allow us to develop an optimal, individualized treatment strategy. METHODS We reviewed demographic and clinicopathological characteristics data from 2010 to 2017 of patients diagnosed with GIST in the Surveillance, Epidemiology, and End Results (SEER) database. The data of the external validation group was reviewed from the Forth Hospital of Hebei Medical University. Univariate and multivariate logistic regression analyses were used to confirm the independent risk factors for distant metastasis in the GIST patients, and univariate and multivariate Cox regression analyses were performed to identify the independent prognostic factors for OS and CSS in the GIST patients with distant metastasis. Subsequently, three web-based novel nomograms were developed, which were evaluated by the receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). RESULTS Of the 3639 patients who met the inclusion criteria, 418 (11.4%) had distant metastases. The risk factors for distant metastasis in GIST patients included sex, primary site, grade, N stage, tumor size, and mitotic count. For OS, the independent prognosis factors for GIST patients with metastasis included age, race, marital, primary site, chemotherapy, mitotic count, and metastasis at the lung, and for CSS, age, race, marital, primary site, and metastasis at the lung were the independent prognosis factors. Three web-based nomograms were constructed based on these independent factors, respectively. The ROC curves, calibration curves, and DCA were performed in the training, testing, and validation sets which confirmed the high accuracy and strong clinical practice power for the nomograms. CONCLUSION Population-based nomograms can help clinicians predict the occurrence and prognosis of distant metastases in patients with GIST, which may be helpful for clinicians to formulate clinical management and appropriate treatment strategies.
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Affiliation(s)
- Haotian Wu
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, 050011, China
| | - Ping'an Ding
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, 050011, China
| | - Jiaxiang Wu
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, 050011, China
| | - Chenyu Sun
- AMITA Health Saint Joseph Hospital Chicago, 2900 N. Lake Shore Drive, Chicago, IL, 60657, USA
| | - Honghai Guo
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, 050011, China
| | - Shuya Chen
- Newham University Hospital, Glen Road, Plaistow, E13 8SL, London, UK
| | - Scott Lowe
- College of Osteopathic Medicine, Kansas City University, 1750 Independence Ave, Kansas City, MO, 64106, USA
| | - Peigang Yang
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, 050011, China
| | - Yuan Tian
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, 050011, China
| | - Yang Liu
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, 050011, China
| | - Qun Zhao
- The Third Department of Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, China.
- Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang, 050011, China.
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Alabdallah E, Al Mouallem MHDM, Al-Ghotani B, Martini N, Al-Mahasna S. Retroperitoneal extra gastrointestinal stromal tumor: A case report. Int J Surg Case Rep 2023; 108:108442. [PMID: 37392585 PMCID: PMC10382849 DOI: 10.1016/j.ijscr.2023.108442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/21/2023] [Accepted: 06/27/2023] [Indexed: 07/03/2023] Open
Abstract
INTRODUCTION Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors. Researchers do not know precisely what leads to GISTs, but genetic mutations play an important role. These mutations have no apparent cause. GISTs are usually asymptomatic tumors, although GI bleeding and weight loss can occur. CT is preferred for investigating potential GISTs. CASE PRESENTATION A 36-year-old unmarried Syrian female came to the hospital complaining of recurrent abdominal pain. CT revealed a large mass occupying a significant portion of the left hypochondrium and the lower part of the epigastrium. The tumor exceeded the median line to the right, pressing on the mesenteric vessels and the intestinal loops below. Immunohistochemistry results showed moderate positivity to CD117 and CD34, which were compatible with the diagnosis of GIST. The entire mass was excised. Physicians performed CT follow-ups every three months for 18 months, and no evidence of recurrence was observed. DISCUSSION Extragastrointestinal GISTs are a rare subtype of GISTs that occur outside the GI tract. GISTs previously used to be misdiagnosed as leiomyoma, leiomyosarcoma, leiomyoblastoma, and schwannoma. Treatment depends on surgery with adjuvant therapy tyrosine kinase inhibitors. Follow-up is recommended as the risk of recurrence is high. CONCLUSION We recommend that GIST, as an extremely rare tumor, should be considered in the differential diagnoses of masses that occur in the extra-intestinal region. Usually, patients need surgery with lymph node resection. However, this was not needed in our case.
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Affiliation(s)
- Ebaa Alabdallah
- Damascus University, Faculty of Medicine, Damascus, Syria; Stemosis for Scientific Research, Damascus, Syria
| | - M H D Moamen Al Mouallem
- Damascus University, Faculty of Medicine, Damascus, Syria; Stemosis for Scientific Research, Damascus, Syria
| | - Basel Al-Ghotani
- Damascus University, Faculty of Medicine, Damascus, Syria; Stemosis for Scientific Research, Damascus, Syria
| | - Nafiza Martini
- Damascus University, Faculty of Medicine, Damascus, Syria; Stemosis for Scientific Research, Damascus, Syria.
| | - Souheb Al-Mahasna
- Damascus University, Faculty of Medicine, Damascus, Syria; Stemosis for Scientific Research, Damascus, Syria
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Choi EL, Taheri N, Chandra A, Hayashi Y. Cellular Senescence, Inflammation, and Cancer in the Gastrointestinal Tract. Int J Mol Sci 2023; 24:9810. [PMID: 37372958 DOI: 10.3390/ijms24129810] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/05/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
Due to modern medical advancements, greater proportions of the population will continue to age with longer life spans. Increased life span, however, does not always correlate with improved health span, and may result in an increase in aging-related diseases and disorders. These diseases are often attributed to cellular senescence, in which cells become disengaged from the cell cycle and inert to cell death. These cells are characterized by a proinflammatory secretome. The proinflammatory senescence-associated secretory phenotype, although part of a natural function intended to prevent further DNA damage, creates a microenvironment suited to tumor progression. This microenvironment is most evident in the gastrointestinal tract (GI), where a combination of bacterial infections, senescent cells, and inflammatory proteins can lead to oncogenesis. Thus, it is important to find potential senescence biomarkers as targets of novel therapies for GI diseases and disorders including cancers. However, finding therapeutic targets in the GI microenvironment to reduce the risk of GI tumor onset may also be of value. This review summarizes the effects of cellular senescence on GI aging, inflammation, and cancers, and aims to improve our understanding of these processes with a goal of enhancing future therapy.
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Affiliation(s)
- Egan L Choi
- Graduate Research Education Program (Choi), Mayo Clinic, Rochester, MN 55905, USA
| | - Negar Taheri
- Department of Physiology and Biomedical Engineering (Taheri, Chandra and Hayashi), Mayo Clinic, Rochester, MN 55905, USA
- Division of Gastroenterology and Hepatology (Taheri and Hayashi), Mayo Clinic, Rochester, MN 55905, USA
| | - Abhishek Chandra
- Department of Physiology and Biomedical Engineering (Taheri, Chandra and Hayashi), Mayo Clinic, Rochester, MN 55905, USA
- Robert and Arlene Kogod Center on Aging (Chandra), Mayo Clinic, Rochester, MN 55905, USA
| | - Yujiro Hayashi
- Department of Physiology and Biomedical Engineering (Taheri, Chandra and Hayashi), Mayo Clinic, Rochester, MN 55905, USA
- Division of Gastroenterology and Hepatology (Taheri and Hayashi), Mayo Clinic, Rochester, MN 55905, USA
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Honjo S, Yamauchi S, Yoshimoto Y, Jun C, Egawa H, Kubota A, Tsuda K, Yube Y, Kaji S, Orita H, Fukunaga T. A vanished gastric gastrointestinal stromal tumor. Surg Case Rep 2023; 9:92. [PMID: 37254018 DOI: 10.1186/s40792-023-01674-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 05/18/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Local resection is the standard treatment for gastrointestinal stromal tumors (GISTs). Laparoscopic and endoscopic cooperative surgery (LECS) is a minimally invasive surgery used to resect GISTs. Herein, we report an extremely rare case of a gastric GIST that grossly vanished during LECS. CASE PRESENTATION A 50-year-old Japanese female was referred to our hospital after an abnormality was detected during an esophagogastroduodenoscopy (EGD) at her annual health checkup. Based on EGD, endoscopic ultrasound (EUS), and computer tomography (CT) findings, the patient was diagnosed with a 50-mm submucosal tumor (SMT) with intraluminal growth on the anterior wall of the lesser curvature of the upper body of the stomach. We routinely use LECS to treat the intraluminal growth type of GISTs. During the intraoperative endoscopy, the intraluminal submucosal tumor, which was detected preoperatively, had vanished. A red-white scar was observed in the regressed tumor region. LECS was performed by resecting at a distance away from the scar tissue and closing the gastric wall with intracavitary sutures. In the evaluation from the tumor section view of the original resected specimen, a 22 × 14 × 8 mm lobular neoplasm was observed that was predominantly located in the gastric submucosa to the muscularis propia. Pathological findings confirmed the diagnosis of GIST with intermediate risk indicated by the Fletcher classification. The patient continued postoperative adjuvant chemotherapy with imatinib and no recurrence was detected over 12 months after surgery. CONCLUSION LECS was performed on the vanished gastric GIST, providing the best surgical treatment and leading to an accurate diagnosis and optimal postoperative care.
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Affiliation(s)
- Sarah Honjo
- Department of Esophageal and Gastroenterological Surgery, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan
| | - Suguru Yamauchi
- Department of Esophageal and Gastroenterological Surgery, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan.
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
| | - Yutaro Yoshimoto
- Department of Esophageal and Gastroenterological Surgery, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan
| | - Chen Jun
- Department of Esophageal and Gastroenterological Surgery, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan
| | - Hiroki Egawa
- Department of Esophageal and Gastroenterological Surgery, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan
| | - Akira Kubota
- Department of Esophageal and Gastroenterological Surgery, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan
| | - Kenki Tsuda
- Department of Esophageal and Gastroenterological Surgery, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan
| | - Yukinori Yube
- Department of Esophageal and Gastroenterological Surgery, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan
| | - Sanae Kaji
- Department of Esophageal and Gastroenterological Surgery, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan
| | - Hajime Orita
- Department of Esophageal and Gastroenterological Surgery, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan
| | - Tetsu Fukunaga
- Department of Esophageal and Gastroenterological Surgery, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan
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