Clinicopathological features and prognosis of small gastrointestinal stromal tumors outside the stomach

Coexistence of small gastrointestinal stromal tumor and pancreatic cancer: A case report and literature review

Small gastrointestinal stromal tumors (GISTs) are rare and malignant tumors that originate in the mesenchymal tissue. Due to their insidious onset and nonspecific symptoms, they are often misdiagnosed, and are generally detected during the diagnosis and treatment of other diseases. The present case report reviewed the treatment process of a patient with a small GIST coexisting with pancreatic cancer who was admitted to the Yiwu Central Hospital (Yiwu, China) in June 2018. The patient was diagnosed and treated comprehensively using a combined approach of urology, and gastrointestinal and hepatobiliary surgery. The present case report provides important clinical insights, which allow for an improved understanding of GIST and provides a reference for clinical treatment.

Clinicopathological Features and Prognosis of Small Gastric Gastrointestinal Stromal Tumors (GISTs)

BACKGROUND

The aim of the present study was to evaluate the safety of endoscopic surgery, the clinicopathological features, and prognoses of small gastric gastrointestinal stromal tumors (GISTs).

METHODS

Small gastric GIST patients (diameter: 0.10-2.00 cm) resected endoscopically in Zhongshan Hospital were retrospectively identified and clinicopathological features and outcomes were collected. The relationship between clinicopathological characteristics and tumor recurrence was analyzed. Receiver operating characteristic (ROC) curve analysis was performed to determine the optimal tumor diameter for predicting malignant potential.

RESULTS

All lesions were completely removed by endoscopy and En bloc resection was 98.5%. The most frequent location was the gastric fundus (60.3%) and the average diameter of all lesions was 1.20 cm (range: 0.10-2.00 cm). Mitoses were calculated as more than 5/50 HPF in 44 (6.8%) patients and nuclear atypia was moderate in 243 (37.5%) patients, severe in 1 (0.2%). Necrosis, mucosal infiltration, and vascular infiltration were detected in 8 (1.2%), 5 (0.7%), and 3 (0.5%) patients, respectively. Tumor size was positively correlated with mitotic index (P < 0.001) and nuclear atypia (P < 0.001). After a median follow-up of 54 months, four patients were confirmed local recurrence. ROC curve analysis identified 1.45 cm as the best cut-off value to predict malignant potential (95% CI: 0·694-0·774). Survival analysis showed that patients with tumor diameters larger than 1.45 cm were associated with more local recurrences after resection (P = 0.011).

CONCLUSIONS

Endoscopic surgery is feasible and safe for small gastric GISTs, especially those in favorable locations. Small gastric GISTs bear a good prognosis as a whole but those with diameters larger than 1.45 cm should receive more intensive surveillance or undergo endoscopic surgery.

Laparoscopic resection of intestinal stromal tumors with transrectal extract specimen: A case report

RATIONALE

Small intestine stromal tumors (SISTs) are a type of gastrointestinal stromal tumor (GIST) that has an insidious onset. Natural orifice specimen extraction (NOSE) surgery has been gradually developed for the treatment of colorectal, stomach, small intestine, hepatobiliary, and gynecological tumors because of its safety and feasibility. This case study explored the possibility of applying the NOSE method for the treatment of SIST.

PATIENT CONCERNS

A 59-year-old male patient was admitted to the hospital after having an irregular abdominal mass for >1 month that was detected by a medical examination. Thoracic and abdominopelvic enhanced computer tomography revealed irregular masses on the left side of the abdominal cavity.

DIAGNOSIS

Sist.

INTERVENTIONS

Nose (laparoscopic resection of intestinal stromal tumors with transrectal extract specimen and no abdominal auxiliary incision) surgery was performed.

OUTCOMES

The patient underwent operation successfully and recuperates well with no complications.

LESSONS

Nose surgery is minimally invasive, results in patient recuperation with no complications, and is considered to be feasible for SIST treatment.

Colonic Gastrointestinal Stromal Tumor: A Population-Based Analysis of Incidence and Survival

Objectives

The incidence of gastrointestinal stromal tumors (GISTs) located in the colon is rare. Current studies mainly focus on case reports for colonic GISTs. Therefore, a population-based analysis was useful to guide the clinical treatment strategy.

Methods

The patients were selected from 2000 to 2015 based on Surveillance, Epidemiology, and End Results (SEER) database. Patients' demographics, tumor characteristics, incidence, treatment, and survival were retrieved for analysis.

Results

249 cases of colonic GISTs were collected. The male-female ratio was close to 1 : 1 (male 51.41%, female 48.59%). Most cases were Caucasians (70.28%), and African Americans accounted for 19.68%. Age of diagnosis ranged from 21 to 93 years with a median (mean) age of 67.5 (65.56). The incidence was rare, only 0.018 per 100,000. It had an annual percentage change (APC = -0.7728) without statistical significance (P = 0.5127) while the incidence of other GISTs increased from 2000 to 2015, with an annual percentage change of 3.9% (P = 0.0001). Surgery was associated with better prognosis whereas chemotherapy did not impact the survival rate.

Conclusion

Colonic GIST is a rare solid tumor, and the incidence is stable. The entity has a poorer prognosis than other GISTs. Surgery improved the survival rate, while chemotherapy did not.

Radiotherapy for Gastrointestinal Stromal Tumors

OBJECTIVE

Gastrointestinal stromal tumors (GISTs) are rare mesenchymal tumors of the gastrointestinal tract, which frequently cause intraabdominal metastases. The current standard of care is surgery for localized cases, and adjuvant imatinib is recommended for tumors with a high risk of recurrence. To date, radiotherapy has not been commonly accepted as a part of multimodality treatment approach other than palliation. However, recently published case reports and some small series suggest that radiotherapy is a valuable option for controlling locally progressive, drug-resistant disease. The aim of this review is to provide a viewpoint from a radiation oncologist concerning the management of GISTs, especially rectal GIST, and clarify the role and technical aspects of radiotherapy in the treatment approach.

DATA SOURCES

A comprehensive search in PubMed using the keywords "radiotherapy for rectal GIST" and "rectal GIST" was undertaken. The literature search included the related articles after 1995.

STUDY SELECTION

The main articles including rectal GIST case reports and GIST series containing rectal cases were the primary references.

RESULTS

Surgery is the mainstay of treatment. However, to date, radiotherapy is included in the multidisciplinary treatment strategy of rectal GISTs in some circumstances with palliative, adjuvant, or definitive intent using different treatment doses and fields.

CONCLUSIONS

Recently reported long-term local control rates indicate that GIST is a radiosensitive disease. This makes radiotherapy a valuable alternative in GIST management with curative intent, especially in patients who (1) cannot tolerate or are resistant to chemotherapy agents, (2) have an unresectable disease, (3) have a gross or microscopic residual disease after surgery, and (4) have a recurrent disease.

Clinico-pathological characteristics and prognostic factors of gastrointestinal stromal tumors among a Chinese population

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms in the gastrointestinal tract, exhibiting wide variability in their biological behavior. The aim of the present study was to investigate the clinicopathological characteristics and prognostic factors of GISTs in Chinese patients. All GIST cases (n=182) retrieved from the pathology database and the archived files in Shanghai Changzheng Hospital between January 2011 and December 2014 were reviewed. The clinical symptoms, preoperative investigations, treatments, pathological characteristics and follow-up data of these patients were reviewed, and univariate and multivariate survival analyses were performed. A total of 73.1% of the GISTs were located in the stomach, and the most common three symptoms included abdominal pain (30.2%), dyspepsia (23.1%) and gastrointestinal bleeding (21.4%). Univariate analysis revealed that larger tumor size (P<0.001), higher mitotic rate (P<0.001), aggressive behavior (P<0.001), negative smooth muscle actin expression (P=0.009) and palliative resection (P<0.001) contributed toward poor overall survival (OS). In addition, non-gastric disease location (P<0.001), larger tumor size (P<0.001), higher mitotic rate (P=0.004), aggressive behavior (P<0.001) and palliative resection (P<0.001) were associated with poor relapse-free survival (RFS). Multivariate analysis indicated that mitotic rate [hazard ratio (HR=3.761, P=0.015)] and aggressive behavior (HR=3.916, P=0.010) were independent risk factors for OS, while non-gastric location (HR=4.740, P=0.002) and aggressive behavior (HR=4.009, P=0.004) were independent risk factors for RFS. The present study provided information on the clinicopathological characteristics and epidemiology of GISTs in the Chinese population. Non-gastric disease location, higher mitotic rate and tumor metastasis or local invasion prior to treatment were identified as predictors of a poor prognosis.