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Zhou Y, Song L, Lyu L, Li S, Wang Q. Gastrointestinal stromal tumor with small cell carcinoma infiltration: a case report. Front Oncol 2024; 14:1389975. [PMID: 38952545 PMCID: PMC11215004 DOI: 10.3389/fonc.2024.1389975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 05/24/2024] [Indexed: 07/03/2024] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the digestive system. They usually occur in the gastrointestinal tract. However, we discovered a rare phenomenon in which small cell carcinoma infiltrated the GIST of a patient. The patient came to the hospital and presented with chest tightness and shortness of breath for 2 months and a dry cough for half a month. As the ancillary tests were refined, it was discovered that he also had a lesion in the pelvic cavity. After pathological examination of the core needle biopsy (CNB) samples from the pelvic cavity lesion, the patient was diagnosed with GIST with small cell carcinoma infiltration. The patient is currently receiving a chemotherapy regimen of etoposide combined with cisplatin.
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Affiliation(s)
| | | | - Li Lyu
- Department of Pathology, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Shengjie Li
- Department of Pathology, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Qimin Wang
- Department of Pathology, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
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2
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Han S, Song M, Wang J, Huang Y, Li Z, Yang A, Sui C, Zhang Z, Qiao J, Yang J. Intelligent identification system of gastric stromal tumors based on blood biopsy indicators. BMC Med Inform Decis Mak 2023; 23:214. [PMID: 37833709 PMCID: PMC10576280 DOI: 10.1186/s12911-023-02324-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: 07/20/2023] [Accepted: 10/03/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND The most prevalent mesenchymal-derived gastrointestinal cancers are gastric stromal tumors (GSTs), which have the highest incidence (60-70%) of all gastrointestinal stromal tumors (GISTs). However, simple and effective diagnostic and screening methods for GST remain a great challenge at home and abroad. This study aimed to build a GST early warning system based on a combination of machine learning algorithms and routine blood, biochemical and tumour marker indicators. METHODS In total, 697 complete samples were collected from four hospitals in Gansu Province, including 42 blood indicators from 318 pretreatment GST patients, 180 samples of gastric polyps and 199 healthy individuals. In this study, three algorithms, gradient boosting machine (GBM), random forest (RF), and logistic regression (LR), were chosen to build GST prediction models for comparison. The performance and stability of the models were evaluated using two different validation techniques: 5-fold cross-validation and external validation. The DeLong test assesses significant differences in AUC values by comparing different ROC curves, the variance and covariance of the AUC value. RESULTS The AUC values of both the GBM and RF models were higher than those of the LR model, and this difference was statistically significant (P < 0.05). The GBM model was considered to be the optimal model, as a larger area was enclosed by the ROC curve, and the axes indicated robust model classification performance according to the accepted model discriminant. Finally, the integration of 8 top-ranked blood indices was proven to be able to distinguish GST from gastric polyps and healthy people with sensitivity, specificity and area under the curve of 0.941, 0.807 and 0.951 for the cross-validation set, respectively. CONCLUSION The GBM demonstrated powerful classification performance and was able to rapidly distinguish GST patients from gastric polyps and healthy individuals. This identification system not only provides an innovative strategy for the diagnosis of GST but also enables the exploration of hidden associations between blood parameters and GST for subsequent studies on the prevention and disease surveillance management of GST. The GST discrimination system is available online for free testing of doctors and high-risk groups at https://jzlyc.gsyy.cn/bear/mobile/index.html .
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Affiliation(s)
- Shangjun Han
- Department of the First Clinical Medical College, Gansu University of Traditional Chinese Medicine, Lanzhou, People's Republic of China
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, People's Republic of China
| | - Meijuan Song
- Department of the First Clinical Medical College, Gansu University of Traditional Chinese Medicine, Lanzhou, People's Republic of China
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, People's Republic of China
| | - Jiarui Wang
- Department of Medical Information and Engineering, Xuzhou Medical University, Xuzhou, People's Republic of China
| | - Yalong Huang
- Department of the First Clinical Medical College, Gansu University of Traditional Chinese Medicine, Lanzhou, People's Republic of China
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, People's Republic of China
| | - Zuxi Li
- Department of the First Clinical Medical College, Gansu University of Traditional Chinese Medicine, Lanzhou, People's Republic of China
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, People's Republic of China
| | - Aijia Yang
- Department of the First Clinical Medical College, Gansu University of Traditional Chinese Medicine, Lanzhou, People's Republic of China
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, People's Republic of China
| | - Changsheng Sui
- Department of the First Clinical Medical College, Gansu University of Traditional Chinese Medicine, Lanzhou, People's Republic of China
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, People's Republic of China
| | - Zeping Zhang
- Department of the First Clinical Medical College, Gansu University of Traditional Chinese Medicine, Lanzhou, People's Republic of China
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, People's Republic of China
| | - Jiling Qiao
- Department of the First Clinical Medical College, Gansu University of Traditional Chinese Medicine, Lanzhou, People's Republic of China
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, People's Republic of China
| | - Jing Yang
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, People's Republic of China.
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Mechahougui H, Michael M, Friedlaender A. Precision Oncology in Gastrointestinal Stromal Tumors. Curr Oncol 2023; 30:4648-4662. [PMID: 37232809 DOI: 10.3390/curroncol30050351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 04/18/2023] [Accepted: 04/25/2023] [Indexed: 05/27/2023] Open
Abstract
GIST (gastrointestinal stromal tumors) represent 20% of sarcomatous tumors and 1-2% of primary gastrointestinal cancers. They have an excellent prognosis when localized and resectable, though their prognosis is poor in the metastatic setting, with limited options after the second line until recently. Four lines are now standard in KIT-mutated GIST and one in PDGFRA-mutated GIST. An exponential growth of new treatments is expected in this era of molecular diagnostic techniques and systematic sequencing. Currently, the main challenge remains the emergence of resistance linked to secondary mutations caused by selective pressure induced by TKIs. Repeating biopsies to tailor treatments might be a step in the right direction, and liquid biopsies at progression may offer a non-invasive alternative. New molecules with wider KIT inhibition are under investigation and could change the catalog and the sequence of existing treatments. Combination therapies may also be an approach to overcome current resistance mechanisms. Here, we review the current epidemiology and biology of GIST and discuss future management options, with an emphasis on genome-oriented therapies.
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Affiliation(s)
- Hiba Mechahougui
- Oncology Department, Geneva University Hospital, 1205 Geneva, Switzerland
| | | | - Alex Friedlaender
- Oncology Department, Geneva University Hospital, 1205 Geneva, Switzerland
- Clinique Générale Beaulieu, 1206 Geneva, Switzerland
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Jansen K, Kluth M, Blessin NC, Hube-Magg C, Neipp M, Mofid H, Lárusson H, Daniels T, Isbert C, Coerper S, Ditterich D, Rupprecht H, Goetz A, Bernreuther C, Sauter G, Uhlig R, Wilczak W, Simon R, Steurer S, Burandt E, Perez D, Izbicki JR, Jacobsen F, Clauditz TS, Marx AH, Krech T. DOG1 overexpression is associated with mismatch repair deficiency and BRAF mutations but unrelated to cancer progression in colorectal cancer. Histol Histopathol 2022; 37:739-748. [PMID: 35642329 DOI: 10.14670/hh-18-475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION The transmembrane channel protein DOG1 (Discovered on GIST1) is normally expressed in the gastrointestinal interstitial cells of Cajal and also in gastrointestinal stroma tumors arising from these cells. However, there is also evidence for a relevant role of DOG1 expression in colorectal cancers. This study was undertaken to search for associations between DOG1 expression and colon cancer phenotype and key molecular alterations. METHODS A tissue microarray containing samples from more than 1,800 colorectal cancer patients was analyzed by immunohistochemistry. RESULTS DOG1 immunostaining was detected in 503 (30.2%) of 1,666 analyzable colorectal cancers and considered weak in 360 (21.6%), moderate in 78 (4.7%), and strong in 65 (3.9%). Strong DOG1 immunostaining was associated with advanced pT stage (p=0.0367) and nodal metastases (p=0.0145) but these associations were not retained in subgroups of 1,135 mismatch repair proficient and 86 mismatch repair deficient tumors. DOG1 positivity was significantly linked to several molecular tumor features including mismatch repair deficiency (p=0.0034), BRAF mutations (p<0.0001), nuclear p53 accumulation (p=0.0157), and PD-L1 expression (p=0.0199) but unrelated to KRAS mutations and the density of tumor infiltrating CD8 positive lymphocytes. CONCLUSION Elevated DOG1 expression is frequent in colorectal cancer and significantly linked to important molecular alterations. However, DOG1 overexpression is largely unrelated to histopathological parameters of cancer aggressiveness and may thus not serve as a prognostic parameter for this tumor entity.
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Affiliation(s)
- Kristina Jansen
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- General, Visceral and Thoracic Surgery Department and Clinic, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martina Kluth
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Niclas C Blessin
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Claudia Hube-Magg
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Neipp
- General, Vascular and Visceral Surgery Clinic, Itzehoe Medical Center, Itzehoe, Germany
| | - Hamid Mofid
- General, Visceral Thoracic and Vascular Surgery Clinic, Regio Clinic Pinneberg, Pinneberg, Germany
| | - Hannes Lárusson
- General, Visceral Thoracic and Vascular Surgery Clinic, Regio Clinic Pinneberg, Pinneberg, Germany
| | - Thies Daniels
- General, Visceral and Tumor Surgery Clinic, Albertinen Hospital, Hamburg, Germany
| | - Christoph Isbert
- Department of General, Gastrointestinal and Colorectal Surgery, Amalie Sieveking Hospital, Hamburg, Germany
| | - Stephan Coerper
- Department of Surgery, General Hospital Martha-Maria Hospital Nuernberg, Nuernberg, Germany
| | - Daniel Ditterich
- Department of Surgery, General Hospital Neustadt/Aisch, Neustadt an der Aisch, Germany
| | - Holger Rupprecht
- Department of Thoracic Surgery, Academic Hospital Neumarkt, Neumarkt/Oberpfalz, Germany
| | - Albert Goetz
- Department of Surgery, General Hospital Roth, Roth, Germany
| | - Christian Bernreuther
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Guido Sauter
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ria Uhlig
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Waldemar Wilczak
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ronald Simon
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Steurer
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Eike Burandt
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel Perez
- General, Visceral and Thoracic Surgery Department and Clinic, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jakob R Izbicki
- General, Visceral and Thoracic Surgery Department and Clinic, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Frank Jacobsen
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Till S Clauditz
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas H Marx
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Pathology, Academic Hospital Fuerth, Fuerth, Germany
| | - Till Krech
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute of Pathology, Clinical Center Osnabrueck, Osnabrueck, Germany
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Immunohistochemical features of gastrointestinal stromal tumors and their role for differential diagnosis and prognosis. EUREKA: HEALTH SCIENCES 2021. [DOI: 10.21303/2504-5679.2021.002183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The aim. To clarify all most important immunohistochemical features of gastrointestinal stromal tumors with different histological patterns and analyze the role of expression of Ki-67, MMP-9, VEGF and p16ink4A as a predictive markers of tumor progression.
Materials and methods. The study is based on analysis of 100 primary GISTs for description of their morphological features and 36 GISTs taken from this 100 for study of prognostic markers.
Results. All spindle cell GISTs have shown diffuse expression of CD117 in tumor cells. The levels of CD117 expression varied from strong expression (3+) until mild expression (1+). Strong expression were seen in 75,8 % of spindle cell GISTs. Epithelioid GISTs demonstrated heterognous moderate or mild expression of CD117. All primary epithelioid GISTs from patients that had relapse of tumor in period from 1 till 3 years demonstrated focal mild expression of CD 117 in tumor cells. Expression of DOG-1 were seen in all 100 cases of GISTs, that were included in our study. The strong expression of DOG-1 (3+) were seen in all 45 GISTs that had low mitotic rate (≤5 mitoses per 50HPF) and not associated with their histological pattern. GISTs with high mitotic rate demonstrated heterogeneous expression of DOG-1 in tumors: moderate expression (2+) with patchy areas of strong expression (3+). Expression of CD56 was not found in spindle cell GISTs, but single tumor cells of epithelioid GISTs that had high mitotic rate demonstrated expression of this marker. The average expression of p16ink4A were higher in tumors that gave relapses compared with tumors without relapses (50,3 % versus 5,7 % respectively, U-test=16.5; p≤0,01).The average expression of MMP-9 also were significantly higher in GISTs that gave relapses: 63,2 % compared with 13,4 % in GISTs without relapse (U-test=16; p≤0 ,01).The strong VEGF expression was found in 66,7 % of GISTs that had relapses and only in 8,3 % of GISTs without relapses. 50 % of GISTs without relapses was negative for VEGF. Finally, the average expression of Ki-67 were 13,4 % in GISTs with relapses and 8,7 % in GISTs without them (U-test=16; p≤0,01).
Conclusion. We highly recommend using DOG-1 for epithelioid GISTs. Additionally in epithelioid GISTs can be used CD56 that can give focal positive reaction in some tumour cells. The following minimal panel of markers for differential diagnosis of spindled GISTs from other mesenchymal tumors of gastrointestinal tract is proposed: CD117, DOG-1 and SMA, where the first too markers will demonstrated the moderate or strong diffuse expression and SMA can be occasionally positive in some tumor cells. p16ink4A, ki-67, VEGF and MMP-9 can be used as additional prognostic markers in GISTs.
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Chiarelli M, Zago M, Tagliabue F, Burati M, Riva C, Vanzati A, Dainese E, Gabrielli F, Guttadauro A, De Simone M, Cioffi U. Small Bowel Intussusception Due to Rare Cardiac Intimal Sarcoma Metastasis: A Case Report. Front Surg 2021; 8:743858. [PMID: 34671641 PMCID: PMC8521089 DOI: 10.3389/fsurg.2021.743858] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/02/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Intimal sarcomas are rare malignant mesenchymal tumors arising from the heart and large blood vessels. Their intraluminal growth leads to vascular obstructive symptoms and peripheral neoplastic embolization. Direct infiltration of the lungs or metastases to the pulmonary system, occur in 40% of cases and extrathoracic spread is frequent, also in presentation. Intussusception is an unusual event in adults, accounting for <5% of bowel obstructions. In most cases it is caused by a malignancy and requires surgical resection. Case Presentation: We describe a rare case of a 50-year-old man suffering of bowel obstruction due to intussusception sustained by a small bowel metastasis of a primary cardiac intimal sarcoma. One year and a half before the onset of abdominal symptoms, a grade II intimal sarcoma was removed from his left atrium and consequently he followed a chemotherapy protocol. Four months later a CT scan revealed local recurrence. Eighteen months after heart surgery he referred to the ER with abdominal pain. CT scan showed an ileal intussusception and the patient was scheduled for surgery. A tract of 10 cm ileus was removed containing an intramural polypoid solid mass. Histological analyses revealed a grade II intimal sarcoma consistent with his first diagnosis. Conclusion: Primary heart tumors are late found and often partially resected, therefore metastatic pathways are to be expected. Adult small bowel intussusception is a rare event and caused by a malignancy in one third of cases. Therefore, our recommendation is to always resect the tract involved in order to perform a proper diagnosis.
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Affiliation(s)
- Marco Chiarelli
- Department of Emergency and Robotic Surgery, A. Manzoni Hospital, ASST Lecco, Lecco, Italy
| | - Mauro Zago
- Department of Emergency and Robotic Surgery, A. Manzoni Hospital, ASST Lecco, Lecco, Italy
| | - Fulvio Tagliabue
- Department of Emergency and Robotic Surgery, A. Manzoni Hospital, ASST Lecco, Lecco, Italy
| | - Morena Burati
- Department of Emergency and Robotic Surgery, A. Manzoni Hospital, ASST Lecco, Lecco, Italy
| | - Cristina Riva
- Department of Pathology, A. Manzoni Hospital, ASST Lecco, Lecco, Italy
| | - Alice Vanzati
- Department of Pathology, A. Manzoni Hospital, ASST Lecco, Lecco, Italy
| | - Emanuele Dainese
- Department of Pathology, A. Manzoni Hospital, ASST Lecco, Lecco, Italy
| | - Francesco Gabrielli
- Department of Surgery, Istituti Clinici Zucchi, University of Milan Bicocca, Monza, Italy
| | - Angelo Guttadauro
- Department of Surgery, Istituti Clinici Zucchi, University of Milan Bicocca, Monza, Italy
| | | | - Ugo Cioffi
- Department of Surgery, University of Milan, Milano, Italy
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Caruso G, Pacini L, Iossa A, Di Cristofano C, Bastianelli D, Silecchia G, Mele M, Petrozza V, Calogero A, De Falco E. A rare case of omental extra-gastrointestinal stromal tumor showing two coexisting mutations on exon 14 of the PDGFRA gene. Gastroenterol Rep (Oxf) 2021; 9:377-379. [PMID: 34567572 PMCID: PMC8460094 DOI: 10.1093/gastro/goaa086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/20/2020] [Accepted: 07/28/2020] [Indexed: 01/12/2023] Open
Affiliation(s)
- Gianluca Caruso
- Pathology Unit, ICOT Hospital, Sapienza University of Rome, Latina, Italy
| | - Luca Pacini
- Clinical Pathology Unit, ICOT Hospital, Sapienza University of Rome, Latina, Italy
| | - Angelo Iossa
- Division of General Surgery and Bariatric Centre of Excellence, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Claudio Di Cristofano
- Pathology Unit, ICOT Hospital, Sapienza University of Rome, Latina, Italy
- Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University, Latina, Italy
| | - Daniela Bastianelli
- Clinical Pathology Unit, ICOT Hospital, Sapienza University of Rome, Latina, Italy
| | - Gianfranco Silecchia
- Division of General Surgery and Bariatric Centre of Excellence, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Maria Mele
- Laboratory of Clinical Pathology, ICOT Hospital, Latina, Italy
| | - Vincenzo Petrozza
- Pathology Unit, ICOT Hospital, Sapienza University of Rome, Latina, Italy
- Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University, Latina, Italy
| | - Antonella Calogero
- Clinical Pathology Unit, ICOT Hospital, Sapienza University of Rome, Latina, Italy
- Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University, Latina, Italy
| | - Elena De Falco
- Clinical Pathology Unit, ICOT Hospital, Sapienza University of Rome, Latina, Italy
- Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University, Latina, Italy
- Mediterranea Cardiocentro, Naples, Italy
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Evaluation of risk classifications for gastrointestinal stromal tumor using multi-parameter Magnetic Resonance analysis. Abdom Radiol (NY) 2021; 46:1506-1518. [PMID: 33063266 DOI: 10.1007/s00261-020-02813-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/29/2020] [Accepted: 10/07/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Gastrointestinal stromal tumor (GIST) is the most common mesenchymal malignancy of the gastrointestinal tract. At present, it is generally believed that the prognosis of GIST is closely related to its risk classification. It may add value to correctly diagnose and evaluate the risk of invasion using a noninvasive imaging examination prior to surgery. MRI has the advantages of multiple parameters and high soft tissue resolution, which may be the potential method to preoperatively evaluate the risk of GIST. PURPOSE To retrospectively evaluate the diagnostic accuracy of multi-parameter MR analysis for preoperative risk classification of GIST. MATERIALS AND METHODS In this 6-year retrospective study, full MRI examination was performed on all 60 GIST cases confirmed classified by pathology, including 35 cases of very low-to-low-risk GIST and 25 cases of intermediate-to-high-risk GIST. Dynamic contrast-enhanced T1- and T2-weighted images, and apparent diffusion coefficient (ADC) maps were reviewed independently by two radiologists blinded to pathologic results. Volume, ADC ratio, three wash-in indexes (WII) were calculated and compared using t-test or Kruskal-Wallis nonparametric test. Sensitivity and specificity analyses were performed to calculate diagnostic accuracy using ROC analyses. Differences were considered significant at p < 0.05. RESULTS All GISTs were resected. Patient age, sex, tumor location and tumor shape did not differ significantly across the two groups (p = 0.798, 0.767, 0.822 and 0.096, respectively). GIST in the intermediate-to-high-risk group presented significantly greater volume (p = 0.0045), lower ADC ratio (p = 0.0125) and faster enhancement (for WII2, p < 0.0001; for WII3, p = 0.0358) than that of GIST in the very low-to-low-risk group. This combination of the volume, ADC ratio and WII2 provided sensitivity of 88%, specificity of 94.29%, and accuracy of 91.7% for the risk classification of GIST. CONCLUSION Multi-parameter MR analysis provides a preoperative imaging standard for accurately distinguishing very low-to-low-risk GIST from intermediate-to-high-risk GIST.
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Wongta K, Tangsirapat V, Chakrapan Na Ayudhya V, Charutragulchai P, Sripreechapattana S, Chakrapan Na Ayudhya K, Poolsavatkitikool R, Sookpotarom P, Vejchapipat P. A giant jejunal gastrointestinal stromal tumor misconceived as pancreatic cystic neoplasm: A case report. Int J Surg Case Rep 2019; 60:253-256. [PMID: 31255936 PMCID: PMC6610676 DOI: 10.1016/j.ijscr.2019.06.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 05/30/2019] [Accepted: 06/12/2019] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Gastrointestinal stromal tumors (GISTs), although not common in gastrointestinal (GI) tumors, constitute the most frequent mesenchymal tumors of the GI tract. This report describes a patient with a large sporadic GIST at proximal jejunum that mimicked the pancreatic cystic neoplasm. CASE PRESENTATION We report a 59-year-old female patient with unexplained weight loss and palpable left upper quadrant abdominal mass for 6 months. Computed tomography (CT) scan demonstrated a heterogeneously mass measuring 10 cm in a maximal diameter at pancreatic body and tail. Laparotomy was done, and the tumor was found at proximal jejunum closed to the ligament of Treitz, so en bloc resection of the tumor was done. The pathological and immunohistochemical study confirmed GISTs. DISCUSSION Although most GISTs are originated from the intestine, they frequently arise from the stomach, the duodenum and rarely from the jejunum. And jejunal GISTs are usually asymptomatic. The misdiagnosis as mucinous cystadenoma of this case might be due to the proximity of the tumor to the body and tail of pancreas, and compressing the adjacent organ due to its large size. CONCLUSION GISTs are most frequently small and arising from the stomach. GISTs are rarely present as a large tumor of the jejunum, and particularly mimicked a pancreatic tumor.
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Affiliation(s)
- Kitti Wongta
- Department of Surgery, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi, 11120, Thailand.
| | - Vorapatu Tangsirapat
- Department of Surgery, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi, 11120, Thailand.
| | - Vichack Chakrapan Na Ayudhya
- Department of Surgery, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi, 11120, Thailand.
| | - Papot Charutragulchai
- Department of Surgery, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi, 11120, Thailand.
| | - Singha Sripreechapattana
- Department of Surgery, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi, 11120, Thailand.
| | - Kobkool Chakrapan Na Ayudhya
- Department of Surgery, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi, 11120, Thailand.
| | - Rapol Poolsavatkitikool
- Department of Surgery, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi, 11120, Thailand.
| | - Paiboon Sookpotarom
- Department of Surgery, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi, 11120, Thailand.
| | - Paisarn Vejchapipat
- Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand.
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Salame H, Issa M, Nicolas G, Haddad J, Haddad MM, Farhat FS, Moubarak H, Kfoury T, Zaghrini E, Wakim R. A Rare Case of a Ruptured Metastatic Hepatic Lesion from a Jejunal Gastrointestinal Stromal Tumor (GIST) Treated by Arterial Embolization. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:1480-1487. [PMID: 30542049 PMCID: PMC6302770 DOI: 10.12659/ajcr.910061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Patient: Male, 68 Final Diagnosis: Ruptured metastatic hepatic lesion from a jejunal GIST Symptoms: Abdominal discomfort • hypotension Medication: — Clinical Procedure: — Specialty: Gastroenterology and Hepatology
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Affiliation(s)
- Hassan Salame
- Department of General Surgery, Al Zahraa Hospital, Beirut, Lebanon
| | - Mahdi Issa
- Department of General Surgery, Mount Lebanon Hospital, Beirut, Lebanon
| | - Gregory Nicolas
- Department of General Surgery, Lebanese American University Medical Center - Rizk Hospital (LAUMCRH), Beirut, Lebanon
| | - Juliano Haddad
- Mount Lebanon Hospital, Lebanese University, Beirut, Lebanon
| | - Marwan M Haddad
- Department of Interventional Radiology, Mount Lebanon Hospital, Beirut, Lebanon
| | - Firas S Farhat
- Department of Radiology, Mount Lebanon Hospital, Beirut, Lebanon
| | - Hussein Moubarak
- Department of General Surgery, Mount Lebanon Hospital, Beirut, Lebanon
| | - Tony Kfoury
- Department of General Surgery, Mount Lebanon Hospital, Beirut, Lebanon
| | - Elie Zaghrini
- Department of Emergency Medicine, Lebanese American University Medical Center - Rizk Hospital (LAUMCRH), Beirut, Lebanon
| | - Raja Wakim
- Department of General Surgery, Mount Lebanon Hospital, Beirut, Lebanon
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11
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Moura DS, Ramos R, Fernandez-Serra A, Serrano T, Cruz J, Alvarez-Alegret R, Ortiz-Duran R, Vicioso L, Gomez-Dorronsoro ML, Garcia Del Muro X, Martinez-Trufero J, Rubio-Casadevall J, Sevilla I, Lainez N, Gutierrez A, Serrano C, Lopez-Alvarez M, Hindi N, Taron M, López-Guerrero JA, Martin-Broto J. Gene expression analyses determine two different subpopulations in KIT-negative GIST-like (KNGL) patients. Oncotarget 2018; 9:17576-17588. [PMID: 29707131 PMCID: PMC5915139 DOI: 10.18632/oncotarget.24799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 02/28/2018] [Indexed: 02/07/2023] Open
Abstract
Introduction There are limited findings available on KIT-negative GIST-like (KNGL) population. Also, KIT expression may be post-transcriptionally regulated by miRNA221 and miRNA222. Hence, the aim of this study is to characterize KNGL population, by differential gene expression, and to analyze miRNA221/222 expression and their prognostic value in KNGL patients. Methods KIT, PDGFRA, DOG1, IGF1R, MIR221 and MIR222 expression levels were determined by qRT-PCR. We also analyzed KIT and PDGFRA mutations, DOG1 expression, by immunohistochemistry, along with clinical and pathological data. Disease-free survival (DFS) and overall survival (OS) differences were calculated using Log-rank test. Results Hierarchical cluster analyses from gene expression data identified two groups: group I had KIT, DOG1 and PDGFRA overexpression and IGF1R underexpression and group II had overexpression of IGF1R and low expression of KIT, DOG1 and PDGFRA. Group II had a significant worse OS (p = 0.013) in all the series, and showed a tendency for worse OS (p = 0.11), when analyzed only the localized cases. MiRNA222 expression was significantly lower in a control subset of KIT-positive GIST (p < 0.001). OS was significantly worse in KNGL cases with higher expression of MIR221 (p = 0.028) or MIR222 (p = 0.014). Conclusions We identified two distinct KNGL subsets, with a different prognostic value. Increased levels of miRNA221/222, which are associated with worse OS, could explain the absence of KIT protein expression of most KNGL tumors.
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Affiliation(s)
- David S Moura
- Institute of Biomedicine of Sevilla (IBiS, HUVR, CSIC, University of Sevilla), Sevilla, Spain
| | - Rafael Ramos
- Pathology Department, Son Espases University Hospital, Palma, Illes Baleares, Spain
| | | | - Teresa Serrano
- Pathology Department, Bellvitge University Hospital, IDIBELL, Barcelona, Spain
| | - Julia Cruz
- Pathology Department, Valencian Oncologic Institute, Valencia, Spain
| | | | - Rosa Ortiz-Duran
- Pathology Department, Josep Trueta University Hospital, Girona, Spain
| | - Luis Vicioso
- Pathology Department, Virgen de la Victoria University Hospital, Malaga, Spain
| | | | - Xavier Garcia Del Muro
- Medical Oncology Department, Institut Català d'Oncologia, IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | | | - Jordi Rubio-Casadevall
- Medical Oncology Department, Catalan Oncologic Institute, Josep Trueta University Hospital, Girona, Spain
| | - Isabel Sevilla
- Medical Oncology Department, Virgen de la Victoria University Hospital, Malaga, Spain
| | - Nuria Lainez
- Medical Oncology Department, Hospital Complex of Navarra, Pamplona, Spain
| | - Antonio Gutierrez
- Hematology Department, Son Espases University Hospital, Palma, Illes Baleares, Spain
| | - Cesar Serrano
- Medical Oncology Department, Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Maria Lopez-Alvarez
- Institute of Biomedicine of Sevilla (IBiS, HUVR, CSIC, University of Sevilla), Sevilla, Spain
| | - Nadia Hindi
- Institute of Biomedicine of Sevilla (IBiS, HUVR, CSIC, University of Sevilla), Sevilla, Spain.,Medical Oncology Department, University Hospital Virgen del Rocio, Sevilla, Spain
| | - Miguel Taron
- Institute of Biomedicine of Sevilla (IBiS, HUVR, CSIC, University of Sevilla), Sevilla, Spain
| | | | - Javier Martin-Broto
- Institute of Biomedicine of Sevilla (IBiS, HUVR, CSIC, University of Sevilla), Sevilla, Spain.,Medical Oncology Department, University Hospital Virgen del Rocio, Sevilla, Spain
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12
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Parab TM, DeRogatis MJ, Boaz AM, Grasso SA, Issack PS, Duarte DA, Urayeneza O, Vahdat S, Qiao JH, Hinika GS. Gastrointestinal stromal tumors: a comprehensive review. J Gastrointest Oncol 2018; 10:144-154. [PMID: 30788170 DOI: 10.21037/jgo.2018.08.20] [Citation(s) in RCA: 137] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are rare neoplasms of the gastrointestinal tract associated with high rates of malignant transformation. Most GISTs present asymptomatically. They are best identified by computed tomography (CT) scan and most stain positive for CD117 (C-Kit), CD34, and/or DOG-1. There have been many risk stratification classifications systems which are calculated based on tumor size, mitotic rate, location, and perforation. The approaches to treating GISTs are to resect primary low-risk tumors, resect high-risk primary or metastatic tumors with imatinib 400 mg daily for 12 months, or if the tumor is unresectable, neoadjuvant imatinib 400 mg daily followed by surgical resection is recommended. Sunitinib is required for KIT exon 9, 13, and 14 mutations, while ponatinib is used for exon 17 mutations and regorafenib for highly refractory tumors. High-risk tumors should be monitored for recurrence with serial abdominal CT scans. Radiofrequency ablation has shown to be effective when surgery is not suitable. Newer therapies of ipilimumab, nivolumab, and endoscopic ultrasound alcohol ablation have shown promising results. This report addresses the epidemiology, clinical presentation, diagnostic imaging, histologic diagnosis, classification and risk stratification, staging and grading, surgical treatment, adjuvant treatment, and metastasis of GISTs.
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Affiliation(s)
- Trisha M Parab
- Department of Surgery, Dignity Health California Hospital Medical Center, Los Angeles, CA, USA
| | - Michael J DeRogatis
- Department of Surgery, Dignity Health California Hospital Medical Center, Los Angeles, CA, USA
| | - Alexander M Boaz
- Department of Surgery, Dignity Health California Hospital Medical Center, Los Angeles, CA, USA
| | - Salvatore A Grasso
- Department of Surgery, Dignity Health California Hospital Medical Center, Los Angeles, CA, USA
| | - Paul S Issack
- Department of Orthopaedic Surgery, New York-Presbyterian Hospital, New York, NY, USA
| | - David A Duarte
- Department of Surgery, Dignity Health California Hospital Medical Center, Los Angeles, CA, USA
| | - Olivier Urayeneza
- Department of Surgery, Dignity Health California Hospital Medical Center, Los Angeles, CA, USA
| | - Saloomeh Vahdat
- Department of Pathology, Dignity Health California Hospital Medical Center, Los Angeles, CA, USA
| | - Jian-Hua Qiao
- Department of Pathology, Dignity Health California Hospital Medical Center, Los Angeles, CA, USA
| | - Gudata S Hinika
- Department of Surgery, Dignity Health California Hospital Medical Center, Los Angeles, CA, USA
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13
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Case of oesophageal gastrointestinal stromal tumour. GASTROENTEROLOGY REVIEW 2018; 12:310-312. [PMID: 29359002 PMCID: PMC5771457 DOI: 10.5114/pg.2017.72109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 06/20/2017] [Indexed: 11/17/2022]
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