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Rasheed MW, Abiodun AE, Eziagu UB, Idowu NA, Kabiru A, Adegboye TA, Oluogun WA, Ayoade AA. Clinicopathological and immunohistochemical characterization of gastrointestinal stromal tumour at four tertiary health centers in Nigeria using CD117, DOG1, and human epidermal growth factor receptor-2 biomarkers. Ann Afr Med 2023; 22:501-507. [PMID: 38358152 PMCID: PMC10775934 DOI: 10.4103/aam.aam_180_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/22/2023] [Accepted: 02/24/2023] [Indexed: 02/16/2024] Open
Abstract
Aims Gastrointestinal stromal tumors (GISTs) are neoplastic lesions that primarily affect the digestive tract and develop from interstitial cells of Cajal. These lesions require histopathological and immunohistochemical characterization due to their malignant potential and personalized treatment. In this investigation, the sex, age, lesional sites of origin, histopathological types, the prevalence of human epidermal growth factor receptors (HER-2) expression, prognostic indices (based on tumor size and mitotic figures), expression of CD117 and DOG1, and characteristics of patients with GIST were all characterized. Materials and Methods This was a retrospective cross-sectional analysis of GIST cases seen at four tertiary health-care centers in Nigeria over a 10-year period (2008-2017) and investigated utilizing histopathological and immunohistochemical (CD117, DOG1, and HER-2) methods. Results In this investigation, there were twenty GIST cases. Notably, the majority (40%) of the cases had tumors with sizes between 7.0 and 8.0 cm; the stomach was the most frequent site (70%) and the spindle cell type of GIST was the most prevalent (80%) histopathological type. In addition, the stomach was significantly associated with GIST as an origin site (with a P = 0.001), and 100% and 50% of these tumors were immunoreactive with CD117 and DOG1, respectively. Conclusions In our study, GISTs most frequently develop in the stomach, and CD117 and DOG1 are essential for correctly diagnosing these tumors. However, HER-2 immunoreactivity is a predictive marker of survival for personalized care.
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Affiliation(s)
- Mumini Wemimo Rasheed
- Department of Anatomic Pathology, University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria
| | - Afolayan Enoch Abiodun
- Department of Anatomic Pathology, University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria
| | | | - Najeem Adedamola Idowu
- Department of Surgery, Ladoke Akintola University of Technology, Ogbomosho, Oyo, Nigeria
| | - Abdullahi Kabiru
- Department of Histopathology, Usmanu Danfodiyo University Teaching Hospital, Usmanu Danfodiyo University, Sokoto, Nigeria
| | - Taiwo Adeyemi Adegboye
- Department of Epidemiology and Community Health, University of Teaching Hospital, Ilorin, Kwara State, Nigeria
| | - Waheed Akanni Oluogun
- Department of Histopathology, Ladoke Akintola University of Technology, Osogho, Nigeria
| | - Adekunle Adebayo Ayoade
- Department of Morbid Anatomy and Histopathology, Ladoke Akintola University of Technology, Ogbomosho, Oyo, Nigeria
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2
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Venkataraman V, George S, Cote GM. Molecular Advances in the Treatment of Advanced Gastrointestinal Stromal Tumor. Oncologist 2023:oyad167. [PMID: 37315115 PMCID: PMC10400151 DOI: 10.1093/oncolo/oyad167] [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: 03/14/2023] [Accepted: 05/19/2023] [Indexed: 06/16/2023] Open
Abstract
Most gastrointestinal stromal tumors (GIST) are driven by activating mutations in Proto-oncogene c-KIT (KIT) or PDGFRA receptor tyrosine kinases (RTK). The emergence of effective therapies targeting these mutations has revolutionized the management of advanced GIST. However, following initiation of first-line imatinib, a tyrosine kinase inhibitor (TKI), nearly all patients will develop resistance within 2 years through the emergence of secondary resistance mutations in KIT, typically in the Adenosine Triphosphate (ATP)-binding site or activation loop of the kinase domain. Moreover, some patients have de novo resistance to imatinib, such as those with mutations in PDGFRA exon 18 or those without KIT or PDGFRA mutation. To target resistance, research efforts are primarily focused on developing next-generation inhibitors of KIT and/or PDGFRA, which can inhibit alternate receptor conformations or unique mutations, and compounds that impact complimentary pathogenic processes or epigenetic events. Here, we review the literature on the medical management of high-risk localized and advanced GIST and provide an update on clinical trial approaches to this disease.
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Affiliation(s)
- Vinayak Venkataraman
- Dana-Farber Cancer Institute, Department of Medical Oncology, Boston, MA, USA
- Mass General Hospital Cancer Center, Center for Sarcoma and Connective Tissue Oncology, Boston, MA, USA
| | - Suzanne George
- Dana-Farber Cancer Institute, Department of Medical Oncology, Boston, MA, USA
| | - Gregory M Cote
- Mass General Hospital Cancer Center, Center for Sarcoma and Connective Tissue Oncology, Boston, MA, USA
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3
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López-Pingarrón L, Almeida H, Soria-Aznar M, Reyes-Gonzales MC, Rodríguez-Moratinos AB, Muñoz-Hoyos A, García JJ. Interstitial Cells of Cajal and Enteric Nervous System in Gastrointestinal and Neurological Pathology, Relation to Oxidative Stress. Curr Issues Mol Biol 2023; 45:3552-3572. [PMID: 37185756 PMCID: PMC10136929 DOI: 10.3390/cimb45040232] [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: 03/11/2023] [Revised: 04/16/2023] [Accepted: 04/17/2023] [Indexed: 05/17/2023] Open
Abstract
The enteric nervous system (ENS) is organized into two plexuses-submucosal and myenteric-which regulate smooth muscle contraction, secretion, and blood flow along the gastrointestinal tract under the influence of the rest of the autonomic nervous system (ANS). Interstitial cells of Cajal (ICCs) are mainly located in the submucosa between the two muscle layers and at the intramuscular level. They communicate with neurons of the enteric nerve plexuses and smooth muscle fibers and generate slow waves that contribute to the control of gastrointestinal motility. They are also involved in enteric neurotransmission and exhibit mechanoreceptor activity. A close relationship appears to exist between oxidative stress and gastrointestinal diseases, in which ICCs can play a prominent role. Thus, gastrointestinal motility disorders in patients with neurological diseases may have a common ENS and central nervous system (CNS) nexus. In fact, the deleterious effects of free radicals could affect the fine interactions between ICCs and the ENS, as well as between the ENS and the CNS. In this review, we discuss possible disturbances in enteric neurotransmission and ICC function that may cause anomalous motility in the gut.
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Affiliation(s)
- Laura López-Pingarrón
- Department of Pharmacology, Physiology and Legal and Forensic Medicine, Faculty of Medicine, University of Zaragoza, 50009 Zaragoza, Spain
| | - Henrique Almeida
- i3S-Instituto de Investigação e Inovação em Saúde, Porto University, 4200-135 Porto, Portugal
- Department of Biomedicine, Faculty of Medicine, Porto University, 4200-319 Porto, Portugal
- Department of Obstetrics and Gynecology, Hospital-CUF Porto, 4100-180 Porto, Portugal
| | - Marisol Soria-Aznar
- Department of Pharmacology, Physiology and Legal and Forensic Medicine, Faculty of Medicine, University of Zaragoza, 50009 Zaragoza, Spain
| | - Marcos C Reyes-Gonzales
- Department of Pharmacology, Physiology and Legal and Forensic Medicine, Faculty of Medicine, University of Zaragoza, 50009 Zaragoza, Spain
| | | | - Antonio Muñoz-Hoyos
- Department of Pediatrics, Faculty of Medicine, University of Granada, 18016 Granada, Spain
| | - Joaquín J García
- Department of Pharmacology, Physiology and Legal and Forensic Medicine, Faculty of Medicine, University of Zaragoza, 50009 Zaragoza, Spain
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4
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Muacevic A, Adler JR, Sukaina M, Shaik Masthan S, Bint I Munir A, Iqbal Y, Qureshi MH, Husnain A, Ghafoor S, Ghafoor B, Nagarajan JS, Pervaiz F, Haseeb ul Rasool M. Histiocytic Sarcoma Secondary to Gastrointestinal Stromal Tumors: A Literature Review. Cureus 2022; 14:e33055. [PMID: 36721560 PMCID: PMC9882698 DOI: 10.7759/cureus.33055] [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: 12/28/2022] [Indexed: 12/29/2022] Open
Abstract
Histiocytic sarcoma (HS) is a rare tumor that may result from the transdifferentiation of preexisting hematolymphoid neoplasms in a subset of patients. There are instances of correlation or concurrence between HS and a number of cancers, particularly B-cell-associated hematopoietic tumors. Only three cases of HS occurring subsequent to or concurrently with gastrointestinal stromal tumors (GIST) have been recorded. Our main objective was to give an overview of demographics, clinical signs and symptoms, histopathological findings, and immunohistochemical and molecular analysis when HS develops secondary to or concurrently with GIST. A search of PubMed, Google Scholar, and ScienceDirect was undertaken using Medical Subject Headings (MeSH) keywords. According to the findings of our review, there were two males (66.6%) and one female (33.3%). The average age of patients at presentation was 59.6 years. On the immunohistochemistry, three patients were positive for cluster of differentiation (CD) 68 (100%), two patients were positive for CD 163 (67%), one patient was positive for leukocyte common antigen (LCA) (33%), and only one patient was positive for CD 4, CD 10, CD 31, CD 45, human leukocyte antigen (HLA)-DR, lysozyme, and vimentin (33%). On molecular investigation, the gastric mass of only one patient (33.33%) contained a KIT mutation on exon 11. Emperipolesis was observed in one patient (33.33%) on histological examination. Our study provides an important overview of the available literature and gives insight into important diagnostic markers of HS when it occurs secondary to or concurrently with GIST.
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5
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A Gastroenterologist's Approach to the Diagnosis and Management of Gastrointestinal Stromal Tumors. Gastroenterol Clin North Am 2022; 51:609-624. [PMID: 36153113 DOI: 10.1016/j.gtc.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal (GI) tract. These tumors have been shown to harbor oncogenic mutations of the c-kit tyrosine kinase receptor or platelet-derived growth factor receptor alpha (PDGFRA). Immunohistochemical analysis of GISTs allows for the differentiation of these tumors from other mesenchymal tumors of the GI tract such as leiomyomas and leiomyosarcomas. All GISTs have the potential to behave in a malignant fashion. Tumor location, size, and mitotic index are factors used to predict the risk of malignant behavior. Endoscopy and endoscopic ultrasound play a critical role in the diagnosis of GISTs and can yield important information to further risk-stratify tumors and determine management. This article provides a gastroenterologist's perspective on the diagnosis and management of GISTs.
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6
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Banerjee S, Yoon H, Ting S, Tang CM, Yebra M, Wenzel AT, Yeerna H, Mesirov JP, Wechsler-Reya RJ, Tamayo P, Sicklick JK. KIT low Cells Mediate Imatinib Resistance in Gastrointestinal Stromal Tumor. Mol Cancer Ther 2021; 20:2035-2048. [PMID: 34376580 PMCID: PMC8492542 DOI: 10.1158/1535-7163.mct-20-0973] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 04/06/2021] [Accepted: 06/30/2021] [Indexed: 11/16/2022]
Abstract
Gastrointestinal stromal tumor (GIST) is commonly driven by oncogenic KIT mutations that are effectively targeted by imatinib (IM), a tyrosine kinase inhibitor (TKI). However, IM does not cure GIST, and adjuvant therapy only delays recurrence in high-risk tumors. We hypothesized that GIST contains cells with primary IM resistance that may represent a reservoir for disease persistence. Here, we report a subpopulation of CD34+KITlow human GIST cells that have intrinsic IM resistance. These cells possess cancer stem cell-like expression profiles and behavior, including self-renewal and differentiation into CD34+KIThigh progeny that are sensitive to IM treatment. We also found that TKI treatment of GIST cell lines led to induction of stem cell-associated transcription factors (OCT4 and NANOG) and concomitant enrichment of the CD34+KITlow cell population. Using a data-driven approach, we constructed a transcriptomic-oncogenic map (Onco-GPS) based on the gene expression of 134 GIST samples to define pathway activation during GIST tumorigenesis. Tumors with low KIT expression had overexpression of cancer stem cell gene signatures consistent with our in vitro findings. Additionally, these tumors had activation of the Gas6/AXL pathway and NF-κB signaling gene signatures. We evaluated these targets in vitro and found that primary IM-resistant GIST cells were effectively targeted with either single-agent bemcentinib (AXL inhibitor) or bardoxolone (NF-κB inhibitor), as well as with either agent in combination with IM. Collectively, these findings suggest that CD34+KITlow cells represent a distinct, but targetable, subpopulation in human GIST that may represent a novel mechanism of primary TKI resistance, as well as a target for overcoming disease persistence following TKI therapy.
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Affiliation(s)
- Sudeep Banerjee
- Department of Surgery, Division of Surgical Oncology, University of California, San Diego, California
- Department of Surgery, University of California, Los Angeles, California
- Moores Cancer Center, University of California, San Diego, California
| | - Hyunho Yoon
- Department of Surgery, Division of Surgical Oncology, University of California, San Diego, California
- Moores Cancer Center, University of California, San Diego, California
- Department of Medical and Biological Sciences, The Catholic University of Korea, Bucheon, Republic of Korea
| | - Stephanie Ting
- Moores Cancer Center, University of California, San Diego, California
- Department of Medicine, Division of Medical Genetics, University of California, San Diego, California
| | - Chih-Min Tang
- Department of Surgery, Division of Surgical Oncology, University of California, San Diego, California
- Moores Cancer Center, University of California, San Diego, California
| | - Mayra Yebra
- Department of Surgery, Division of Surgical Oncology, University of California, San Diego, California
- Moores Cancer Center, University of California, San Diego, California
| | - Alexander T Wenzel
- Moores Cancer Center, University of California, San Diego, California
- Department of Medicine, Division of Medical Genetics, University of California, San Diego, California
| | - Huwate Yeerna
- Moores Cancer Center, University of California, San Diego, California
- Department of Medicine, Division of Medical Genetics, University of California, San Diego, California
| | - Jill P Mesirov
- Moores Cancer Center, University of California, San Diego, California
- Department of Medicine, Division of Medical Genetics, University of California, San Diego, California
| | | | - Pablo Tamayo
- Moores Cancer Center, University of California, San Diego, California
- Department of Medicine, Division of Medical Genetics, University of California, San Diego, California
- UCSD Center for Novel Therapeutics, La Jolla, California
| | - Jason K Sicklick
- Department of Surgery, Division of Surgical Oncology, University of California, San Diego, California.
- Moores Cancer Center, University of California, San Diego, California
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7
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Baiomi A, Abbas H, Bhavna B. Gastrointestinal Stromal Tumor as a Rare Cause of Abdominal Mass: A Case Report and Literature Review. Cureus 2021; 13:e14070. [PMID: 33903833 PMCID: PMC8062314 DOI: 10.7759/cureus.14070] [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] [Indexed: 11/05/2022] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are soft tissue sarcomas that can arise from any part of the digestive system. GISTs represent 1% of gastric neoplasms. We report a rare case of a GIST tumor in a 59-year-old woman who presented with abdominal pain and weight loss. Computed tomography (CT) of the abdomen with intravenous contrast revealed a left upper quadrant abdominal mass and biopsy showed GIST. She was treated with imatinib to downsize the tumor prior to undergoing surgical resection of the tumor.
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Affiliation(s)
- Ahmed Baiomi
- Internal Medicine, BronxCare Health System, New York, USA
| | - Hafsa Abbas
- Gastroenterology, BronxCare Health System, New York, USA
| | - Balar Bhavna
- Internal Medicine, BronxCare Health System, New York, USA
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8
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Ambrosio M, Testa AC, Moro F, Franchi D, Scifo MC, Rams N, Epstein E, Alcazar JL, Hidalgo JJ, Van Holsbeke C, Burgetova A, Dundr P, Cibula D, Fischerova D. Imaging in gynecological disease (19): clinical and ultrasound features of extragastrointestinal stromal tumors (eGIST). ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 56:749-758. [PMID: 31909545 DOI: 10.1002/uog.21968] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 12/18/2019] [Accepted: 12/20/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To describe the clinical and sonographic characteristics of extragastrointestinal stromal tumors (eGISTs). METHODS This was a retrospective multicenter study. The data of patients with a histological diagnosis of eGIST who had undergone preoperative ultrasound examination were retrieved from the databases of nine large European gynecologic oncology centers. One investigator from each center reviewed stored images and ultrasound reports, and described the lesions using the terminology of the International Ovarian Tumor Analysis and Morphological Uterus Sonographic Assessment groups, following a predefined ultrasound evaluation form. Clinical, surgical and pathological information was also recorded. RESULTS Thirty-five women with an eGIST were identified; in 17 cases, the findings were incidental, and 18 cases were symptomatic. Median age was 57 years (range, 21-85 years). Tumor marker CA 125 was available in 23 (65.7%) patients, with a median level of 23 U/mL (range, 7-403 U/mL). The vast majority of eGISTs were intraperitoneal lesions (n = 32 (91.4%)); the remaining lesions were retroperitoneal (n = 2 (5.7%)) or preperitoneal (n = 1 (2.9%)). The most common site of the tumor was the abdomen (n = 23 (65.7%)), and less frequently the pelvis (n = 12 (34.3%)). eGISTs were typically large (median largest diameter, 79 mm) solid (n = 31 (88.6%)) tumors, and were less frequently multilocular-solid tumors (n = 4 (11.4%)). The echogenicity of solid tumors was uniform in 8/31 (25.8%) cases, which were all hypoechogenic. Twenty-three solid eGISTs were non-uniform, either with mixed echogenicity (9/23 (39.1%)) or with cystic areas (14/23 (60.9%)). The tumor shape was mainly lobular (n = 19 (54.3%)) or irregular (n = 10 (28.6%)). Tumors were typically richly vascularized (color score of 3 or 4, n = 31 (88.6%)) with no shadowing (n = 31 (88.6%)). Based on pattern recognition, eGISTs were usually correctly classified as a malignant lesion in the ultrasound reports (n = 32 (91.4%)), and the specific diagnosis of eGIST was the most frequent differential diagnosis (n = 16 (45.7%)), followed by primary ovarian cancer (n = 5 (14.3%)), lymphoma (n = 2 (5.7%)) and pedunculated uterine fibroid (n = 2 (5.7%)). CONCLUSIONS On ultrasound, eGISTs were usually solid, non-uniform pelvic or abdominal lobular tumors of mixed echogenicity, with or without cystic areas, with rich vascularization and no shadowing. The presence of a tumor with these features, without connection to the bowel wall, and not originating from the uterus or adnexa, is highly suspicious for eGIST. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- M Ambrosio
- Department of Obstetrics and Gynecology, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - A C Testa
- Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Dipartimento Scienze della Vita e Sanità pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - F Moro
- Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - D Franchi
- Division of Gynecology, European Institute of Oncology, Milan, Italy
| | - M C Scifo
- Department of Obstetrics and Gynecology, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - N Rams
- Hospital Santa Cruz y San Pablo, Barcelona, Spain
| | - E Epstein
- Department of Clinical Science and Education, Karolinska Institutet & Department of Obstetrics and Gynecology, Södersjukhuset, Stockholm, Sweden
| | - J L Alcazar
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain
| | - J J Hidalgo
- Department of Obstetrics and Gynecology, Clinic Hospital Valencia, Valencia, Spain
| | | | - A Burgetova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - P Dundr
- Department of Pathology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - D Cibula
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - D Fischerova
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
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Ren L, Qian H, Wang J, Jin P, Hu Q, Yu J, Zhang X, Zhang Y, Huang H. A Serosa-Originated Gastric Stromal Tumor Misdiagnosed by Ultrasonography and Frozen Section Pathology: A Case Report. Onco Targets Ther 2020; 13:5831-5835. [PMID: 32606793 PMCID: PMC7314643 DOI: 10.2147/ott.s257013] [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: 04/05/2020] [Accepted: 05/30/2020] [Indexed: 11/23/2022] Open
Abstract
Gastric gastrointestinal stromal tumor (GIST) is a mesenchymal neoplasm, typically arising from the muscularis propria layer of the stomach wall. Serosa-derived GIST is rarely seen and has not been reported yet. A 49-year-old Chinese female was presented with marked abdominal distension. Ultrasonography revealed a retroperitoneal tumor adjacent to the stomach wall with an intact structure of five echo layers, indicating a non-stomach tumor origin. Preoperative radiological studies suggested tight tumor-stomach adjacency, which was confirmed by intraoperative dissection. Initial frozen section indicated a pathological diagnosis of spindle cell tumor, which turned out to be a gastric GIST originated from the serosa layer of the stomach wall. The current case demonstrates the rare occurrence of serosa-derived GIST. This case also suggests difficulties in preoperative diagnosis of gastric GISTs, especially when uncommon pathological conditions like rare tumor origins were presented.
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Affiliation(s)
- Lizhong Ren
- Department of Ultrasound, Shengzhou People's Hospital, Shaoxing 312400, People's Republic of China
| | - Hongrong Qian
- Department of Ultrasound, Shengzhou People's Hospital, Shaoxing 312400, People's Republic of China
| | - Junsen Wang
- Department of Pathology, Shengzhou People's Hospital, Shaoxing 312400, People's Republic of China
| | - Piaopiao Jin
- Health Management Center, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, People's Republic of China
| | - Qida Hu
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, People's Republic of China
| | - Jiajie Yu
- Department of Surgery, Shengzhou People's Hospital, Shaoxing 312400, People's Republic of China
| | - Xin Zhang
- Department of Radiology, Shengzhou People's Hospital, Shaoxing 312400, People's Republic of China
| | - Yun Zhang
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, People's Republic of China
| | - Haifeng Huang
- Department of Surgery, Shengzhou People's Hospital, Shaoxing 312400, People's Republic of China
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10
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Almquist M, Nordenström E. R1 Resection in Gastrointestinal Stromal Tumors Is Not Worse Than R0. JAMA Surg 2020; 155:e200398. [PMID: 32236515 DOI: 10.1001/jamasurg.2020.0398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Martin Almquist
- Department of Clinical Sciences Lund, Lund University; Section of Endocrine and Sarcoma, Department of Surgery, Skåne University Hospital, Lund, Sweden
| | - Erik Nordenström
- Department of Clinical Sciences Lund, Lund University; Section of Endocrine and Sarcoma, Department of Surgery, Skåne University Hospital, Lund, Sweden
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11
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Gastrointestinal stromal tumor (GIST) in an adolescent. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2018. [DOI: 10.1016/j.epsc.2018.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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12
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Arellano-López P, Solalinde-Vargas R, Guzmán-Mejía J, González-Pérez L, Zamora-García A. Gastrointestinal stromal tumor of the stomach. Case report. REVISTA MÉDICA DEL HOSPITAL GENERAL DE MÉXICO 2018. [DOI: 10.1016/j.hgmx.2016.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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13
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Sarmiento R, Bonginelli P, Cacciamani F, Salerno F, Gasparini G. Gastrointestinal Stromal Tumors (GISTs): From Science to Targeted Therapy. Int J Biol Markers 2018; 23:96-110. [DOI: 10.1177/172460080802300206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. GISTs represent a distinct category of tumors characterized by oncogenic mutations of the KIT receptor tyrosine kinase in a majority of patients. KIT is useful not only for the diagnosis but also for targeted therapy of this disease. Imatinib, a tyrosine kinase inhibitor, is widely used in advanced and metastatic GISTs. This agent revolutionized the treatment strategy of advanced disease and is being tested in the neoadjuvant and adjuvant settings with encouraging results. New therapeutic agents like sunitinib have now been approved, enriching the treatment scenario for imatinib-resistant GISTs. The present review reports on the peculiar characteristics of this disease through its biology and molecular patterns, focusing on the predictive value of KIT mutations and their correlation with clinical outcome as well as on the activity of and resistance to approved targeted drugs.
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Affiliation(s)
- R. Sarmiento
- Division of Medical Oncology, San Filippo Neri Hospital, Rome - Italy
| | - P. Bonginelli
- Division of Medical Oncology, San Filippo Neri Hospital, Rome - Italy
| | - F. Cacciamani
- Division of Medical Oncology, San Filippo Neri Hospital, Rome - Italy
| | - F. Salerno
- Division of Medical Oncology, San Filippo Neri Hospital, Rome - Italy
| | - G. Gasparini
- Division of Medical Oncology, San Filippo Neri Hospital, Rome - Italy
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14
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Sawaki A, Kanda T, Komatsu Y, Nishida T. Impact of rechallenge with imatinib in patients with advanced gastrointestinal stromal tumor after failure of imatinib and sunitinib. Gastroenterol Res Pract 2014; 2014:342986. [PMID: 24587795 PMCID: PMC3920623 DOI: 10.1155/2014/342986] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 12/27/2013] [Indexed: 11/18/2022] Open
Abstract
Purpose. This retrospective, nonrandomized study investigated the effect of imatinib rechallenge plus best supportive care (BSC) on overall survival after imatinib and sunitinib treatment for patients with locally advanced or metastatic gastrointestinal stromal tumor (GIST). Methods. Twenty-six patients who had previously been exposed to both imatinib and sunitinib were enrolled in this study. The treatment regimen was BSC with or without imatinib, based on the patient's choice after discussion with his or her physician. The primary endpoint was overall survival, and secondary endpoints were time to treatment failure, clinical response rate assessed by Choi criteria, and safety. Results. Fourteen patients were treated with imatinib plus BSC and 12 received BSC alone. Median overall survival was greatly improved for the imatinib group, although differences were not significant (22 months for imatinib plus BSC versus 4 months for BSC; P = 0.058). Three patients (21%) had a clinical response in the imatinib group, and one had a clinical response in the BSC alone group. Imatinib was well tolerated. Conclusions. Rechallenge with imatinib may be associated with improvement in overall survival without deteriorating performance status in patients who failed imatinib and sunitinib. A prospective study should be considered to confirm the efficacy of rechallenge with imatinib.
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Affiliation(s)
- Akira Sawaki
- Department of Gastroenterology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya-shi, Aichi 464-8681, Japan
| | - Tatsuo Kanda
- Digestive and General Surgery 2 Division, Niigata University Hospital, 754 Ichibancho, Asahimachidori, Chuo-ku, Niigata-shi, Niigata 951-8510, Japan
| | - Yoshito Komatsu
- Department of Cancer Chemotherapy, Hokkaido University Hospital, Cancer Center, Kita 14-jo Nishi 5-chome, Kita-ku, Sapporo-shi, Hokkaido 060-8648, Japan
| | - Toshirou Nishida
- Department of Surgery, Osaka University, School of Medicine, 2-2 Yamadaoka, Suita-shi, Osaka 565-0871, Japan
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15
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Heldin CH, Lennartsson J. Structural and functional properties of platelet-derived growth factor and stem cell factor receptors. Cold Spring Harb Perspect Biol 2013; 5:a009100. [PMID: 23906712 DOI: 10.1101/cshperspect.a009100] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The receptors for platelet-derived growth factor (PDGF) and stem cell factor (SCF) are members of the type III class of PTK receptors, which are characterized by five Ig-like domains extracellularly and a split kinase domain intracellularly. The receptors are activated by ligand-induced dimerization, leading to autophosphorylation on specific tyrosine residues. Thereby the kinase activities of the receptors are activated and docking sites for downstream SH2 domain signal transduction molecules are created; activation of these pathways promotes cell growth, survival, and migration. These receptors mediate important signals during the embryonal development, and control tissue homeostasis in the adult. Their overactivity is seen in malignancies and other diseases involving excessive cell proliferation, such as atherosclerosis and fibrotic diseases. In cancer, mutations of PDGF and SCF receptors-including gene fusions, point mutations, and amplifications-drive subpopulations of certain malignancies, such as gastrointestinal stromal tumors, chronic myelomonocytic leukemia, hypereosinophilic syndrome, glioblastoma, acute myeloid leukemia, mastocytosis, and melanoma.
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Affiliation(s)
- Carl-Henrik Heldin
- Ludwig Institute for Cancer Research, Uppsala University, SE-751 24 Uppsala, Sweden.
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16
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Zhong Y, Deng M, Liu B, Chen C, Li M, Xu R. Primary gastrointestinal stromal tumors: Current advances in diagnostic biomarkers, prognostic factors and management of its duodenal location. Intractable Rare Dis Res 2013; 2:11-7. [PMID: 25343095 PMCID: PMC4204577 DOI: 10.5582/irdr.2013.v2.1.11] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Revised: 02/14/2013] [Accepted: 02/17/2013] [Indexed: 02/07/2023] Open
Abstract
Gastrointestinal stromal tumors (GIST) constitute 1-3% of all gastrointestinal malignancies and is the most common mesenchymal tumor of the gastrointestinal tract. Although GIST were first described in the literature in the year 1941, important advances of kit mutation and tyrosine kinase inhibitors were not made to understand and manage GIST until the last decade. Here current advances in research of possible cellular origin, diagnostic biomarkers and prognostic factors of primary GIST are reviewed, and the management of primary duodenal GIST is focused on due to its specific location. It is possible that personalized assessment and therapy will turn out to be another milestone for primary GIST.
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Affiliation(s)
- Yuesi Zhong
- Department of Hepatobiliary Surgery, Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Meihai Deng
- Department of Hepatobiliary Surgery, Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Bo Liu
- Department of General Surgery, Lingnan Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Cheng Chen
- Department of Hepatobiliary Surgery, Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Mingliang Li
- Department of Hepatobiliary Surgery, Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Ruiyun Xu
- Department of Hepatobiliary Surgery, Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
- Address correspondence to: Dr. Ruiyun Xu, Department of Hepatobiliary Surgery, Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, China. E-mail:
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17
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Safety and efficacy of image-guided percutaneous biopsies in the diagnosis of gastrointestinal stromal tumors. Clin Imaging 2012; 36:19-23. [PMID: 22226438 DOI: 10.1016/j.clinimag.2011.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Accepted: 03/30/2011] [Indexed: 01/26/2023]
Abstract
BACKGROUND After the invention of effective target agent therapy for gastrointestinal stromal tumors (GISTs), percutaneous biopsies may be indicated for unresectable diseases or before neoadjuvant chemotherapy. The purpose of this study was to evaluate the safety and efficacy of percutaneous biopsies for GISTs. MATERIAL AND METHODS Fifty-eight procedures of transluminal biopsies or image-guided percutaneous biopsies in 49 patients at our Institution from 1999 to 2010 were retrospectively reviewed. RESULT Twenty-three transluminal biopsies, 20 ultrasonography-guided biopsies, and 15 CT-guided biopsies were performed. Failure rate was higher in the group of transluminal biopsies (17%). There is no major procedure-related complication in patients who underwent percutaneous biopsy. However, life-threatening bleeding after transluminal biopsies happened in two patients. CONCLUSION Image-guided percutaneous biopsy is a safe and efficient alternative tool for the diagnosis of patients with GISTs.
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18
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Abstract
Gastrointestinal stromal tumors (GISTs) are soft tissue sarcomas arising in the GI tract. Most GISTs have an activating mutation in KIT or PDGFR-alpha and respond to treatment with imatinib mesylate (Gleevec, Novartis), a small molecule tyrosine kinase inhibitor that blocks downstream signaling of the mutated kinase. Imatinib has dramatically improved survival in patients with unresectable or metastatic GIST; however, approximately 15 percent of patients do not respond to imatinib, and many others progress after an initial period of response or disease stabilization. New agents that target multiple kinases in GIST as well as downstream effector molecules are being developed and tested in clinical trials.
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Affiliation(s)
- Michelle S Boyar
- Mesothelioma/Sarcoma Program, Division of Medical Oncology, Columbia College of Physicians and Surgeons, Columbia University Medical Center, New York, New York, USA.
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19
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Somaiah N, von Mehren M. New therapeutic approaches for advanced gastrointestinal stromal tumors. Hematol Oncol Clin North Am 2009; 23:139-50, x. [PMID: 19248977 PMCID: PMC2861350 DOI: 10.1016/j.hoc.2008.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The management of advanced gastrointestinal stromal tumor is increasingly complex because of imatinib refractory disease. Primary resistance to imatinib is uncommon, and most patients progress after development of additional genetic changes. This article reviews management strategies including surgical approaches, local modalities for progressive liver metastases, as well as novel therapeutic agents.
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Affiliation(s)
- Neeta Somaiah
- Fellow, Hematology Oncology, Fox Chase Cancer Center, Philadelphia, PA, , Add: 333 Cottman Ave., Philadelphia, PA-19111, Tel: 215 728-3545, Fax: 215 728-3639
| | - Margaret von Mehren
- Director, Sarcoma Oncology, Fox Chase Cancer Center, , Add: 333 Cottman Ave., Philadelphia, PA-19111, Tel: 215 728-2674, Fax: 215 728-3639
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20
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Abstract
Sarcomas comprise a heterogeneous group of mesenchymal neoplasms. They can be grouped into 2 general categories, soft tissue sarcoma and primary bone sarcoma, which have different staging and treatment approaches. This review includes a discussion of both soft tissue sarcomas (malignant fibrous histiocytoma, liposarcoma, leiomyosarcoma, synovial sarcoma, dermatofibrosarcoma protuberans, angiosarcoma, Kaposi sarcoma, gastrointestinal stromal tumor, aggressive fibromatosis or desmoid tumor, rhabdomyosarcoma, and primary alveolar soft-part sarcoma) and primary bone sarcomas (osteosarcoma, Ewing sarcoma, giant cell tumor, and chondrosarcoma). The 3 most important prognostic variables are grade, size, and location of the primary tumor. The approach to a patient with a sarcoma begins with a biopsy that obtains adequate tissue for diagnosis without interfering with subsequent optimal definitive surgery. Subsequent treatment depends on the specific type of sarcoma. Because sarcomas are relatively uncommon yet comprise a wide variety of different entities, evaluation by oncology teams who have expertise in the field is recommended. Treatment and follow-up guidelines have been published by the National Comprehensive Cancer Network (www.nccn.org).
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Affiliation(s)
- Keith M Skubitz
- Department of Medicine, University of Minnesota Medical School and Masonic Cancer Center, Minneapolis, USA.
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21
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Gutierrez JC, De Oliveira LOP, Perez EA, Rocha-Lima C, Livingstone AS, Koniaris LG. Optimizing diagnosis, staging, and management of gastrointestinal stromal tumors. J Am Coll Surg 2007; 205:479-91 (Quiz 524). [PMID: 17765165 DOI: 10.1016/j.jamcollsurg.2007.04.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2006] [Revised: 01/22/2007] [Accepted: 04/02/2007] [Indexed: 01/22/2023]
Affiliation(s)
- Juan C Gutierrez
- Department of Surgery, Division of Surgical Oncology, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL 33136, USA
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22
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Badalamenti G, Rodolico V, Fulfaro F, Cascio S, Cipolla C, Cicero G, Incorvaia L, Sanfilippo M, Intrivici C, Sandonato L, Pantuso G, Latteri MA, Gebbia N, Russo A. Gastrointestinal stromal tumors (GISTs): focus on histopathological diagnosis and biomolecular features. Ann Oncol 2007; 18 Suppl 6:vi136-40. [PMID: 17591808 DOI: 10.1093/annonc/mdm243] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors of the gastrointestinal tract that are believed to originate from a neoplastic transformation of the intestinal pacemaker cells (interstitial cells of Cajal) normally found in the bowel wall or their precursors. Although the microscopic features have been known for a long time, the defining characteristic of GIST is the presence of the cell-surface antigen CD117 (KIT), which is demonstrated by immunohistochemistry. KIT, which is a growth factor transmembrane receptor, is the product of the proto-oncogene c-kit (chromosome 4). Surgical removal remains the only curative treatment for patients with GISTs. Tumor size, mitotic index, anatomic location, tumor rupture and disease-free interval are the classic characteristics used to predict the clinical course of patients who undergo complete gross resection. Most GISTs express constitutively activated mutant isoforms of KIT or kinase platelet-derived growth factor receptor alpha (PDGFRA) that are potential therapeutic targets for imatinib mesylate. Imatinib mesylate is a rationally designed, molecularly specific oral anticancer agent that selectively inhibits several protein tyrosine kinases central to the pathogenesis of human cancer and which has demonstrated remarkable clinical efficacy in patients with chronic myeloid leukemia and malignant GISTs. More recently Sunitinib, a new KIT/PDGFRA kinase inhibitor, has been tested in patients with GIST resistant to imatinib, with promising results.
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Affiliation(s)
- G Badalamenti
- Section of Medical Oncology, Università di Palermo, Italy
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23
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Terkivatan T, Kliffen M, de Wilt JHW, van Geel AN, Eggermont AMM, Verhoef C. Giant solitary fibrous tumour of the liver. World J Surg Oncol 2006; 4:81. [PMID: 17118185 PMCID: PMC1661593 DOI: 10.1186/1477-7819-4-81] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2006] [Accepted: 11/21/2006] [Indexed: 02/07/2023] Open
Abstract
Background Solitary fibrous tumour (SFT) is an uncommon mesenchymal neoplasm that most frequently affects the pleura, although it has been reported with increasing frequency in various other sites such as in the peritoneum, pericardium and in non-serosal sites such as lung parenchyma, upper respiratory tract, orbit, thyroid, parotid gland, or thymus. Liver parenchyma is rarely affected. Clinically, SFTs cause symptoms after having reached a certain size or when vital structures are involved. In recent years, SFTs are more often identified and distinguished from other tumours with a similar appearance due to the availability of characteristic immunohistochemical markers. Case presentation In this manuscript we report the case of a large tumour of the liver, which was histologically diagnosed as a SFT, and showed involvement of a single hepatic segment. Because of the patient's presentation and clinical course, it may represent a radiation-induced lesion. Conclusion When a SFT has been diagnosed, surgery is the treatment of choice. The small number of patients with a SFT of the liver and its unknown natural behaviour creates the need to a careful registration and follow-up of all identified cases
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Affiliation(s)
- Türkan Terkivatan
- Department of Surgical Oncology, Erasmus University Medical Center, Daniel den Hoed Cancer Center, Rotterdam, The Netherlands
| | - Mike Kliffen
- Department of Pathology, Erasmus University Medical Center, Daniel den Hoed Cancer Center, Rotterdam, The Netherlands
| | - Johannes HW de Wilt
- Department of Surgical Oncology, Erasmus University Medical Center, Daniel den Hoed Cancer Center, Rotterdam, The Netherlands
| | - Albertus N van Geel
- Department of Surgical Oncology, Erasmus University Medical Center, Daniel den Hoed Cancer Center, Rotterdam, The Netherlands
| | - Alexander MM Eggermont
- Department of Surgical Oncology, Erasmus University Medical Center, Daniel den Hoed Cancer Center, Rotterdam, The Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus University Medical Center, Daniel den Hoed Cancer Center, Rotterdam, The Netherlands
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24
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Basterretxea Badiola L, Arévalo Lobera S, Zapata Morcillo E, Peláez Lorenzo B, Díaz de Corcuera Frutos I, La Casta Muñoa A, Felipo Berlanga F. [Gastrointestinal stromal tumors presenting as pelvic masses]. GASTROENTEROLOGIA Y HEPATOLOGIA 2006; 29:447-50. [PMID: 17020677 DOI: 10.1157/13092563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Gastrointestinal stromal tumors (GIST) appear in the abdominal cavity in less than 5% of patients. We present two cases of extraintestinal GIST attended in our service and treated with imatinib mesylate. We review the current treatment of these neoplasms with targeted therapies.
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Affiliation(s)
- L Basterretxea Badiola
- Servicio de Oncología Médica, Hospital Donostia, Po. Dr Beguiristain s/n, 20014 San Sebastián, Guipúzcoa, Spain.
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25
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Liu FY, Qi JP, Xu FL, Wu AP. Clinicopathological and immunohistochemical analysis of gastrointestinal stromal tumor. World J Gastroenterol 2006; 12:4161-5. [PMID: 16830365 PMCID: PMC4087364 DOI: 10.3748/wjg.v12.i26.4161] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the clinicopathological features of gastrointestinal stromal tumor (GIST) and to study the reference indexes for malignancy.
METHODS: Fifty-two cases of primary GIST were distinguished from a group of gastrointestinal mesenchymal tumors using a panel of antibodies such as CD117 and CD34 by immunohistochemical SP method. Their biological behaviors were analyzed using the expression of p21WAF1 and Bax in 52 cases of GIST.
RESULTS: Grossly, the tumor size was between 1.5 cm and 13 cm (mean: 5.5 cm). Focal areas of hemorrhage, necrosis, or small cyst formation could be seen. Microscopically, the tumor was composed of spindle cells (20 cases), epithelioid cells (20 cases) and mixed cells (12 cases). Immunohistochemically, CD117 and CD34 showed diffuse strong positive expressions, the positive rates were 98.1% and 92.3%. SMA, S-100, NSE, NF and MBP showed focal positive expressions, the positive rates were 48.1%, 28.8%, 25%, 21.2% and 42.3% respectively. Vimentins were all positive desmin and CgA were all negative. In normal adult stomach and intestine, the immunoreactive staining for CD117 and CD34 showed immunoreactive interstitial cells of Cajal in myenteric neuroplexus. Among the 52 cases of GIST, 27 were positive for p21WAF1 (51.9%), 29 for Bax (55.8%). The expression of p21WAF1 and Bax had no significent difference with the localization, size, histological subtype of GIST, but had a significent difference with the histological grade (P = 0.000, respectively). p21WAF1 expression had a positive correlation to Bax expression (r = 0.461, P = 0.001, κ = 0.459).
CONCLUSION: GIST has complicated arrangements and various cell types. Positivity of CD117 and CD34 is the most valuable factor in diagnosing GIST. Expression of p21WAF1 and Bax plays an important role in potential malignancy and malignancy rather than in benign GIST. p21WAF1 and Bax may be used as the markers in the assessment of GIST malignant potential.
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Affiliation(s)
- Feng-Yu Liu
- Department of Pathology, First Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
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26
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Isaac JC, Willmore C, Holden JA, Layfield LJ. A c-kit-negative gastrointestinal stromal tumor with a platelet-derived growth factor receptor alpha mutation. Appl Immunohistochem Mol Morphol 2006; 14:52-6. [PMID: 16540731 DOI: 10.1097/01.pai.0000156866.84350.ec] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Gastrointestinal stromal tumors (GISTs) are well-recognized mesenchymal neoplasms of the intestinal tract. A diagnosis of GIST is not always possible using IHC techniques for detection of c-kit. The authors describe a 64-year-old man who presented with an upper abdominal quadrant mass. Histology showed a predominantly epithelioid neoplasm with focal "spindle cell" areas. IHC studies were positive for muscle markers and negative for c-kit. The morphologic and immunophenotypic appearance could be compatible with either a smooth muscle tumor or a GIST. Because of the differences in treatment protocols and prognosis between these two entities, molecular studies to detect c-kit or platelet-derived growth factor receptor (PDGFR) activating mutations were performed. No mutations were found in the c-kit gene, but a mutation was detected in the PDGFR gene. This additional molecular study allowed the authors to formulate the precise diagnosis of a c-kit-negative GIST with strong smooth muscle marker expression.
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Affiliation(s)
- Jorge C Isaac
- University of Utah, Health Sciences Center, Salt Lake City, Utah.
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27
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Abstract
Gastrointestinal stromal tumors (GISTs), the most common nonepithelial neoplasms of the gastrointestinal (GI) tract, occur most commonly in the stomach. These neoplasms were previously classified as smooth muscle tumors, but it has become apparent that they represent distinct clinicopathologic entities. All GISTs should be considered as having malignant potential, although they display varying degrees of aggressiveness. Although usually asymptomatic, large GISTs may present with pain or bleeding. Definitive diagnosis is made by immunohistochemical staining of the tissue for CD117, also known as KIT protein, a cell membrane receptor with tyrosine kinase activity. Size and mitotic activity are predictive of malignant behavior. Primary treatment for GISTs with high malignant potential is surgical resection. Specific therapy targeting the KIT receptor with imatinib has resulted in improved outcomes for patients with unresectable, metastatic, and recurrent disease.
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28
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Bucher P, Egger JF, Gervaz P, Ris F, Weintraub D, Villiger P, Buhler LH, Morel P. An audit of surgical management of gastrointestinal stromal tumours (GIST). Eur J Surg Oncol 2006; 32:310-4. [PMID: 16414236 DOI: 10.1016/j.ejso.2005.11.021] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2005] [Revised: 10/26/2005] [Accepted: 11/08/2005] [Indexed: 01/13/2023] Open
Abstract
AIM To analyze GIST outcome after primary resection and to determine if a new grading system could adequately predict there prognosis. METHODS A retrospective review (1993-2002) identified 80 patients who underwent primary surgical resection for, c-KIT positive, GIST. Follow-up was complete for all patients (median follow-up 42, range 1-132, months). GIST were classified as low or high grade according to the following parameters: size, mitotic rate, mitotic index (MiB1), presence of necrosis, invasion of adjacent structure and presence of metastasis. RESULTS GIST originated from the stomach (46), small bowel (30), colon and rectum two and mesentery two. At surgery, 94% of cases presented with localized disease and 6% blood born metastasis with or without lymph node invasion. Resections were complete (R0) in 72 cases. R0 resection correlated with prognosis (p<0.01). Sixty GIST were classified as low grade (median follow-up 60 months) and 20 as high grade (median follow-up 27 months). Five-year actuarial survival of patients with low or high grade GIST were of 95 and 21%, respectively, (p<0.001). CONCLUSION Prognosis of GIST after surgical treatment is influenced by completeness of primary resection and tumour malignant potential. Low grade GIST have an excellent prognosis after surgery alone, while high grade GIST have a high rate of recurrence after primary resection. Adjuvant treatment should be advocated for patient with either high grade GIST or after incomplete primary resection. The presented grading system can reliably predict GIST outcome after primary surgical treatment. Complete surgical resection offers good chance of cure for low grade GIST, while for high grade GIST surgery alone is not sufficient. The presented grading system could be used to identify patients who may benefit of adjuvant treatment with imatinib mesylate after GIST resection.
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Affiliation(s)
- P Bucher
- Department of Surgery, Visceral and Transplantation Surgery Clinic, Geneva University Hospital, 24 Rue Micheli-du-Crest, 1211 Geneva 14, Switzerland.
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29
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Kim KM, Kang DW, Moon WS, Park JB, Park CK, Sohn JH, Jeong JS, Cho MY, Jin SY, Choi JS, Kang DY. Gastrointestinal stromal tumors in Koreans: it's incidence and the clinical, pathologic and immunohistochemical findings. J Korean Med Sci 2005; 20:977-84. [PMID: 16361808 PMCID: PMC2779330 DOI: 10.3346/jkms.2005.20.6.977] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Seven hundred forty seven cases of gastrointestinal stromal tumors (GISTs) in Koreans who were diagnosed between 2001 and 2002 were analyzed to evaluate their occurrence and their clinical, pathologic and immunohistochemical findings. The most frequent location of tumor was in the stomach (63%), followed by the small intestine (30%), the colorectum (5%), and the esophagus (2%). c-kit expression was found in 93.6% of the cases, while CD34, SMA and S-100 protein was positive in 80.1%, 28.2%, and 20.2%, respectively. c-kit positivity was high in the stomach (94.2%) and small intestine (94.6%), while it was relatively low in the colorectum (85.0%), and esophagus (81.2%). The positivity for CD34 was correlated with the higher risk of GISTs (p = 0.04). Follow up of the patients showed that 58 primary GISTs patients died and 20 of these patients were recurrent or metastatic at the time of diagnosis. The pathologic diagnosis to predict the risk of aggressive behavior of GISTs was correlated with the numbers of tumor, clinical stage, epithelioid histologic type, cellularity, cellular atypia, necrosis, and mucosal invasion (p = 0.00). GISTs with a poor prognosis were closely related to the clinical stage at presentation, the locations of the tumor, and the ages of the patients.
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Affiliation(s)
- Kyoung-Mee Kim
- Department of Pathology, The Catholic University of Korea, Seoul, Korea
| | - Dong Wook Kang
- Department of Pathology, Eulji University, Daejeon, Korea
| | - Woo Sung Moon
- Department of Pathology, Chunbuk National University, Jeonju, Korea
| | - Jae Bok Park
- Department of Pathology, Catholic University of Daegue, Daegu, Korea
| | - Cheol Keun Park
- Department of Pathology, Sungkyunkwan University, Seoul, Korea
| | - Jin Hee Sohn
- Department of Pathology, Sungkyunkwan University, Seoul, Korea
| | - Jin Sook Jeong
- Department of Pathology, Dong-A University, Busan, Korea
| | - Mee-Yon Cho
- Department of Pathology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - So-Young Jin
- Department of Pathology, Soonchunhyang University, Seoul, Korea
| | | | - Dae Young Kang
- Department of Pathology, Chungnam National University, Daejeon, Korea
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Nagai K, Matsumura Y, Nomura J, Inui M, Tagawa T. A case of double cancer involving oral malignant melanoma and gastrointestinal stromal tumor (GIST). Int J Oral Maxillofac Surg 2005; 34:328-30. [PMID: 15741044 DOI: 10.1016/j.ijom.2004.06.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2004] [Indexed: 12/19/2022]
Abstract
We report a very rare case of double cancer involving palatal malignant melanoma and gastrointestinal stromal tumor (GIST), a rare tumor of the gastrointestinal tract originating from a primitive mesenchymal cell. After chemotherapy, radiation therapy, and treatment with interferon and OK-432, the GIST was resected and the melanoma disappeared. The patient has had no evidence of recurrent tumor, and the patient's clinical course has been uneventful for 1 year. This is probably the first report of synchronous double cancer involving oral malignant melanoma and GIST.
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Affiliation(s)
- K Nagai
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Mie University, Tsu, Mie 514-8507, Japan.
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31
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Lucchetta MC, Liberati G, Petraccia L, Campanella J, Grassi M. Gastrointestinal stromal tumors: a seldom diagnosed cause of severe anemia. Dig Dis Sci 2005; 50:815-9. [PMID: 15906750 DOI: 10.1007/s10620-005-2645-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Maria Cristina Lucchetta
- Department of Clinical and Applied Medical Therapy, Policlinico Umberto I, University of Rome "La Sapienza," 00185 Roma, Italy
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Padula A, Chin NW, Azeez S, Resetkova E, Andriko JA, Miettinen M. Primary gastrointestinal stromal tumor of the esophagus in an HIV-positive patient. Ann Diagn Pathol 2005; 9:49-53. [PMID: 15692952 DOI: 10.1053/j.anndiagpath.2004.10.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We describe a rare case of malignant gastrointestinal stromal tumor (GIST) of the esophagus presenting in an HIV-positive man. Not only did the tumor arise from an unusual anatomic site for GIST, namely, the esophagus, but it also had a predominant epithelioid cell morphology that is uncommon and preferentially associated with aggressive behavior. Exhaustive immunohistochemical studies showed strong reactivities to the classic GIST marker, CD34, and to the current more sensitive and more specific GIST marker, CD117/ c-kit protein. This immunophenotype corresponded to that of stromal tumors arising in the more common sites like stomach and small intestine as well as to that of a reported series of esophageal GISTs in the general population. Mutations of the c-kit protein was detected in the tumor, confirming previous observations. This further documents that esophageal GIST and the more common benign esophageal spindle cell lesions are pathologically distinct entities and despite its rarity, esophageal GIST should be recognized by pathologists and clinicians. The occurrence of this tumor in an HIV-positive patient is coincidental, and it resulted in an extremely unusual metastatic site that has not been reported for GISTs.
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Affiliation(s)
- Anthony Padula
- Department of Hematophatology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Affiliation(s)
- Anil M Bahadursingh
- Department of Surgery, St. Louis University School of Medicine, St. Louis, Missouri, USA
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34
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Raspollini MR, Amunni G, Villanucci A, Pinzani P, Simi L, Paglierani M, Taddei GL. c-Kit Expression in Patients with Uterine Leiomyosarcomas. Clin Cancer Res 2004; 10:3500-3. [PMID: 15161707 DOI: 10.1158/1078-0432.ccr-03-0363] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Uterine leiomyosarcomas are rare tumors characterized by their resistance to chemotherapy and radiation treatment. Surgery is the primary method of treatment, but for patients with unresectable disease, alternate therapeutic options are clearly warranted. According to initial observations of c-KIT expression, correlation with a bad prognosis, and the successful therapeutic possibility of STI571 in gastrointestinal stromal tumors, the data have encouraged us to study c-KIT expression in these tumors. EXPERIMENTAL DESIGN We analyzed the expression of c-KIT and genetic assessment of exon 11 of c-kit gene in 32 uterine leiomyosarcomas. RESULTS In 17 cases (53.1%), we observed a c-KIT expression in tumor cells. Of the 17 patients with distinct c-KIT-positive immunoreactivity, eight had I or II stage disease and nine had III or IV stage disease. Molecular genetic analysis of exon 11, analyzed by direct DNA sequencing, was performed for all of the c-KIT-positive uterine leiomyosarcomas. No mutations were found. CONCLUSION The conventional chemotherapy in leiomyosarcomas appears to be ineffective for patients with metastatic or unresectable disease, and the management of these patients poses a special problem. In these women, new therapeutic strategies are warranted. The treatment with STI571 in leiomyosarcoma patients might be hypothesized, because uterine leiomyosarcomas also express c-KIT.
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Inoue T, Suzuki T, Nakagawa K, Kurokawa Y, Satomi S, Moriya T, Sasano N, Sasano H. Immunohistopathological and molecular genetic features of a case in which gastrointestinal stromal tumor recurred five times. Pathol Int 2004; 54:196-200. [PMID: 14989743 DOI: 10.1111/j.1440-1827.2004.01607.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Gastrointestinal stromal tumor (GIST) is a distinct group of mesenchymal neoplasms recently shown to exhibit differentiation toward interstitial cells of Cajal. Although previous studies have shown that the clinical outcome of patients with GIST is associated with mitotic activity, the proliferation index determined by the Ki-67 labeling index, immunophenotype (CD34 and/or p53) and mutation in exon 11 of the c-kit, a definitive discrimination between benign and malignant GIST has not yet been established. We report a patient in whom malignant GIST in the abdomen recurred five times. In this case, the primary GIST and the five recurrent GIST were associated with c-kit immunoreactivity, but the mitotic index of the GIST tended to be increasingly higher with subsequent recurrences. Mutational analysis of the c-kit revealed that the primary and recurrent GIST were mutant-negative. These data indicated that 'morphologically appearing benign' tumors with lower proliferative parameters may also have the capacity of metastasis and recurrence.
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Affiliation(s)
- Tsukasa Inoue
- Department of Pathology, Tohoku University School of Medicine, Sendai, Japan.
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Matsuyama A, Kamoshida S, Mizoguchi Y, Shimomura R, Hirasawa Y, Inada KI, Tsutsumi Y. Appropriate Epitope Retrieval for c-kit Protein Immunostaining in Routinely Prepared Specimens of Gastrointestinal Stromal Tumor. Acta Histochem Cytochem 2004. [DOI: 10.1267/ahc.37.87] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Atsuji Matsuyama
- Department of Pathology, Fujita Health University School of Medicine
| | - Shingo Kamoshida
- Department of Pathology, Fujita Health University School of Medicine
| | | | - Ryoichi Shimomura
- Department of Pathology, Fujita Health University School of Medicine
| | - Yutaka Hirasawa
- Joint Research Clinical Laboratory, Fujita Health University Hospital
| | - Ken-ichi Inada
- Department of Pathology, Fujita Health University School of Medicine
| | - Yutaka Tsutsumi
- Department of Pathology, Fujita Health University School of Medicine
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37
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N/A. N/A. Shijie Huaren Xiaohua Zazhi 2003; 11:1732-1735. [DOI: 10.11569/wcjd.v11.i11.1732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Wang L, Felix JC, Lee JL, Tan PY, Tourgeman DE, O'Meara AT, Amezcua CA. The proto-oncogene c-kit is expressed in leiomyosarcomas of the uterus. Gynecol Oncol 2003; 90:402-6. [PMID: 12893208 DOI: 10.1016/s0090-8258(03)00274-9] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The proto-oncogene c-kit encodes for a 145-kDa transmembrane tyrosine kinase receptor. Interaction with its ligand, stem cell factor, is essential in the development of hematopoietic stem cells, mast cells, gametocytes, melanocytes, and interstitial cells of Cajal. C-kit expression has been identified in a number of different neoplasms that includes mastocytosis/mast cell leukemia, acute myeloblastic leukemia, seminoma/dysgerminoma, and gastrointestinal stromal tumors. This study examines c-kit expression in uterine endometrial stromal sarcomas, leiomyomas, and leiomyosarcomas using immunohistochemistry. METHODS Archival tissue from 38 patients with the uterine mesenchymal tumors (16 leiomyosarcomas, 8 leiomyomas, 11 low-grade endometrial stromal sarcomas, and 3 high-grade endometrial stromal sarcomas) was stained with polyclonal antibody for c-kit. Modified avidin biotin (ABC) immunoperoxidase method was employed for antibody detection. Individual tumors were considered positive if more than 10% of the cells comprising the neoplasm displayed immunoreactive staining. Staining intensity was graded 1+ to 3+ and distribution graded as focal (10-30% of the cells), intermediate (30-60% of the cells), or diffuse (>60% of the cells). RESULTS C-kit was positive in 12 (75%) of the 16 leiomyosarcomas. The staining was 3+ and diffuse in the majority of the positive tumors. C-kit expression was not detected in any of the 8 leiomyomas. Two of the 3 high-grade endometrial stromal sarcomas displayed c-kit positivity. Staining was diffuse and 3+ in both of these tumors. Expression of c-kit was observed in only 3 of the 11 low-grade endometrial stromal sarcomas. CONCLUSIONS C-kit is expressed in uterine leiomyosarcomas and endometrial stromal sarcomas. Adjunctive diagnostic studies using c-kit may be useful in distinguishing leiomyosarcomas from benign leiomyomas in uterine tumors that offer uncharacteristic features. Furthermore, studies should investigate the prospect of treating these malignant tumors with tyrosine kinase inhibitors.
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Affiliation(s)
- Lina Wang
- Department of Pathology, University of Southern California Keck School of Medicine, Los Angeles, CA 90033, USA
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39
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Affiliation(s)
- Juan Rosai
- Department of Pathology, National Cancer Institute, Milan, Italy
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40
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Raspollini MR, Villanucci A, Amunni G, Paglierani M, Taddei A, Taddei GL. C-kit expression in uterine leiomyosarcomas: an immunocytochemical study of 29 cases of malignant smooth muscle tumors of the uterus. J Chemother 2003; 15:81-4. [PMID: 12678420 DOI: 10.1179/joc.2003.15.1.81] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Uterine malignant stromal tumors are rare neoplasms characterized by fatal prognosis. At the moment no effective systemic treatment is available for metastases or recurrent disease. The drugs employed in advanced neoplasms are iposfamide, doxorubicin or epidoxorubicin, but the clinical response to chemotherapy is poor. Recent studies have shown that cells in gastrointestinal stromal tumors express a growth factor receptor with tyrosine kinase activity termed c-kit. Lately reports of efficacy of a specific anticancer drug with imatinib (ST1571) based on specific molecular abnormalities of proto-oncogene c-kit present in gastrointestinal stromal tumors induced us to identify the c-kit phenotype also in uterine leiomyosarcomas. These data may be useful for treating metastatic uterine leiomyosarcomas with increased c-kit kinase activity.
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Affiliation(s)
- M R Raspollini
- Dipartimento di Patologia Umana e Oncologia, Università degli Studi di Firenze, Florence, Italy
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Shidham VB, Chivukula M, Gupta D, Rao RN, Komorowski R. Immunohistochemical comparison of gastrointestinal stromal tumor and solitary fibrous tumor. Arch Pathol Lab Med 2002; 126:1189-92. [PMID: 12296756 DOI: 10.5858/2002-126-1189-icogst] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT The differential diagnosis of gastrointestinal stromal tumors (GIST) and solitary fibrous tumors (SFT) may be a diagnostic challenging because of overlapping clinicopathologic features. Many studies have shown consistent immunoreactivity for CD117 (c-Kit) in GIST. However, only a few studies have evaluated CD117 expression in SFT, and these studies have used an antibody from Santa Cruz Biotechnology. In non-GIST lesions, reactivity with this antibody has been shown to differ from that with a CD117 antibody from Dako Corporation. The immunoreactivity of SFT with the Dako CD117 antibody has not been reported. Conversely, CD99 is a marker for SFT, and its expression in GIST has not been evaluated. OBJECTIVE To study the immunohistochemical profiles of GIST and SFT to evaluate their diagnostic overlap. DESIGN We studied the immunoreactivity of 27 unequivocal GIST and 19 unequivocal extra-abdominal SFT for CD117, CD34, CD99, alpha-smooth muscle actin, vimentin, CD31, S100 protein, and muscle-specific actin. All antibodies, including CD117, were from Dako Corporation. RESULTS We found positive immunoreactivity for CD117 in 100% of GIST and none of SFT; for CD34 in 89% of GIST, and 100% of SFT; for CD99 in 89% of GIST and 100% of SFT; for alpha-smooth muscle actin in 48% of GIST and 31% of SFT; for vimentin in 89% of GIST and 90% of SFT; and for muscle-specific actin in 22% of GIST and none of SFT. None of the GIST or SFT showed immunoreactivity for CD31 and S100 protein. CONCLUSIONS The major difference between GIST and SFT was strong CD117 immunoexpression in all GIST and an absence of this expression in all SFT. With the exception of muscle-specific actin, the prevalence of immunoreactivity for the markers studied did not differ substantially between these 2 tumors. We conclude that GIST and SFT show distinctly divergent immunoprofiles with respect to CD117 and muscle-specific actin.
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Affiliation(s)
- Vinod B Shidham
- Department of Pathology, Medical College of Wisconsin, Milwaukee 53226, USA.
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Li P, Wei J, West AB, Perle M, Greco MA, Yang GCH. Epithelioid gastrointestinal stromal tumor of the stomach with liver metastases in a 12-year-old girl: aspiration cytology and molecular study. Pediatr Dev Pathol 2002; 5:386-94. [PMID: 12198577 DOI: 10.1007/s10024-001-0250-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2001] [Accepted: 03/14/2002] [Indexed: 12/11/2022]
Abstract
Gastrointestinal stromal tumor (GIST), a stromal tumor of the gastrointestinal tract defined as CD117 (c-kit)-positive neoplasm, occurs primarily in adults. GIST with CD117 (c-kit) mutation and certain cytogenetic abnormalities is associated with malignancy, though a definite relationship between prognosis and molecular alterations remains to be elucidated. We report the cytologic features of an epithelioid GIST arising in the stomach of a child and metastatic to the liver, and the molecular mutational analysis of both the primary gastric tumor and the liver metastasis. Literature of pediatric GISTs was also reviewed. Fine needle aspiration of the liver metastasis, processed by Ultrafast Papanicolaou stain, showed fragments of cohesive small epithelioid cells with bland oval nuclei and unipolar cytoplasm transected by capillaries. Immunohistochemically, all nodules in the stomach and liver expressed CD117 (c-kit). Interestingly, some of the gastric tumor clusters were uniformly CD34 positive, whereas others were uniformly CD34 negative, suggesting heterogeneity of tumor clones. The presence of neurosecretory granules further subtyped the tumor into gastric autonomic nerve tumor (GANT). Molecular mutational analysis, performed in both the gastric tumor and the liver metastasis, showed no sequence abnormality in exons 9, 11, and 13 of CD117 (c-kit). Cytogenetic study revealed normal karyotype. These features might suggest a different molecular mechanism leading to malignancy in certain GISTs arising in children.
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Affiliation(s)
- Peng Li
- Department of Pathology, New York University School of Medicine, 560 First Avenue, New York, NY 10016, USA
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Picken MM, Curry JL, Lindgren V, Clark JI, Eble JN. Metanephric adenosarcoma in a young adult: morphologic, immunophenotypic, ultrastructural, and fluorescence in situ hybridization analyses: a case report and review of the literature. Am J Surg Pathol 2001; 25:1451-7. [PMID: 11684965 DOI: 10.1097/00000478-200111000-00016] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Metanephric neoplasms are uncommon renal tumors that arise in both children and adults. They may be composed of small epithelial cells or benign stroma, or both, and are termed metanephric adenoma, metanephric stromal tumor, or metanephric adenofibroma, respectively. Thus far, these tumors have been known for their benign behavior. We present the case of a 21-year-old woman who developed a neoplasm composed of a renal epithelial component identical to metanephric adenoma combined with a malignant spindle cell sarcoma. The epithelial component was positive for pankeratin AE1/3, whereas the sarcomatous component was negative for epithelial markers and positive for vimentin, CD34, and CD117. No smooth muscle differentiation was apparent in the sarcoma by immunohistochemistry or ultrastructural analysis. By fluorescent in situ hybridization analysis of the sarcomatous component there was monosomy of the X chromosome, but no apparent variation from the normal diploid pattern for chromosomes 3, 7, 12, and 17. We conclude that the spectrum of metanephric neoplasia should be expanded to include malignant stromal variants, and we propose the term "metanephric adenosarcoma" for the present case.
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Affiliation(s)
- M M Picken
- Department of Pathology, Loyola University Medical Center, Chicago, Illinois 60153, USA.
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Abstract
The understanding of gastrointestinal stromal tumors (GIST) is complex because of their divergent differentiation and unpredictable behavior. However, our understanding is becoming clearer, despite some cases of tumors which are exceptions from the typical cases. Tumor size, mitotic rate and, to a lesser degree, location, are the most important predictive parameters for the behavior of GIST. In this study, expression of p53 protein was evaluated in 15 cases of GIST. Tumors were divided into three groups: (i) benign (mitotic index [MI] < 5/50 high-power fields [HPF] and size < 5 cm); (ii) borderline (MI < 5/50 HPF and size > or = 5 cm); and (iii) malignant (MI > or = 5/50 HPF, irrespective of size). The mean values of p53 expression in the three groups were significantly different (benign, 10.6%; borderline, 33.8%; and malignant, 71%). The conclusion of the present study is that p53 overexpression correlates well with the malignant potential of GIST.
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Affiliation(s)
- I A Al-Bozom
- Department of Pathology (32), King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia.
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Cui JH, Krueger U, Henne-Bruns D, Kremer B, Kalthoff H. Orthotopic transplantation model of human gastrointestinal cancer and detection of micrometastases. World J Gastroenterol 2001; 7:381-6. [PMID: 11819794 PMCID: PMC4688726 DOI: 10.3748/wjg.v7.i3.381] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To establish a relevant animal model of human gastrointestinal cancer, which can be used for repetitive investigations, so as to improve our understanding and management of carcinogenesis and cancer metastasis.
METHODS: Intact tissues of human colorectal and pancreatic cancers were transplanted in nude mice. The biological characteristics of the original and the corresponding transplanted tumors were investigated by HE staining, PAS staining and immunostaining. The metastases in the livers and lungs of nude mice were investigated by immunostaining with biotinylated mab KL-1 and by RT-PCR using CK20 specific primers.
RESULTS: There were totally 9 of 16 surgical specimens growing in nude mice subcutaneously and/or orthotopically (4 of 6 colorectal and 5 of 10 pancreatic cancer). Tumor cell content of the specimens and freezing of tissue specimens are important factors influencing the growth of transplanted tumor. In the group of fresh tumor tissues with greater than 50% tumor cell content, the success rate of the transplantation was 100% (3 cases of pancreatic cancer and 3 cases of colorectal cancer). The orthotopically transplanted tumors resemble the original tumor morphologically and biologically, including TAA expression such as CEA by immunohistochemistry, and CEA level in the serum of mice. Ki-67 labeling index and the expression of TAA especially K-ras, 17-1A and RA-96, are associated with the potential of tumor growth in nude mice. Micrometastases in the lungs and livers of tumor bearing mice can be detected by immunostaining with biotinylated mab KL-1 and CK20-specific RT-PCR.
CONCLUSION: An orthotopic transplantation model for human colon and pancreatic cancer in nude mice has been set up. We have also established sensitive detection methods with CK-immunohistochemistry and CK20-RT-PCR to study xenotransplanted human cancer and its metastatic cancer cells in the liver and lung of nude mice. This study may be helpful in understanding the mechanism of cancer metastasis and in developing new diagnostic methods and therapeutic strategies for metastases including micrometastases.
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Affiliation(s)
- J H Cui
- Department of General Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou 310003, Zhejiang Province,China.
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