Gastrointestinal Stromal Tumor Surgery and Adjuvant Therapy (original) (raw)
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Are gastrointestinal stromal tumours really asymptomatic?
Journal of Clinical and Analytical Medicine
Aim: Gastrointestinal stromal tumours (GISTs) detected incidentally during abdominal surgical interventions or imaging may cause serious morbidity and mortality. We retrospectively investigated the histopathological diagnoses of GISTs made in our clinic and possible symptoms caused by the tumours prior to diagnosis. Material and Method: We retrospectively reviewed the files of patients who underwent surgery in the general surgery clinic of Kahramanmaras Sutcu Imam University between April 2012 and January 2017 and who were histopathologically diagnosed with GISTs; all were included in the study. Demographic data including age and sex, and data on preoperative complaints at the time of admission, tumour location, metastasis, local recurrence, and death were obtained. Results: The mean male and female patient ages were 57.1 ± 15.2 and 51.3 ± 15.3 years, respectively. Abdominal pain was the most common symptom (46.2%); other symptoms included weight loss, a palpable abdominal mass, constipation, incontinence, and lower gastrointestinal tract bleeding. The ileum was the most frequently involved region of the gastrointestinal tract (30.8%); other affected areas included the jejunum, lower intestinal tract, omentum, rectum, peritoneum, stomach, and pancreas. The CD117 positivity rate was 92.3%, the CD34 positivity rate was 50%, the actin positivity rate was 69.2%, and the desmin positivity rate was 15.4%. Discussion: GISTs are generally found incidentally, but they are accompanied by some symptoms in most of patients. However, as the symptoms are shared by many diseases, they are often overlooked by doctors and patients; these tumours are not diagnosed in a timely manner.
World Journal of Surgical Oncology, 2011
Background: Gastrointestinal stromal tumors (GIST) are mesenchymal tumors of the gastrointestinal tract, usually kit-positive, that are believed to originate from interstitial cell of Cajal, or their related stem cells. The most common clinical presentation of these tumors is gastrointestinal bleeding, otherwise they may cause intestinal obstruction, abdominal pain, a palpable mass, or can be incidentally detected during surgery or endoscopic/ radiological procedures. Prognosis is related to the size of the tumor and to the mitotic rate; other prognostic factors are tumor location, tumor resection margins, tumor rupture, and c-kit mutation that may interfere with molecular target therapy efficacy.
Visceral Medicine
Background: Differentiation between benign and malignant subepithelial lesions (SELs) in the upper gastrointestinal tract (UGT) leads to far-reaching clinical consequences. An accurate diagnosis can be challenging because of the insufficient diagnostic yield of upper endoscopy, endoscopic ultrasound (EUS), and different types of biopsy. Aim: Our aim was to reveal the efficacy of upper endoscopic and EUS features for the differential diagnosis of hypoechogenic SELs (gastrointestinal stromal tumors [GISTs] and leiomyomas) in the UGT. Materials and Methods: The research covers a case series study of 27 hypoechogenic SELs in the UGT between 2012 and 2015 at Vilnius University Hospital Santaros Klinikos. Upper endoscopic and EUS features of SELs were recorded. In order to standardize the diagnostic approach to GISTs and leiomyomas, we assigned scores for seven upper endoscopic and EUS features. Results: The mean total scores in the GIST group were significantly higher than those in the leiomyoma group: 3.25 ± 1.71 and 0.53 ± 0.83 (p < 0.0001), respectively. Increment by one score increased the odds ratio for GIST 5.87 times (95% CI 1.63-21.11; p = 0.007). The total score demonstrated very good discriminatory features of GISTs against leiomyomas (area under the receiver operating characteristic curve 0.94 [0.86-1]). The cutoff value of 1.5 total score indicated 83.3% sensitivity and 93.3% specificity in diagnosing GISTs. Conclusions: Upper endoscopy and EUS are useful methods in making a definite diagnosis of SELs. Their diagnostic accuracy for the differential diagnosis of GISTs and leiomyomas is sufficient.
2014
Background and Aims: To examine the association between endoscopic and histological diagnoses concerning malignancies of the gastrointestinal tract. Material and Methods: Two hundred thirthy one patients who underwent upper or lower gastrointestinal system endoscopy and had endoscopic biopsy were recruited retrospectively from the files of our center between the years of 2010 and 2012. The study was based on four types of endoscopic lesions including: mucosal irregularity, ulcerovegetating mass, ulcer and polyp, and four histopathologic diagnoses including polyps, ulcer, gastritis and adenocarcinoma. Results: In all, 199 of 213 (86.1%) patients had gastric and duodenal biopsies and the remaining 32 (13.9%) had colonic and rectal biopsies. The mean age of the patients was 63.5 years and the mean microscopic size of the lesions was 12 mm. Fifty four (23.4%) patients had histopathologic diagnosis of malignancy. Of all the lower gastrointestinal system biopsies, 59.4% were diagnosed as ...
Incidence of gastrointestinal stromal tumours is underestimated: Results of a nation-wide study
European Journal of Cancer, 2005
Gastrointestinal stromal tumours (GIST) are identified by their specific morphology added with immunohistochemical staining with anti-CD117, the phenotypic marker for GIST in the majority of cases. In this study the reported incidence of GIST and GISTlike tumours before and after the routine availability of the specific diagnostic marker CD117 antigen was investigated. All patients with GIST or GIST-like tumours were selected from PALGA, a nation-wide network and registry of histo-and cytopathology in the Netherlands, to calculate the incidence in 1995 and longitudinally over time between 1998 and 2003. Pathological reports were retrieved to assess the type of immunostaining used and to assess the risk category for malignant behaviour according to the recently published consensus criteria. The annual incidence of GIST as distilled from the national pathology registry increased from 2.1 per million inhabitants in 1995 to 12.7 per million inhabitants in 2003. The incidence of GIST-like tumours decreased from 17.6 per million inhabitants in 1995 to 12.7 per million inhabitants in 2003. The incidences were stable from 2000 onwards. Additional analysis in 2003 indicated that more than 90% of the GIST tested was CD117 positive, compared to only 4% of the GIST-like tumours. Almost 50% of the GIST was considered to be at high-risk for malignant behaviour, according to the consensus criteria. The increased incidence of GIST 1995-2003 is related to increased understanding of GIST pathobiology and the routine availability of the diagnostic immunohistochemical antibody directed against the CD117 antigen.