scholarly journals Gastrointestinal Stromal Tumors: Alexandria University Experience

2021 ◽  
Author(s):  
Maher Soliman
Keyword(s):  
Risk Score ◽  
Tumor Size ◽  
Gastrointestinal Stromal Tumors ◽  
Multivariate Analyses ◽  
Disease Free Survival ◽  
Margin Status ◽  
High Power Field ◽  
Mesenchymal Tumors ◽  
Male Predominance ◽  
Stromal Tumors

Abstract Introduction Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract (GIT) that can arise in any parts of the GIT. The clinical behavior and prognosis of GISTs remain unpredictable. The purpose of this study was to evaluate the clinicopathological features and prognostic factors of GISTs. Methods The medical files of 93 patients with nonmetastatic GIST presented to our hospital were reviewed. The clinical and pathological parameters, treatment, and follow-up data were collected and correlated to survival outcome using univariate and multivariate analyses. Results The median age of patients was 48.9 years with a slight male predominance. Abdominal pain (39.8%) was the commonly presenting symptom. About 60% of GISTs originated from the stomach and 22% from the small intestine. Tumors stained positive for CD117 in 95.7%. The median diameter of the tumors was 7 cm. Mitotic counts were < 5/50 high power field in 55.9% of tumors. About 44% of patients had high risk tumors. All patients underwent surgery and about 60.2% of patients received adjuvant imatinib mesylate.The 5-year disease-free survival (DFS) and overall survival (OS) were 74.5 and 80%, respectively. Margin status, tumor site, tumor size, mitotic counts, and risk score were significantly associated with DFS and OS in both univariate and multivariate analyses. Conclusion Surgery is the mainstay treatment for nonmetastatic GISTs. Tumor size, tumor location, margin status, mitotic count, and risk score were predictive factors for DFS and OS of GISTs.

Outcomes of multivisceral resection of gastric gastrointestinal stromal tumors.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 91-91
Author(s):  
Sabha Ganai ◽  
Mitchell Posner ◽  
Vivek N. Prachand ◽  
John C. Alverdy ◽  
Eugene A. Choi ◽  
...  
Keyword(s):  
Tumor Size ◽  
Gastrointestinal Stromal Tumors ◽  
Disease Free Survival ◽  
Multivisceral Resection ◽  
Response To Therapy ◽  
Hospital Length Of Stay ◽  
Free Survival ◽  
Stromal Tumors ◽  
Gastric Gists ◽  
Disease Free

91 Background: Despite the recent introduction of imatinib and laparoendoscopic techniques to the management of gastric gastrointestinal stromal tumors (GISTs), outcomes remain uncertain in the setting of multivisceral involvement. Methods: We conducted a retrospective review of 69 consecutive patients who underwent resection of gastric GISTs from October 2002 through August 2011. Median follow-up was 19 months (interquartile range [IQR] 4-37). Results: Patients were 51% female, with a mean age of 65 ± 13 years and BMI of 30 ± 8 kg/m2. Patients undergoing multivisceral resection (n=13) had a longer interval from diagnosis to surgery (7.4 [IQR 1.9 – 15.0] vs. 1.3 [IQR 0.7-3.5] months, p<0.01), greater use of neoadjuvant imatinib (62% vs. 4%, p<0.001), and greater preoperative tumor size (12 ± 8 vs. 4 ± 3 cm, p<0.001) in comparison to gastric-only resections (n=56). Patients were less likely to be managed laparoscopically (8% vs. 71%, p<0.001), had a longer operative time (286 ± 92 vs. 152 ± 65 min, p<0.001), and were less likely to be R0 (69% vs. 98%, p<0.001). While patients undergoing multivisceral resection were more likely to have a pathological complete response to therapy (23% vs. 0, p<0.01), they were also more likely to have metastatic disease present (31% vs. 0, p<0.01). Hospital length of stay was greater (median 8 [IQR 7-9] vs. 3 [IQR 2-6] days, p<0.001). There were no significant differences in grade or mitotic index between groups, or in the use of adjuvant imatinib (54% vs. 23%). Overall survival was less in patients undergoing multivisceral resection (63% vs. 86% at 3 years, p<0.05), as was disease-free survival (52% vs. 71% at 3 years, p<0.05). Median disease-free survival was 50 and 66 months, respectively (p<0.01). Controlling for tumor size, grade, resection status, and the use of neoadjuvant imatinib, multivisceral resection was an independent predictor of disease-free survival (p<0.05). Conclusions: Multivisceral involvement is associated with tumors of greater size, and despite an increased use of neoadjuvant imatinib, it is associated with poor outcome for patients with gastric GISTs.

scholarly journals Gastrointestinal stromal tumors: Microscopic and immunihistochemical features

2007 ◽  
Vol 64 (9) ◽  
pp. 597-603
Author(s):  
Gorana Rancic ◽  
Vuka Katic ◽  
Ljubinka Jankovic-Velickovic ◽  
Milan Rancic
Keyword(s):  
Mitotic Index ◽  
Tumor Size ◽  
Gastrointestinal Stromal Tumors ◽  
Malignant Tumors ◽  
Smooth Muscle Actin ◽  
Biological Behavior ◽  
Mesenchymal Tumors ◽  
Stromal Tumors ◽  
S 100 ◽  
Cells Of Cajal

Background/Aim. Gastrointestinal (GI) stromal tumors (GIST) are the most common mesenchymal tumors of GI tract. The most frequent localization is gastric (60-70%) followed by intestinal localization (20-30%). The histogenesis, classification, diagnostic criteria and biological behavior of GIST are still discussable. Gastrointestinal stromal tumors are thought to originate from interstitial pacemaker intestinal cells of Cajal. Histologic appearance of a GIST is complicated and biologic potential unpredictable. The aim of of tha study was to investigate anatomic localization , the size of the tumor, incapsulation, microscopic and immunohistochemical characteristics. Methods. The study involved 21 GIST taken by a complete resection in the period from 1994-2006. The analysed parameters were the localization, size, microscopic (mitotic index, nectosis, bleeding, invasivity) and immunohistochemical characteristics (CD117 (ckit), CD34, desmin, vimentin, smooth muscle actin and s- 100 protein expression. Results. Gastrointestinal stromal tumors (n=21) size varied from 10-150 mm were most frequently gastric localised with predominance of malignant tumors (85.72%). Most GIST were comprised of a uniform spindle cell population, but some were dominated by epitheloid cells. Eosinophilic cells stained CD117, CD34 and vimentin positively, were usually arranged in fascicles with the presence of skeinoid fibers. Positive correlation of biologic potential and tumor size, haemorrhagia and mitotic index were found, so as negative correlation of biologic potential and incapsulation. Conclusion. The above results, a specially localization, tumor size, mitotic index, CD117, CD34 and vimentin positivity, may be helpful for setting of a widespread criteria for diagnostic and differential diagnosis of GIST and their use in practice and therapy. .

scholarly journals Surgical Approaches and Oncological Outcomes in the Management of Duodenal Gastrointestinal Stromal Tumors (GIST)

2021 ◽  
Vol 10 (19) ◽  
pp. 4459
Author(s):  
Nikolaos Vassos ◽  
Aristotelis Perrakis ◽  
Werner Hohenberger ◽  
Roland S. Croner
Keyword(s):  
High Risk ◽  
Surgical Approach ◽  
Tumor Size ◽  
Gastrointestinal Stromal Tumors ◽  
Tumor Biology ◽  
Disease Free Survival ◽  
Extended Resection ◽  
Stromal Tumors ◽  
Duodenal Gist ◽  
Increased Risk

Background: Duodenal gastrointestinal stromal tumors (GIST) are a rare subset of GIST. Their surgical management in this anatomically complex region consists of varied approaches, and the administration of imatinib mesylate (IM) has not been clarified. Methods: We retrospectively reviewed patients with duodenal GIST treated during a 10-year-period. We analysed the clinicopathological characteristics and survival factors and evaluated the perioperative and long-term outcomes based on the extent of resection ((ocal-resection (LR) versus pancreaticoduodenectomy (PD)) and the IM-administration. The median follow-up period was 60 months (range, 12–140). Results: A total of thirteen patients (M:F = 7:6) with median age of 64 years (range, 42–77) underwent resection of duodenal GIST. Median tumor size was 5.2 cm (range, 1.5–13.3). Eight patients (61.5%) underwent LR and five patients (38.5%) PD. R0-resection was achieved in 92.5%. Neoadjuvant IM-therapy was administered in five patients leading to tumor downsizing and in 40% to less-extended resection. The PD group consisted of larger tumors with higher mitotic count, mostly located in D2 (p = 0.031). The PD group had longer operative time (p = 0.026), longer hospital stay (p = 0.016), and higher rate of postoperative complications (p = 0.128). The actuarial 1-, 3-, and 5-year overall survival were 92.5%, 84%, and 73.5%, respectively, whereas the disease-free survival rates at 1, 3, and 5 years were 91.5%, 83%, and 72%, respectively. A tendency towards increased risk of disease recurrence was demonstrated for patients with tumor >5 cm and high-risk potential. There was not statistic survival benefit for one or the other surgical approach. Conclusion: The type of resection depends on duodenal site of origin and tumor size. LR can be the treatment of choice for duodenal GIST whenever technically feasible. Recurrence of duodenal GIST is dependent on tumor biology rather than surgical approach. Administration of IM in neaodjuvant setting should be considered in cases with high-risk GIST scheduled for PD since it might facilitate less-extended resection.

Outcomes of multivisceral resection of gastric gastrointestinal stromal tumors.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 10090-10090
Author(s):  
Sabha Ganai ◽  
Mitchell Posner ◽  
Vivek N. Prachand ◽  
John C. Alverdy ◽  
Eugene A. Choi ◽  
...  
Keyword(s):  
Tumor Size ◽  
Gastrointestinal Stromal Tumors ◽  
Disease Free Survival ◽  
Multivisceral Resection ◽  
Response To Therapy ◽  
Adjuvant Imatinib ◽  
Free Survival ◽  
Stromal Tumors ◽  
Gastric Gists ◽  
Disease Free

10090 Background: Despite the recent introduction of imatinib and laparoendoscopic techniques to the management of gastric gastrointestinal stromal tumors (GISTs), outcomes remain uncertain in the setting of multivisceral involvement. Methods: We conducted a retrospective review of 73 consecutive patients who underwent resection of gastric GISTs from October 2002 through December 2011. Median follow-up was 22 months (interquartile range [IQR] 6-37). Results: Patients were 51% female, with a mean age of 65 ± 12 years and BMI of 30 ± 8 kg/m2. Patients undergoing multivisceral resection (n=14) had a longer interval from diagnosis to surgery (7.3 [IQR 1.9 – 15.0] vs. 1.3 [IQR 0.7-4.2] months, p<0.01), greater use of neoadjuvant imatinib (64% vs. 3%, p<0.0001), and greater preoperative tumor size (12 ± 8 vs. 4 ± 3 cm, p<0.0001) in comparison to gastric-only resections (n=59). Patients were less likely to be managed laparoscopically (7% vs. 71%, p<0.0001), had a longer operative time (310 ± 117 vs. 145 ± 62 min, p<0.0001), and were less likely to be R0 (71% vs. 98%, p<0.001). While patients undergoing multivisceral resection were more likely to have a pathological complete response to therapy (29% vs. 0, p<0.001), they were also more likely to have metastatic disease present (29% vs. 0, p<0.001). Hospital length of stay was greater (median 8 [IQR 6-9] vs. 3 [IQR 2-6] days, p<0.0001). There were no significant differences in grade or mitotic index between groups. There was greater use of adjuvant imatinib (64% vs. 25%, p<0.05). Overall survival was less in patients undergoing multivisceral resection (64% vs. 87% at 3 years, p<0.05), as was disease-free survival (52% vs. 71% at 3 years, p<0.05). Median overall and disease-free survival were 43 and 22 months after multivisceral resection for gastric GISTs. Controlling for tumor size, grade, resection status, and the use of neoadjuvant imatinib, multivisceral resection and use of adjuvant imatinib were both independent predictors of disease-free survival (p<0.05). Conclusions: Multivisceral involvement is associated with tumors of greater size and, despite an increased use of neoadjuvant imatinib, it is associated with poor outcome for patients with gastric GISTs.

Multislice imaging of gastrointestinal stromal tumors

2018 ◽  
pp. 3-14
Keyword(s):  
Computed Tomography ◽  
Key Words ◽  
Gold Standard ◽  
Gastrointestinal Stromal Tumors ◽  
Mesenchymal Tumors ◽  
Stromal Tumors ◽  
Preferential Localization ◽  
Multislice Imaging ◽  
Computed Tomography Diagnosis

Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the digestive tract (1%). These tumors express the CD 117 in 95% of cases. The stomach is the preferential localization (70%). Diagnosis is difficult and sometimes late. Progress of imaging has greatly improved the management and the prognosis. Computed tomography (CT) is the gold standard for diagnosis, staging, and treatment follow-up. The increasing recognition of GIST’s histopathology and the prolonged survival revealed some suggestive imaging aspects. Key words: gastro-intestinal stromal tumors; computed tomography; diagnosis

scholarly journals Gastrointestinal Stromal Tumors (GISTs): Novel Therapeutic Strategies with Immunotherapy and Small Molecules

2021 ◽  
Vol 22 (2) ◽  
pp. 493
Author(s):  
Christos Vallilas ◽  
Panagiotis Sarantis ◽  
Anastasios Kyriazoglou ◽  
Evangelos Koustas ◽  
Stamatios Theocharis ◽  
...  
Keyword(s):  
Tyrosine Kinase ◽  
Tyrosine Kinase Inhibitors ◽  
Gastrointestinal Stromal Tumors ◽  
Kinase Inhibitors ◽  
Checkpoint Inhibitors ◽  
Survival Rates ◽  
Cancer Therapeutics ◽  
Gastrointestinal Neoplasms ◽  
Mesenchymal Tumors ◽  
Stromal Tumors

Gastrointestinal stromal tumors (GISTs) are the most common types of malignant mesenchymal tumors in the gastrointestinal tract, with an estimated incidence of 1.5/100.000 per year and 1–2% of gastrointestinal neoplasms. About 75–80% of patients have mutations in the KIT gene in exons 9, 11, 13, 14, 17, and 5–10% of patients have mutations in the platelet-derived growth factor receptor a (PDGFRA) gene in exons 12, 14, 18. Moreover, 10–15% of patients have no mutations and are classified as wild type GIST. The treatment for metastatic or unresectable GISTs includes imatinib, sunitinib, and regorafenib. So far, GIST therapies have raised great expectations and offered patients a better quality of life, but increased pharmacological resistance to tyrosine kinase inhibitors is often observed. New treatment options have emerged, with ripretinib, avapritinib, and cabozantinib getting approvals for these tumors. Nowadays, immune checkpoint inhibitors form a new landscape in cancer therapeutics and have already shown remarkable responses in various tumors. Studies in melanoma, non-small-cell lung cancer, and renal cell carcinoma are very encouraging as these inhibitors have increased survival rates. The purpose of this review is to present alternative approaches for the treatment of the GIST patients, such as combinations of immunotherapy and novel inhibitors with traditional therapies (tyrosine kinase inhibitors).

scholarly journals Skeletal Muscle Metastasis of a GIST: A Case Report and Review of the Literature

2016 ◽  
Vol 2016 ◽  
pp. 1-5
Author(s):  
Olga D. Savvidou ◽  
George D. Chloros ◽  
Georgios D. Agrogiannis ◽  
Penelope Korkolopoulou ◽  
Georgios N. Panagopoulos ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Case Report ◽  
Soft Tissue ◽  
Gastrointestinal Stromal Tumors ◽  
Review Of The Literature ◽  
Soft Tissue Metastasis ◽  
Mesenchymal Tumors ◽  
Stromal Tumors ◽  
Skeletal Muscle Metastasis ◽  
Muscle Metastasis

Gastrointestinal stromal tumors (GISTs) are the most common malignant mesenchymal tumors of the gastrointestinal tract. The most common sites of metastasis are the liver and the peritoneum, whereas metastasis to soft tissue is rare. The authors present the case of a 78-year-old male with a soft tissue metastasis of a GIST and the current literature is reviewed.

Imatinib in the Management of Multiple Gastrointestinal Stromal Tumors Associated With a Germline KIT K642E Mutation

2007 ◽  
Vol 131 (9) ◽  
pp. 1393-1396
Author(s):  
Janet Graham ◽  
Maria Debiec-Rychter ◽  
Christopher L. Corless ◽  
Robin Reid ◽  
Rosemarie Davidson ◽  
...  
Keyword(s):  
Gastrointestinal Stromal Tumors ◽  
Interstitial Cells Of Cajal ◽  
Germline Mutations ◽  
Mesenchymal Tumors ◽  
Stromal Tumors ◽  
Pdgfra Gene ◽  
Oncogenic Mutations ◽  
Esophageal Tumors ◽  
Exon 11 ◽  
Cells Of Cajal

Abstract Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gut and are distinguished by expression of CD117 (c-Kit). Oncogenic mutations in the KIT or PDGFRA gene are detected in approximately 85% of sporadic GISTs. In recent years, examples of familial GIST have been reported in which germline mutations of KIT or PDGFRA result in multiple GISTs, skin disorders, and other abnormalities. The most common germline mutations are in KIT exon 11, mutations in exons 8 and 17 have also been described, and there are 2 families with germline PDGFRA mutations. We present a case in which a germline KIT exon 13 mutation (K642E) was discovered in a patient with multiple GISTs of rectum, small intestine, and esophagus, as well as diffuse hyperplasia of the interstitial cells of Cajal. To our knowledge, this is only the second germline example of this particular mutation. The patient's esophageal tumors were stabilized with imatinib.

scholarly journals Gastric schwannoma: a benign tumor often misdiagnosed as gastrointestinal stromal tumor

2015 ◽  
Vol 5 (3) ◽  
Author(s):  
Apurva S. Shah ◽  
Pravin M. Rathi ◽  
Vaibhav S. Somani ◽  
Astha M. Mulani
Keyword(s):  
Differential Diagnosis ◽  
Gastrointestinal Stromal Tumor ◽  
Gastrointestinal Stromal Tumors ◽  
Rare Case ◽  
Benign Tumor ◽  
Stromal Tumor ◽  
Mesenchymal Tumors ◽  
Stromal Tumors ◽  
Gastric Schwannoma ◽  
Gastric Mass

Gastric schwannomas are rare mesenchymal tumors that arise from the nerve plexus of gut wall. They present with nonspecific symptoms and are often detected incidentally. Preoperative investigation is not pathognomic and many are therefore misdiagnosed as gastrointestinal stromal tumors. We report a rare case of a 37-year old woman who underwent laparotomy for complex bilateral ovarian cyst with resection of gastric-gastrointestinal stromal tumor preoperatively, but confirmed to have a gastric schwannomas postoperatively. This case underscores the differential diagnosis of submucosal, exophytic gastric mass as schwannoma.

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