Advances in Clinical and Experimental Medicine

Adv Clin Exp Med
Impact Factor (IF) – 1.262
Index Copernicus (ICV) – 155.19, MNiSW – 15
Rejection rate – 65.13%
License – Creative Commons (CC BY-NC-ND 4.0)
ISSN 1899–5276 (print),   ISSN 2451-2680 (online)
Periodicity – monthly

Download PDF

Advances in Clinical and Experimental Medicine

2014, vol. 23, nr 4, July-August, p. 567–573

Publication type: original article

Language: English

The Clinical and Histopathological Factors in Patients Operated on for Gastric GIST Tumors with Unclear Diagnosis

Sebastian Niedźwiecki1,A,B,C,D,E,F, Janusz Piekarski1,A,B,C,D,E,F, Arkadiusz Jeziorski1,A,B,C,D,E,F

1 Department of Surgical Oncology, Medical University of Łódź, Poland

Abstract

Background. The preoperative radiological diagnosis of GIST is complicated by its varied macroscopic morphology. Moreover, the precision of preoperative histopathological diagnostics is reduced by the submucosal localization of the lesion.
Objectives. The goal of the study was to perform a retrospective analysis of the clinical and histopathological factors seen in patients operated on for a stomach GIST tumor with unclear diagnosis.
Material and Methods. Two groups of GIST patients treated in our department were compared with regard to their histopathological and clinical data. The first group (9 patients, group 1) comprised patients with a histopathological diagnosis for stomach GIST confirmed before the surgical procedure, while the second group (10 patients, group 2) comprised patients with no solid histopathological diagnosis before surgery. The following clinical and histopathological variables were analyzed in the study: age, gender, presence or absence of metastases, anatomical location of metastases, symptoms, tumor size, surgical mortality, tumor recurrence, treatment with imatinib, patient survival in months, histological subtype, mitotic index, cellular atypia, necrosis, tumor ulceration and Ki-67. The results were analyzed statistically.
Results. The mean survival time differed significantly between the two study groups: group 1 being 12 months and group 2 being 8 months. The lower survival time in group 2 was connected with the higher stage of the disease at the moment of diagnosis.
Conclusion. Our findings suggest that GIST tumors with an unclear diagnosis are recognized at a late stage of the disease. The more advanced stage of the tumor probably results from faster tumor growth caused by higher proliferation activity. These GIST tumors are characterized by a lower survival rate due to the later stage of the disease at the time of diagnosis.

Key words

gastric GIST tumor, difficult diagnostic GIST, difficulties in diagnosis.

References (30)

  1. Neto RA, Logullo AF, Stávale JN, Lourenço LG: Ki-67 expression score correlates to survival rate in gastrointestinal stromal tumors (GIST). Acta Cirúrgica Brasileira 2012, 27, 315–321.
  2. Halpern J, Kim YJ, Sultana R, Villani G: Effectiveness of radiation therapy in GIST: A case report. J Gastrointest Oncol 2012, 3, 143–146.
  3. Zhou L, Liu C, Bai JG, Wei JC, Qu K, Tian F, Tai MH, Wang RT, Meng FD: A rare giant gastrointestinal stromal tumor (GIST) of the stomach traversing the upper abdomen: a case report and literature review. World J Surg Oncol 2012, 10, 66–70.
  4. Valls-Ferrusola E, García-Garzón JR, Ponce-López A, Soler-Peter M, Fuertes-Cabero S, Moragas-Solanes M, Riera-Gil E, Carrió-Gasset I, Lomeña-Caballero F: Patterns of extension of gastrointestinal stromal tumors (GIST) treated with imatinib (Gleevec)® by 18F-FDG PET/CT REV ESP ENFERM DIG 2012, 104, 360–366.
  5. Hirota S, Isozaki K, Moriyama Y, Hashimoto K, Nishida T, Ishiguro S, Kawano K, Hanada M, Kurata A, Takeda M, Muhammad Tunio G, Matsuzawa Y, Kanakura Y, Shinomura Y, Kitamura Y: Gain-of-function mutations of c-kit in human gastrointestinal stromal tumors. Science 1998, 279, 577–580.
  6. Singer S, Rubin BP, Lux ML, Chen CJ, Demetri GD, Fletcher CD, Fletcher JA: Prognostic value of KIT mutation type, mitotic activity, and histologic subtype in gastrointestinal stromal tumors. J Clin Oncol 2002, 20, 3898–3905.
  7. Dasanu CA: Length of adjuvant imatinib therapy in GIST: Weighing benefits, side effects and costs. J Oncol Pharm Pract 2012, 18, 379–380.
  8. Valadăo M, Linhares E: The role of the surgeon in the management of GIST. Rev Col Bras Cir 2009, 36, 261–265.
  9. Ciresa M, D’Angelillo RM, Ramella S, Cellini F, Gaudino D, Stimato G, Fiore M, Greco C, Nudo R, Trodella L: Molecularly targeted therapy and radiotherapy in the management of localized gastrointestinal stromal tumor (GIST) of the rectum: a case report. Tumori 2009, 95, 236–233.
  10. Sanchez Hidalgo JM, Rufian Peña S, Ciria Bru R, Naranjo Torres A, Muñoz Casares C, Ruiz Rabelo J, Briceño Delgado J: Gastrointestinal Stromal Tumors (GIST): A Prospective Evaluation of Risk Factors and Prognostic Scores. J Gastrointest Canc 2010, 41, 27–37.
  11. Miettinen M, Lasota J: Gastrointestinal stromal tumors. Review on morphology, molecular pathology, prognosis, and differential diagnosis. Arch Pathol Lab Med 2006, 130, 1466–1478.
  12. Stamatakos M, Douzinas E, Stefanaki C, Safioleas P, Polyzou E, Levidou G, Safioleas M: Gastrointestinal stromal tumor. World J Surg Oncol 2009, 7, 61–69.
  13. Wroński M, Cebulski W, Pawłowski W, Krasnodębski IW: Diagnostic difficulties in patients with gastrointestinal stromal tumour. Przegl Gastroenterol 2006, 1, 115–120.
  14. Burkill GJ, Badran M, Al-Muderis O, Meirion Thomas J, Judson IR, Fisher C, Moskovic EC: Malignant gastrointestinal stromal tumor: distribution, imaging features, and pattern of metastatic spread. Radiology 2003, 226, 527–532.
  15. Otomi Y, Otsuka H, Morita N, Terazawa K, Furutani K, Harada M, Nishitani H: Relationship between FDG uptake and the pathological risk category in gastrointestinal stromal tumors. J Med Invest 2010, 57, 270–274.
  16. Wang CM, Fu H, Zhao GF, Wang J, Shi YQ: CT Scan is not Everything in the Evaluation of a Patient with Gastrointestinal Tumors (GIST) Under Imatinib Therapy. Pathol Oncol Res 2012, 18, 1095–1097.
  17. Kim CJ, Day S, Yeh KA: Gastrointestinal stromal tumours: analysis of clinical and pathologic factors. Am Surg 2001, 67, 135–137.
  18. Ludwig DJ, Traverso LW: Gut stromal tumours and their clinical behavior. Am J Surg 1997, 173, 390–394.
  19. DeMatteo RP, Lewis JJ, Leung D, Mudan SS, Woodruff JM, Brennan MF: Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival. Ann Surg 2000, 231, 51–58.
  20. Demetri GD, von Mehren M, Antonescu CR, DeMatteo RP, Ganjoo KN, Maki RG, Pisters PW, Raut CP, Riedel RF, Schuetze S, Sundar HM, Trent JC, Wayne JD: NCCN Task Force report: update on the management of patients with gastrointestinal stromal tumors. J Natl Compr Canc Netw 2010, 8, Suppl 2, 1–41.
  21. El-Hanafy E, El-Hemaly M, Hamdy E, El-Raouf AA, El-Hak NG, Atif E: Surgical management of gastric gastrointestinal stromal tumor: a single center experience. Saudi J Gastroenterol 2011, 17, 189–193.
  22. Dematteo RP, Gold JS, Saran L, Gönen M, Liau KH, Maki RG, Singer S, Besmer P, Brennan MF, Antonescu CR: Tumor mitotic rate, size, and location independently predict recurrence after resection of primary gastrointestinal stromal tumor (GIST). Cancer 2008, 1, 112, 608–615.
  23. Henckens T, Van de Putte D, Van Renterghem K, Ceelen W, Pattyn P, Van Nieuwenhove Y: Laparoendoscopic single-site gastrectomy for a gastric GIST using double-bended instruments. J Laparoendosc Adv Surg Tech A 2010, 20, 469–471.
  24. Novitsky YW, Kercher KW, Sing RF, Heniford BT: Long-term Outcomes of Laparoscopic Resection of Gastric Gastrointestinal Stromal Tumors. Ann Surg 2006, 243, 738–745.
  25. Bümming P, Ahlman H, Andersson J, Meis-Kindblom JM, Kindblom LG, Nilsson B: Population-based study of the diagnosis and treatment of gastrointestinal stromal tumours. Br J Surg 2006, 93, 836–843.
  26. Werewka-Maczuga A, Osiński T, Chrzan R, Buczek M, Urbanik A: Characteristics of computed tomography imaging of gastrointestinal stromal tumor (GIST) and related diagnostic problems. Pol J Radiol 2011, 76, 38–48.
  27. Kawamoto K, Yamada Y, Utsunomiya T, Okamura H, Mizuguchi M, Motooka M, Hirata N, Watanabe H, Sakai K, Kitagawa S, Kinukawa N, Masuda K: Gastrointestinal submucosal tumours: evaluation with endoscopic US. Radiology 1997, 205, 733–740.
  28. DeMatteo RP, Lewis JJ, Leung D, Mudan SS, Woodruff JM, Brennan MF: Two Hundred Gastrointestinal Stromal Tumors Recurrence Patterns and Prognostic Factors for Survival Annals of Surgery 2000, 231, 51–58.
  29. Sánchez Hidalgo JM, Muñoz Casares FC, Rufian Peña S, Naranjo Torres A, Ciria Bru R, Briceño Delgado J, López Cillero P: Gastrointestinal stromal tumors (GIST): factors predictive of survival after R0-cytoreduction. Rev Esp Enferm Dig 2007, 99, 703–708.
  30. Aparicio T, Boige V, Sabourin JC, Crenn P, Ducreux M, Le Cesne A, Bonvalot S: Prognostic factors after surgery of primary resectable gastrointestinal stromal tumours. Eur J Surg Oncol 2004, 30, 1098–1103.