Gastric tumors in children: single-center study with emphasis on treatment of repeated recurrence

Gastrointestinal Stromal Tumors (GISTs) in Pediatric Patients: A Case Report and Literature Review

Gastrointestinal stromal tumors (GISTs) are rare mesenchymal neoplasms that primarily affect adults, with pediatric cases constituting only 0.5-2.7% of the total. Pediatric GISTs present unique clinical, genetic, and pathological features that distinguish them from adult cases. This literature review aims to elucidate these differences, emphasizing diagnostic and therapeutic challenges. We discuss the resistance of pediatric GISTs to conventional chemotherapy and highlight the importance of surgical intervention, especially in emergency situations involving intra-abdominal bleeding. The review also explores the molecular characteristics of pediatric GISTs, including rare mutations such as quadruple-negative wild-type GIST with an FGF3 gene gain mutation. To illustrate these points, we conclude with a case from our clinic involving a 15-year-old female with multiple CD117-positive gastric GISTs and a quadruple-negative wild-type genetic profile who required urgent surgical intervention following a failed tumor embolization. This case underscores the critical need for early diagnosis and individualized therapeutic strategies combining oncologic and surgical care to improve outcomes in pediatric GIST patients.

Nonpolypous Hamartomas of the Gastrointestinal Tract: An Updated Review on Classification, Denominations, and Clinical Management

PURPOSE

To perform the first systematic report about histological subtypes of nonpolypous hamartomas of the gastrointestinal (GI) tract, from esophagus to anal canal.

DESIGN

From over 19,000 studies about hamartomas, most of them published as case series or case presentations, we have selected the most representative ones for the GI tract, excluding polyposis syndromes. To have a whole picture of these hamartomas, all of the data were combined with the personal experience of the authors who are GI pathologists.

RESULTS

The examined articles showed predominance of vascular and combined vascular and mesenchymal hamartomas. Arteriovenous hamartomas or Brunner gland hamartomas are mainly diagnosed in the small intestine, with preponderance for duodenum. Other malformations such cavernous hamartomas are more specific for the colorectal segments, whereas chondromatous hamartomas or those derived from the neural ectoderm were mostly reported in the esophagus. As newly recognized entities were admitted in the last years, misdiagnosis is frequent, and the best therapeutic approach is far to be known.

CONCLUSION

Even rare, hamartomas of the GI tract need to be differentiated from tumors and familial polyposis syndromes. Knowing their proper denominations and possible complications is valuable for gastroenterologists, pathologists, and surgeons, to be aware in the differential diagnosis.