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Skhiri W, Saad J, Mazhoud I, Maatouk M, Chaouch A, Salem AB. Gastrointestinal stromal tumor of the ampulla of Vater: A case report and literature review. Int J Surg Case Rep 2022; 99:107598. [PMID: 36137430 PMCID: PMC9568698 DOI: 10.1016/j.ijscr.2022.107598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 02/07/2023] Open
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Lee SJ, Song KB, Lee YJ, Kim SC, Hwang DW, Lee JH, Shin SH, Kwon JW, Hwang SH, Ma CH, Park GS, Park YJ, Park KM. Clinicopathologic Characteristics and Optimal Surgical Treatment of Duodenal Gastrointestinal Stromal Tumor. J Gastrointest Surg 2019; 23:270-279. [PMID: 30132296 DOI: 10.1007/s11605-018-3928-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 08/09/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND The clinicopathologic characteristics of duodenal gastrointestinal stromal tumor (GIST) were unclear and the optimal surgical procedure for duodenal GIST remains poorly defined. We aimed to analyze clinicopathological characteristics, survival outcomes based on the surgical procedure, and recommend optimal surgical treatment for duodenal GIST. METHODS From July 2000 to April 2017, 118 patients with localized duodenal GIST underwent curative surgical resection at a single institution. We retrospectively reviewed the clinicopathological characteristics and survival outcomes. RESULTS The 5-year overall survival (OS) and disease-free survival (DFS) rates were 94.9 and 79.2%, respectively. On multivariate analysis, the mitotic count was a statistically significant prognostic factor for DFS. Limited resection (LR) was performed in 20 patients with GIST in the first or fourth portion of the duodenum. Both LR and pancreaticoduodenectomy (PD) were performed in 98 patients with GIST in second or third portion of the duodenum. The patients in the LR group had less late complications than in the PD group and no postoperative newly developed diabetes mellitus. The minimally invasive LR (MI-LR) group had a shorter duration of surgery and shorter length of postoperative hospital stay. CONCLUSION LR is a feasible and effective surgical treatment for patients with small-sized and antimesenteric-sided duodenal GIST in terms of late complications and postoperative diabetic complications. MI-LR has better perioperative outcomes than open LR. Therefore, we should consider MI-LR as an optimal surgical treatment for selected patients with duodenal GIST.
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Affiliation(s)
- Seung Jae Lee
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43-gil, Seoul, Songpa-gu, 05505, South Korea
| | - Ki Byung Song
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43-gil, Seoul, Songpa-gu, 05505, South Korea.
| | - Young-Joo Lee
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43-gil, Seoul, Songpa-gu, 05505, South Korea
| | - Song Cheol Kim
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43-gil, Seoul, Songpa-gu, 05505, South Korea
| | - Dae Wook Hwang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43-gil, Seoul, Songpa-gu, 05505, South Korea
| | - Jae Hoon Lee
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43-gil, Seoul, Songpa-gu, 05505, South Korea
| | - Sang Hyun Shin
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43-gil, Seoul, Songpa-gu, 05505, South Korea
| | - Jae Woo Kwon
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43-gil, Seoul, Songpa-gu, 05505, South Korea
| | - Seung Hyun Hwang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43-gil, Seoul, Songpa-gu, 05505, South Korea
| | - Chung Hyeun Ma
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43-gil, Seoul, Songpa-gu, 05505, South Korea
| | - Gui Suk Park
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43-gil, Seoul, Songpa-gu, 05505, South Korea
| | - Ye Jong Park
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43-gil, Seoul, Songpa-gu, 05505, South Korea
| | - Kwang-Min Park
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43-gil, Seoul, Songpa-gu, 05505, South Korea
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Popivanov G, Tabakov M, Mantese G, Cirocchi R, Piccinini I, D'Andrea V, Covarelli P, Boselli C, Barberini F, Tabola R, Pietro U, Cavaliere D. Surgical treatment of gastrointestinal stromal tumors of the duodenum: a literature review. Transl Gastroenterol Hepatol 2018; 3:71. [PMID: 30363779 DOI: 10.21037/tgh.2018.09.04] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 09/04/2018] [Indexed: 01/10/2023] Open
Abstract
Background Gastrointestinal stromal tumors (GIST) are the most frequent mesenchymal tumours in the digestive tract. The duodenal GIST (dGIST) is the rarest subtype, representing only 4-5% of all GIST, but up to 21% of the resected ones. The diagnostic and therapeutic management of dGIST may be difficult due to the rarity of this tumor, its anatomical location, and the clinical behavior that often mimic a variety of conditions; moreover, there is lack of consent for their treatment. This study has evaluated the scientific literature to provide consensus on the diagnosis of dGIST and to outline possible options for surgical treatment. Methods An extensive research has been carried out on the electronic databases MEDLINE, Scopus, EMBASE and Cochrane to identify all clinical trials that report an event or case series of dGIST. Results Eighty-six studies that met the inclusion criteria were identified with five hundred forty-nine patients with dGIST: twenty-seven patients were treated with pancreatoduodenectomy and ninety-six with only local resection (segmental/wedge resections); in four hundred twenty-six patients it is not possible identify the type of treatment performed (pancreatoduodenectomy or segmental/wedge resections). Conclusions dGISTs are a very rare subset of GISTs. They may be asymptomatic or may involve symptoms of upper GI bleeding and abdominal pain at presentation. Because of the misleading clinical presentation the differential diagnosis may be difficult. Tumours smaller than 2 cm have a low biological aggressiveness and can be followed annually by endoscopic ultrasound. The biggest ones should undergo radical surgical resection (R0). In dGIST there is no uniformly adopted surgical strategy because of the low incidence, lack of experience, and the complex anatomy of the duodenum. Therefore, individually tailored surgical approach is recommended. R0 resection with 1-2 cm clear margin is required. Lymph node dissection is not recommended due to the low incidence of lymphatic metastases. Tumor rupture should be avoided.
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Affiliation(s)
- Georgi Popivanov
- Military Medical Academy, Clinic of Endoscopic, Endocrine surgery and Coloproctology, Sofia, Bulgaria
| | - Mihail Tabakov
- University Hospital Sv. Ivan Rilski, Surgical Clinic, Sofia, Bulgaria
| | - George Mantese
- Department of Surgical Sciences, The University of Rome "La Sapienza", Rome, Italy
| | - Roberto Cirocchi
- Department of Surgical Sciences, The University of Rome "La Sapienza", Rome, Italy
| | - Irene Piccinini
- Department of Surgical Sciences, The University of Rome "La Sapienza", Rome, Italy
| | - Vito D'Andrea
- Department of Surgical and Biomedical Sciences, University of Perugia, Italy
| | - Piero Covarelli
- Department of Surgical Sciences, The University of Rome "La Sapienza", Rome, Italy
| | - Carlo Boselli
- Department of Surgical Sciences, The University of Rome "La Sapienza", Rome, Italy
| | - Francesco Barberini
- Department of Surgical Sciences, The University of Rome "La Sapienza", Rome, Italy
| | - Renata Tabola
- Department and Clinic of Gastrointestinal and General Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Ursi Pietro
- Department of Surgical and Biomedical Sciences, University of Perugia, Italy
| | - Davide Cavaliere
- General Surgery and Surgical Oncology, Morgagni-Pierantoni Hospital, Forlì, Italy
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Liu Z, Zheng G, Liu J, Liu S, Xu G, Wang Q, Guo M, Lian X, Zhang H, Feng F. Clinicopathological features, surgical strategy and prognosis of duodenal gastrointestinal stromal tumors: a series of 300 patients. BMC Cancer 2018; 18:563. [PMID: 29764388 PMCID: PMC5952823 DOI: 10.1186/s12885-018-4485-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 05/08/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The relatively low incidence of duodenal gastrointestinal stromal tumors (GISTs) and the unique anatomy make the surgical management and outcomes of this kind of tumor still under debate. Thus, this study aimed to explore the optimal surgical strategy and prognosis of duodenal GISTs. METHODS A total of 300 cases of duodenal GISTs were obtained from our center (37 cases) and from case reports or series (263 cases) extracted from MEDLINE. Clinicopathological features, type of resections and survivals of duodenal GISTs were analyzed. RESULTS The most common location of duodenal GISTs was descending portion (137/266, 51.5%). The median tumor size was 4 cm (0.1-28). Most patients (66.3%) received limited resection (LR). Pancreaticoduodenectomy (PD) was mainly performed for GISTs with larger tumor size or arose from descending portion (both P < 0.05). For both the entire cohort and tumors located in the descending portion, PD was not an independent risk factor for disease-free survival (DFS) and disease-specific survival (DSS) (both P > 0.05). Duodenal GISTs were significantly different from gastric GISTs with respect to tumor size, mitotic index and NIH risk category (all P < 0.05). The DFS and DSS of duodenal GISTs was significantly worse than that of gastric GISTs (both P < 0.05). CONCLUSIONS LR was a more prevalent surgical procedure and PD was mainly performed for tumors with larger diameter or located in descending portion. Type of resection was not an independent risk factor for the prognosis of duodenal GISTs. Prognosis of duodenal GISTs was significantly worse than that of gastric GISTs.
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Affiliation(s)
- Zhen Liu
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, 127 West Changle Road, 710032, Xi’an, Shaanxi Province China
- Department of General Surgery, No.1 Hospital of PLA, 74 Jingning Road, Lanzhou, 730030 China
| | - Gaozan Zheng
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, 127 West Changle Road, 710032, Xi’an, Shaanxi Province China
| | - Jinqiang Liu
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, 127 West Changle Road, 710032, Xi’an, Shaanxi Province China
- Cadre’ s sanitarium, 62101 Army of PLA, 67 Nahu Road, Xinyang, 464000 Henan China
| | - Shushang Liu
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, 127 West Changle Road, 710032, Xi’an, Shaanxi Province China
| | - Guanghui Xu
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, 127 West Changle Road, 710032, Xi’an, Shaanxi Province China
| | - Qiao Wang
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, 127 West Changle Road, 710032, Xi’an, Shaanxi Province China
- Department of General Surgery, No. 91 Hospital of PLA, 239 Gongye Road, Jiaozuo, 454000 Henan China
| | - Man Guo
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, 127 West Changle Road, 710032, Xi’an, Shaanxi Province China
| | - Xiao Lian
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, 127 West Changle Road, 710032, Xi’an, Shaanxi Province China
| | - Hongwei Zhang
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, 127 West Changle Road, 710032, Xi’an, Shaanxi Province China
| | - Fan Feng
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, the Fourth Military Medical University, 127 West Changle Road, 710032, Xi’an, Shaanxi Province China
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Cavallini M, Cecera A, Ciardi A, Caterino S, Ziparo V. Small Periampullary Duodenal Gastrointestinal Stromal Tumor Treated by Local Excision: Report of a Case. TUMORI JOURNAL 2018; 91:264-6. [PMID: 16206653 DOI: 10.1177/030089160509100311] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Gastrointestinal stromal tumors (GIST) are mainly located in the stomach and the small bowel, with the duodenum accounting for about 4%. We report the case of a 66-year-old woman with a periampullary GIST of the duodenum that was treated by local excision and direct duodenal wall defect repair. Since no definitive clinical criteria have been established to differentiate malignant from benign mesenchymal tumors, preoperative cytology was not available and surgical removal of the 3.5 cm tumor was feasible, the patient was treated conservatively. The morbidity and mortality rates of the more radical and invasive duodenopancreatectomy, in particular when dealing with a soft pancreatic stump with a narrow pancreatic duct, are, in our opinion, too high for a potentially benign disease when the more conservative procedure is feasible. Four years after surgery the patient is doing well and control CT scan showed the absence of local recurrence.
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Affiliation(s)
- Marco Cavallini
- Department of Surgery Pietro Valdoni, Second Faculty of Medicine, University of Rome, La Sapienza, Italy.
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Limited resections for duodenal gastrointestinal stromal tumors and their oncologic outcomes. Surg Today 2016; 46:110-116. [PMID: 25860591 DOI: 10.1007/s00595-015-1163-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 02/12/2015] [Indexed: 01/13/2023]
Abstract
PURPOSE Limited resection is considered a treatment option for duodenal gastrointestinal stromal tumors (GISTs) whenever technically feasible, but the optimal technique for this is still not well defined. We present the various types of limited resections for duodenal GISTs and analyze their postoperative outcomes. METHODS The subjects of this retrospective clinicopathologic analysis were 21 patients who underwent limited resections for duodenal GIST between May, 2001 and June, 2014. The median follow-up period was 52 months (range 5-125 months). RESULTS The patients comprised 12 men and 9 women, with a median age of 59 years (range 45-75 years), all of whom were treated by various forms of limited resection with clear margins. There were ten wedge resections with primary closure (eight open/two laparoscopic), two wedge resections with Roux-en Y duodenojejunostomy, three segmental duodenectomies with end-to-end duodenoduodenostomy, and six segmental duodenectomies with end-to-end duodenojejunostomy. Hepatic metastasis was found 27 months after surgery in one patient, who was given imatinib mesylate for 17 months to slow disease progression. The other 20 patients were alive and recurrence free at the time of writing. CONCLUSION Excellent recurrence-free survival was achieved after limited resections, supporting the consideration of various methods of limited resection as the treatment of choice for duodenal GISTs.
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Kobayashi M, Hirata N, Nakaji S, Shiratori T, Fujii H, Ishii E. Gastrointestinal stromal tumor of the ampulla of Vater: A case report. World J Gastroenterol 2014; 20:4817-4821. [PMID: 24782637 PMCID: PMC4000521 DOI: 10.3748/wjg.v20.i16.4817] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Revised: 02/09/2014] [Accepted: 03/05/2014] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal stromal tumors (GISTs) usually develop in the stomach and small intestine and only rarely occur at the ampulla of Vater, with only 11 cases reported in the literature. We report a case of a GIST of the ampulla of Vater. A 36-year-old, previously healthy man presented with a loss of consciousness lasting a few minutes. A gastroduodenal endoscopy revealed a submucosal tumor with central ulceration at the ampulla of Vater. The enhanced computed tomography scan revealed a smooth-outlined hypervascular solid mass (24 mm × 30 mm) in the second part of the duodenum. Neither lymphadenopathy nor metastasis was observed. Magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography showed normal bile and pancreatic ducts. Biopsies were collected from the ulcerative lesion, and the tumor was diagnosed as a GIST. A submucosal tumor with central ulceration may be a characteristic form of GISTs of the ampulla of Vater, and biopsy studies are useful for the diagnosing such tumors. The patient underwent pancreatoduodenectomy, and the operative specimen revealed a 2.2-cm GIST with 1 mitosis per 50 high-power fields. The gold standard for treatment of GISTs is surgical resection without rupture of a capsule. If technically possible, local resection may be considered. However, when the location of the lesion presents challenges, a pancreatoduodenectomy should be performed for GIST of the ampulla of Vater.
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Ahmadi O, Nicholson MDL, Gould ML, Mitchell A, Stringer MD. Interstitial cells of Cajal are present in human extrahepatic bile ducts. J Gastroenterol Hepatol 2010; 25:277-85. [PMID: 19793166 DOI: 10.1111/j.1440-1746.2009.05980.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIMS Interstitial cells of Cajal (ICC) are distributed with smooth muscle throughout the gastrointestinal tract and are involved in regulating motility. ICC were recently discovered in the wall of the human gallbladder. This study sought to determine whether ICC are present in human bile ducts. METHODS Biliary tract samples were obtained from several sources: surgical specimens (n = 16, 11 women, mean age 61 years); archival post-mortem specimen (n = 1, 86 years, man); and cadavers (n = 2, 68 and 80 years, men). Paraffin-embedded sections (3 microm) from the gallbladder (fundus, body and neck) and both extrahepatic and intrahepatic bile ducts were investigated. A double immunofluorescence protocol using polyclonal and monoclonal c-kit antibodies and mast cell tryptase was used to distinguish c-kit-positive cells with typical ICC morphology from c-kit-positive mast cells. Small bowel samples were used as positive controls. ICC in the gallbladder were confirmed by ultrastructural study. RESULTS c-kit-positive cells with characteristic ICC morphology were identified in the subepithelial and muscular layers of the gallbladder and extrahepatic bile ducts. They were most prominent within the muscle layer of the extrahepatic bile ducts where they were organized into loosely arranged laminae running parallel to circular smooth muscle fibers. ICC were not found in intrahepatic bile ducts. CONCLUSION This study demonstrates for the first time that ICC are present in human extrahepatic bile ducts where they are more densely aggregated than in the gallbladder. This cellular network is likely to be involved in biliary tract motility and its related disorders.
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Affiliation(s)
- Omid Ahmadi
- Department of Anatomy and Structural Biology, Otago School of Medical Sciences, University of Otago, New Zealand
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Akatsu T, Aiura K, Kawachi S, Tanabe M, Shimazu M, Ueda M, Kameyama K, Kitajima M. Duodenal gastrointestinal stromal tumor adjacent to the minor papilla with concomitant pancreatic divisum. Dig Dis Sci 2007; 52:3191-8. [PMID: 17443410 DOI: 10.1007/s10620-006-9254-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2005] [Accepted: 02/08/2006] [Indexed: 01/30/2023]
Affiliation(s)
- Tomotaka Akatsu
- Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku-ku, Tokyo 160-8582, Japan
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Moss AC, Callery MP, Falchuk KR. Gastrointestinal [corrected] stromal tumor of the ampulla of vater mimicking a duodenal ulcer. Clin Gastroenterol Hepatol 2007; 5:A26. [PMID: 17916534 DOI: 10.1016/j.cgh.2007.07.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Alan C Moss
- Division of Gastroenterology, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, Massachusetts, USA
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von Mehren M. Imatinib-refractory gastrointestinal stromal tumors: the clinical problem and therapeutic strategies. Curr Oncol Rep 2007; 8:192-7. [PMID: 16618383 DOI: 10.1007/s11912-006-0019-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Treatment of gastrointestinal stromal tumor (GIST) is a paradigm for targeted therapy. These mesenchymal tumors are refractory to standard chemotherapy and radiation therapy. Targeted therapy has successfully exploited the oncologic drivers of GIST--the tyrosine kinases, KIT, and the platelet-derived growth factor receptor. Therapy with imatinib has dramatically altered the natural history of patients with advanced GIST. However, patients are developing resistance to imatinib and thus presenting with a major clinical challenge. Alternative approaches to imatinib-refractory disease are needed. Newer approaches using biologic data regarding the mechanisms of resistance are being tested alone or in combination with imatinib and are the focus of this review. Effective novel agents for imatinib-refractory GIST used as single agents or in combination with imatinib will likely become future regimens to be tested in first-line metastatic disease and in the adjuvant setting.
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Affiliation(s)
- Margaret von Mehren
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA.
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Yildirgan MI, Başoglu M, Atamanalp SS, Albayrak Y, Gürsan N, Onbaş O. Duodenal Stromal Tumor: Report of a Case. Surg Today 2007; 37:426-9. [PMID: 17468827 DOI: 10.1007/s00595-004-3400-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2004] [Accepted: 04/21/2004] [Indexed: 01/19/2023]
Abstract
Gastrointestinal stromal tumors are rare tumors of the gastrointestinal (GI) tract that arise from primitive mesenchymal cells. Gastrointestinal stromal tumors account for approximately 80% all of gastrointestinal mesenchymal tumors. Duodenal stromal tumors (DSTs) manifest with unexplained melena, pain, bleeding, anemia, sometimes a partial duodenal obstruction and, rarely, with obstructive jaundice. If the tumor is successfully treated, its prognosis is usually good because of its non-aggressive nature. If resected, the prognosis is favorable in a majority of cases, and it is much better than in carcinomas of the duodenum. In this article, we report a case of DST originating from the first and second portion of the duodenum. Our patient did not have any problems postoperatively and remained symptom-free at 18 months after surgery.
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Affiliation(s)
- M Ilhan Yildirgan
- Department of General Surgery, Faculty of Medicine, Ataturk University, 25240 Erzurum, Turkey
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Takeda A, Watanabe Y, Uehara T, Maruyama T, Tanaka H, Matsuzaki H, Arima H, Natsune T, Kudo H, Sakama A, Tohnosu N, Shimada H, Sato H. Successful surgical resection of a huge gastrointestinal stromal tumor of the third portion of the duodenum. J Gastroenterol Hepatol 2007; 22:283-4. [PMID: 17295890 DOI: 10.1111/j.1440-1746.2006.04484.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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Tarn C, Skorobogatko YV, Taguchi T, Eisenberg B, von Mehren M, Godwin AK. Therapeutic effect of imatinib in gastrointestinal stromal tumors: AKT signaling dependent and independent mechanisms. Cancer Res 2006; 66:5477-86. [PMID: 16707477 DOI: 10.1158/0008-5472.can-05-3906] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Most gastrointestinal stromal tumors (GISTs) possess a gain-of-function mutation in c-KIT. Imatinib mesylate, a small-molecule inhibitor against several receptor tyrosine kinases, including KIT, platelet-derived growth factor receptor-alpha, and BCR-ABL, has therapeutic benefit for GISTs both via KIT and via unknown mechanisms. Clinical evidence suggests that a potential therapeutic benefit of imatinib might result from decreased glucose uptake as measured by positron emission tomography using 18-fluoro-2-deoxy-d-glucose. We sought to determine the mechanism of and correlation to altered metabolism and cell survival in response to imatinib. Glucose uptake, cell viability, and apoptosis in GIST cells were measured following imatinib treatment. Lentivirus constructs were used to stably express constitutively active AKT1 or AKT2 in GIST cells to study the role of AKT signaling in metabolism and cell survival. Immunoblots and immunofluorescent staining were used to determine the levels of plasma membrane-bound glucose transporter Glut4. We show that oncogenic activation of KIT maximizes glucose uptake in an AKT-dependent manner. Imatinib treatment markedly reduces glucose uptake via decreased levels of plasma membrane-bound Glut4 and induces apoptosis or growth arrest by inhibiting KIT activity. Importantly, expression of constitutively active AKT1 or AKT2 does not rescue cells from the imatinib-mediated apoptosis although glucose uptake was not blocked, suggesting that the potential therapeutic effect of imatinib is independent of AKT activity and glucose deprivation. Overall, these findings contribute to a clearer understanding of the molecular mechanisms involved in the therapeutic benefit of imatinib in GIST and suggest that a drug-mediated decrease in tumor metabolism observed clinically may not entirely reflect therapeutic efficacy of treatment.
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Affiliation(s)
- Chi Tarn
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania 19111, USA
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Darnell A, Dalmau E, Pericay C, Musulén E, Martín J, Puig J, Malet A, Saigí E, Rey M. Gastrointestinal stromal tumors. ACTA ACUST UNITED AC 2006; 31:387-99. [PMID: 16465584 DOI: 10.1007/s00261-004-0092-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2004] [Accepted: 03/17/2005] [Indexed: 12/23/2022]
Abstract
BACKGROUND We reviewed radiologic features of gastrointestinal stromal tumors (GISTs) and correlated them with clinical and pathologic findings. METHODS We investigated a series of 39 c-Kit-positive GISTs. Clinical and radiologic findings and management of these patients were recorded. RESULTS Twenty women and 19 men (mean age 64 years) had histologically proved GIST. Tumor locations were the small bowel (n = 20), stomach (n = 14), rectum (n = 4), and omentum (n = l). Symptoms at presentation were most frequently gastrointestinal bleeding (n = 14) and abdominal pain (n = l1). Tumors were classified as very low risk (n = 2), low risk (n = 10), intermediate risk (n = 12), and high risk (n = 11). Ultrasonography, computed tomography, magnetic resonance, digital subtraction angiography, and barium series were used in the evaluation of these tumors. Most tumors were seen as well-delineated soft tissue masses with heterogeneous contrast enhancement. Necrosis, calcification, and ulceration were most commonly seen in large tumors that presented a more aggressive behavior. CONCLUSION GISTs can arise anywhere in the gastrointestinal tract and present a great variety of clinical and radiologic features, depending mostly on size and location.
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Affiliation(s)
- A Darnell
- Department of Radiology, UDIAT-CD, Corporació Sanitària Parc Taulí, Parc Taulí s/n 08208 Sabadell, Spain.
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16
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Wellmann K, Gohla G, Wenk H. [Malignant gastrointestinal stromal tumor (GIST) of the papilla vateri. A rare tumor entity]. Chirurg 2004; 75:196-9. [PMID: 14991183 DOI: 10.1007/s00104-003-0737-0] [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: 12/17/2022]
Abstract
We present the case report of a 68-year-old female patient who had a malignant gastrointestinal stromal tumor of the papilla of Vater. The abdominal CT showed a coin-shaped lesion in the liver (segment VIII). Intraoperative rapid histological examination detected an old parasitic hepatic cyst. To exclude metastasis, we performed duodenopancreatectomy with curative intention. The postoperative course was without complications and neither chemotherapy nor other adjunct treatment was necessary. Because of heterogeneity, the different localization, and in this case the rare localization, surgery of gastrointestinal stromal tumors is difficult. However, we adhered to oncological and therapeutic standards of surgery for papillary carcinoma. This case is discussed based on a review of the literature. However, until now there has been no case report of gastrointestinal stromal tumor of the papilla of Vater in the literature.
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Affiliation(s)
- K Wellmann
- Klinik für Allgemein-, Gefäss- und Viszeralchirurgie, Zentralkrankenhaus Bremen Nord.
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17
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Kefalas CH, Altrabulsi B, Milvenan JS, Goldschmiedt M. Endoscopic electrosurgical snare resection of leiomyosarcoma of main duodenal papilla. Gastrointest Endosc 2004; 59:743-5. [PMID: 15114331 DOI: 10.1016/s0016-5107(04)00172-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Costas H Kefalas
- Division of Gastroenterology, University of Texas Southwestern Medical Center, Dallas, USA
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Abstract
Gastrointestinal stromal tumors (GISTs), the most common mesenchymal tumors of the intestinal tract, are characterized by the expression of KIT, also known as CD117. Increasingly, primary tumors from novel sites are being described. The KIT gene is commonly mutated, causing constitutive activation of the protein and aberrant growth. Recently, tumors with platelet-derived growth factor receptor (PDGFR)-a mutations have been described in GISTs with wild-type KIT. Factors that predict for an unfavorable outcome are being recognized. A specific molecularly targeted drug, imatinib mesylate, has altered the treatment of this disease. The results of phase I, II, and III clinical trials have consistently demonstrated activity of this agent and elucidated the patient and tumor characteristics associated with response to imatinib. The current challenge in caring for these patients is to identify the appropriate clinical setting for treatment with imatinib and to define the approach to patients whose tumors are insensitive or refractory to imatinib.
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Affiliation(s)
- Margaret von Mehren
- Department of Medical Oncology, Fox Chase Cancer Center, 7701 Burholme Avenue, Philadelphia, PA 19111, USA.
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