1
|
Erhan SS, Kulduk G, Dobral A, Bugra A. An entity that should be kept in mind: Synchronous gastrointestinal stromal tumor encountered in resection materials obtained for the detection of intra-abdominal malignancies. North Clin Istanb 2023; 10:797-802. [PMID: 38328725 PMCID: PMC10846574 DOI: 10.14744/nci.2022.98623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/31/2022] [Accepted: 11/27/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Gastrointestinal stromal tumors (GISTs), often sporadic, arise from interstitial Cajal cells of the gastrointestinal tract or their stem cell-like precursors. Apart from tumor-associated syndromes, it has been reported that GISTs are also associated with other tumors. There is no clear information about the etiology of these synchronous tumors. In this study, we wanted to present the clinicopathological features of 13 cases diagnosed as synchronous GIST with other tumors. METHODS Demographic characteristics of the cases, risk of progressive disease score, tumor localization, size, and the mitotic activity of tumors along with survival status were evaluated. RESULTS Thirteen of 101 cases diagnosed with GIST had a primary tumor synchronous with GIST. Synchronous GISTs were located in the stomach and small intestine. Most of the cases were detected incidentally in the intraoperative and post-operative periods. Risk scores for progressive disease were categorized as low (n=1), very low (n=1), and no risk (n=11). Non-GIST tumors were located in the stomach, transverse colon, left colon, rectum, gallbladder, kidney, and retroperitoneal space. Histological tumor types were adenocarcinoma, diffuse large B-cell lymphoma, mesothelioma, and neuroendocrine tumor. Life expectancy was found to be significantly lower in synchronous GISTs. CONCLUSION In cases operated for non-GIST tumors, the possibility of incidental detection of GIST should always be kept in mind.
Collapse
Affiliation(s)
- Selma Sengiz Erhan
- Department of Pathology, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkiye
| | - Gamze Kulduk
- Department of Pathology, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkiye
| | - Arzu Dobral
- Department of Pathology, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkiye
| | - Aytul Bugra
- Division of Histopathology, Department of Morgue, Council of Forensic Medicine, Istanbul, Turkiye
| |
Collapse
|
2
|
Liu J, Huang BJ, Ding FF, Tang FT, Li YM. Synchronous occurrence of gastric cancer and gastrointestinal stromal tumor: A case report and review of the literature. World J Gastrointest Oncol 2023; 15:1807-1822. [PMID: 37969409 PMCID: PMC10631440 DOI: 10.4251/wjgo.v15.i10.1807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/20/2023] [Accepted: 09/14/2023] [Indexed: 10/10/2023] Open
Abstract
BACKGROUND To evaluate the clinicopathological features and prognosis of gastric cancer (GC) occurring synchronously with gastrointestinal stromal tumor (GIST). CASE SUMMARY We report 19 patients with concurrent GC and GIST (17 male and 2 female, median age 62 years). GC was most often located in the lower third of the stomach. GIST was diagnosed preoperatively in four patients. GIST was most often located in the gastric body (n = 8, 42%). The most common growth pattern in GIST was extraluminal (n = 12, 63%). The positive expression rates of CD117 and CD34 in GIST were 100% and 95%, respectively. Most patients with GIST (n = 17, 89%) were very low or low risk. There was no recurrence of GIST during follow-up. The 3-year cumulative survival rate was 73.9%, and the 5-year cumulative survival rate was 59.2%. The combined analysis of this study and literature reports (47 reports, 157 patients) found that GC and GIST were usually located in the lower third (42%) and middle third (51%) of the stomach. GC was usually early (stage I: 42%), poorly differentiated (42%) intestinal-type adenocarcinoma (51%). GISTs were primarily small in diameter (median: 1.2 cm) and very low or low risk (89%). CONCLUSION Synchronous GC and GIST may not be rare. They have specific clinicopathological characteristics, and may have mutual inhibition in pathogenesis and progression.
Collapse
Affiliation(s)
- Jie Liu
- Department of General Surgery, Lanzhou University Second Hospital, Lanzhou 730030, Gansu Province, China
- Key Laboratory of the Digestive System Tumors of Gansu Province, Lanzhou University Second Hospital, Lanzhou 730030, Gansu Province, China
| | - Bin-Jie Huang
- Department of General Surgery, Lanzhou University Second Hospital, Lanzhou 730030, Gansu Province, China
- Key Laboratory of the Digestive System Tumors of Gansu Province, Lanzhou University Second Hospital, Lanzhou 730030, Gansu Province, China
| | - Fei-Fei Ding
- Department of General Surgery, Lanzhou University Second Hospital, Lanzhou 730030, Gansu Province, China
- Key Laboratory of the Digestive System Tumors of Gansu Province, Lanzhou University Second Hospital, Lanzhou 730030, Gansu Province, China
| | - Fu-Tian Tang
- Department of General Surgery, Lanzhou University Second Hospital, Lanzhou 730030, Gansu Province, China
- Key Laboratory of the Digestive System Tumors of Gansu Province, Lanzhou University Second Hospital, Lanzhou 730030, Gansu Province, China
| | - Yu-Min Li
- Department of General Surgery, Lanzhou University Second Hospital, Lanzhou 730030, Gansu Province, China
- Key Laboratory of the Digestive System Tumors of Gansu Province, Lanzhou University Second Hospital, Lanzhou 730030, Gansu Province, China
| |
Collapse
|
3
|
Ma J, Zhu J, Yu S, Zhou C, Duan S, Zhang Y. An ileal gastrointestinal stromal tumor misdiagnosed as pelvic metastases from rectal cancer: a case report. Front Oncol 2023; 13:1164391. [PMID: 37182150 PMCID: PMC10166831 DOI: 10.3389/fonc.2023.1164391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/05/2023] [Indexed: 05/16/2023] Open
Abstract
With the advancement of imaging and pathological diagnostic methods, it is not uncommon to see synchronous gastrointestinal stromal tumors (GIST) and other primary cancers, the most common of which are synchronous gastric cancer and gastric GIST. However, synchronous advanced rectal cancer and high-risk GIST in the terminal ileum are extremely rare, and they are easily misdiagnosed as rectal cancer with pelvic metastases due to their special location near iliac vessels. Herein, we report a 55-year-old Chinese woman with rectal cancer. Preoperative imaging revealed a middle and lower rectal lesion with a right pelvic mass (considered possible metastasis from rectal cancer). Through multidisciplinary discussions, we suspected the possibility of rectal cancer synchronous with a GIST in the terminal ileum. Intraoperative exploration by laparoscopy revealed a terminal ileal mass with pelvic adhesion, a rectal mass with plasma membrane depression, and no abdominal or liver metastases. Laparoscopic radical proctectomy (DIXON) plus partial small bowel resection plus prophylactic loop ileostomy was performed, and the pathological report confirmed the coexistence of advanced rectal cancer and a high-risk ileal GIST. The patient was treated with the chemotherapy (CAPEOX regimen) plus targeted therapy(imatinib) after surgery, and no abnormalities were observed on the follow-up examination. Synchronous rectal cancer and ileal GIST are rare and easily misdiagnosed as a rectal cancer with pelvic metastases, and careful preoperative imaging analysis and prompt laparoscopic exploration are required to determine the diagnosis and prolong patient survival.
Collapse
Affiliation(s)
- Jun Ma
- Department of General Surgery, Anqing Municipal Hospital, Anqing, China
| | - Juan Zhu
- Department of Imaging, Anqing Municipal Hospital, Anqing, China
| | - Shuihong Yu
- Research and Experimental Center, Anqing Medical and Pharmaceutical College, Anqing, China
| | - Chaoping Zhou
- Department of General Surgery, Anqing Municipal Hospital, Anqing, China
| | - Shuqiang Duan
- Department of Pathology, Anqing Municipal Hospital, Anqing, China
| | - Yaming Zhang
- Department of General Surgery, Anqing Municipal Hospital, Anqing, China
| |
Collapse
|
4
|
Fukuda H, Sakurai Y, Nomoto Y, Nakamura Y, Karaki H, Okaya T, Hirai F, Abe M, Sugano I. Gastric collision tumor composed of early-stage gastric carcinoma and gastrointestinal stromal tumor: a case report. Clin J Gastroenterol 2022; 15:1055-1060. [DOI: 10.1007/s12328-022-01708-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 09/20/2022] [Indexed: 11/27/2022]
|
5
|
Szczepaniak K, Nasierowska-Guttmejer A. The occurrence of gastrointestinal stromal tumors with second malignancies - Case series of a single institution experience. Pathol Res Pract 2021; 228:153662. [PMID: 34749214 DOI: 10.1016/j.prp.2021.153662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 10/17/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Gastrointestinal stromal tumors (GISTs) may coexist with different types of malignancies, either synchronously or metachronously. The aim of this study was to characterize the clinical and histopathological features of GIST coexisting with other neoplasms. METHODS A retrospective analysis of 76 GISTs cases diagnosed at our institution between January 2003 and March 2020 was performed. A subgroup of cases with concomitant second malignancy was selected. The clinical and pathologic records were reviewed. RESULTS 18 out of 76 patients (23.7%) with GISTs were diagnosed with the second neoplasms. In 11 cases GISTs were diagnosed metachronously to the second malignancy, whereas 7 cases of GIST were synchronous. The most common concomitant neoplasms were breast cancer and gastric cancer. The concomitant GIST were located mainly in small intestine (52.6%). 14 GISTs were classified as very low or low-risk (77.8%), 3 as moderate risk (16.7%) and 1 as high risk tumors (5.6%). CONCLUSION The coexistence of GIST with other malignancies may be more common, than it has been considered. As the most of concomitant GISTs occurs metachronously to the second malignancy, studying of this phenomenon requires a long-term follow-up.
Collapse
Affiliation(s)
- K Szczepaniak
- Department of Pathology, Central Clinical Hospital of the Ministry of Interior, Wołoska 137, 02-507 Warsaw, Poland
| | - A Nasierowska-Guttmejer
- Department of Pathology, Central Clinical Hospital of the Ministry of Interior, Wołoska 137, 02-507 Warsaw, Poland; Faculty of Medicine, Lazarski University in Warsaw, Świeradowska 43, 02-662 Warsaw, Poland.
| |
Collapse
|
6
|
Koçer M, Muallaoğlu S, Çetin B, Coşkun HŞ, Karahan N, Gürdal O. Second Primary Tumors in Patients with Gastrointestinal Stromal Tumors: A Single-Center Experience. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57050494. [PMID: 34068309 PMCID: PMC8153290 DOI: 10.3390/medicina57050494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 05/07/2021] [Accepted: 05/11/2021] [Indexed: 11/18/2022]
Abstract
Background and Objectives: In this study, we investigated the frequency and type of second primary malignant tumors (SPMTs) accompanying gastrointestinal stromal tumors (GISTs), patient and tumor characteristics, and follow-up and survival data. Materials and Methods: We included 20 patients with SPMTs from a total of 103 patients with GISTs in a single center in Turkey. At the time of GIST diagnosis, patient age, sex, presentation symptoms, localization, pathological features of the tumor, stage, recurrence risk scoring for localized disease, treatments received, time of SPMT association, follow-up times, and survival analysis were recorded for each patient. Localization, histopathology, and stage of SPMT accompanying GISTs were also recorded accordingly. Results: SPMT was detected in 19.4% of patients with GISTs. Of the patients, 50% were men and 50% were women. The mean age at the time of diagnosis of GIST was 63.8 ± 10.81 years (range: 39–77 years). Of the GISTs, 60% were localized in the stomach, 25% in the small intestine, and 70% were at low risk. Of the SPMTs, 60% were in the gastrointestinal system. SPMTs were diagnosed as synchronous with GISTs in 50% of the patients. The mean follow-up period of the patients from the diagnosis of GIST was 45.6 (0.43–129.6) months. When the data were finalized, 5% died due to GIST, 35% died due to SPMT, and 15% died due to non-disease-related causes. Conclusions: SPMT was detected in 19.4% of patients with GISTs. GISTs were frequently located in the stomach, and most of them were at low risk. The most common SPMTs were gastrointestinal system tumors, and their coexistence was found to be synchronous. Most patients died due to SPMT during follow-up.
Collapse
Affiliation(s)
- Murat Koçer
- Medical Oncology Subdivision, Department of Internal Medicine, Antalya Training and Research Hospital, Health Sciences University, Muratpaşa, Antalya 07100, Turkey
- Correspondence: ; Tel.: +90-542-513-9666
| | - Sadık Muallaoğlu
- Medical Oncology Clinic, Private Iskenderun Gelişim Hospital, Iskenderun 31200, Turkey;
| | - Bülent Çetin
- Medical Oncology Subdivision, Department of Internal Medicine, Süleyman Demirel University Faculty of Medicine, Isparta 32260, Turkey;
| | - Hasan Şenol Coşkun
- Medical Oncology Subdivision, Department of Internal Medicine, Akdeniz University Faculty of Medicine, Konyaaltı, Antalya 07070, Turkey;
| | - Nermin Karahan
- Department of Pathology, Süleyman Demirel University Faculty of Medicine, Isparta 32260, Turkey;
| | - Osman Gürdal
- Department of Biostatistics and Medical Informatics, Süleyman Demirel University Faculty of Medicine, Isparta 32260, Turkey;
| |
Collapse
|
7
|
Large incidental gastrointestinal stromal tumors in a patient presenting with acutely symptomatic nephrolithiasis: A case report. Radiol Case Rep 2019; 14:555-560. [PMID: 30847013 PMCID: PMC6393756 DOI: 10.1016/j.radcr.2019.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/04/2019] [Accepted: 02/08/2019] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are rare mesenchymal neoplasms, representing approximately 1%-2% of all primary gastrointestinal malignancies. Incidental GISTs are often less than 1 cm when discovered and have been reported predominantly in obese patients undergoing surgery for other medical indications. We present the rare case of a large incidental GIST in a nonobese patient with acutely symptomatic nephrolithiasis. Large GISTs may be treated with neoadjuvant imatinib mesylate to reduce tumor size prior to surgery, though some tumors may experience little change in size despite effective treatment. Treatment response for GISTs can be monitored via imaging studies, such as computed tomography or magnetic resonance imaging, but computed tomography is generally preferred over magnetic resonance imaging.
Collapse
|
8
|
Risk of second primary tumors in GIST survivors: A systematic review and meta-analysis. Surg Oncol 2019; 29:64-70. [PMID: 31196495 DOI: 10.1016/j.suronc.2019.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 02/02/2019] [Accepted: 03/02/2019] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Gastrointestinal stromal tumors (GISTs) are rare mesenchymal tumors arising in the gastrointestinal tract. Second primary tumors (SPTs) have been reported frequently, either synchronously or during follow-up, in patients diagnosed with GISTs. METHODS We carried out an electronic search of PubMed, SCOPUS, Web of Science, EMBASE, and the Cochrane Library seeking articles investigating the incidence of SPTs in patients with concomitant GIST. All studies were evaluated for heterogeneity before meta-analysis and for publication bias. Pooled incidence rate was estimated using fixed- and random-effects models. Subsite of SPTs was also investigated. RESULTS A total of 32 studies met the inclusion criteria, for a total of 19,627 patients with a diagnosis of GIST. The pooled prevalence of SPTs was 20%, with 14% and 3% being synchronous and metachronous tumors, respectively. We found a risk for several specific cancer sites, in particular gastrointestinal (5%) and genitourinary tract cancers (3%). The most frequently associated malignancies were: colorectal (17%), prostate (14%), gastric (9%), esophageal (5.5%), lung (5.4%), hepato-biliopancreatic (4.7%), breast (4.6%), lymphoma (4.4%), kidney (4.35%), and sarcomas (3.3%). Regression analyses revealed a significant positive association for all SPTs with follow-up and Miettinen risk. CONCLUSIONS Our results indicate that 20% of patients with GIST experienced a SPT, primarily synchronously with a diagnosis of GIST. In particular, we observed an excess of incident gastrointestinal tumors. These findings have important implications for both pathologists, who should perform extensive molecular analysis of surgical non-GIST specimens in resected patients, and for oncologists, who should continue to follow up GIST patients.
Collapse
|
9
|
Yamamoto S, Nishimura N, Mizuno M, Shimodate Y, Doi A, Mouri H, Matsueda K, Yamamoto H. Endoscopic Submucosal Dissection for Gastric-phenotype Adenoma on the Surface of Gastric Gastrointestinal Stromal Tumor. Intern Med 2019; 58:201-205. [PMID: 30210112 PMCID: PMC6378170 DOI: 10.2169/internalmedicine.1122-18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We herein report a rare case of a gastric adenoma overlying a gastrointestinal stromal tumor (GIST) that was removed by endoscopic submucosal dissection (ESD). A 78-year-old woman was referred to our hospital. Esophagogastroduodenoscopy revealed an elevated lesion of 15 mm in diameter overlying a submucosal mass in the gastric cardia. ESD was performed for the epithelial neoplasm, and biopsy specimens were obtained directly from the exposed surface of the submucosal tumor. The epithelial tumor was a tubular adenoma with focal severe atypia and a gastric phenotype. Biopsy specimens revealed a GIST, which was resected by laparoscopic intragastric surgery afterward.
Collapse
Affiliation(s)
- Shumpei Yamamoto
- Department of Gastroenterology, Kurashiki Central Hospital, Japan
| | | | - Motowo Mizuno
- Department of Gastroenterology, Kurashiki Central Hospital, Japan
| | - Yuichi Shimodate
- Department of Gastroenterology, Kurashiki Central Hospital, Japan
| | - Akira Doi
- Department of Gastroenterology, Kurashiki Central Hospital, Japan
| | - Hirokazu Mouri
- Department of Gastroenterology, Kurashiki Central Hospital, Japan
| | | | - Hiroshi Yamamoto
- Department of Gastroenterology, Kurashiki Central Hospital, Japan
| |
Collapse
|
10
|
Liu S, Liu H, Dong Y, Wang F, Wang H, Chen J. Gastric carcinoma with a gastrointestinal stromal tumor - A case report and literature review. Med Sci (Paris) 2018; 34 Focus issue F1:15-19. [PMID: 30403169 DOI: 10.1051/medsci/201834f103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Gastric carcinoma (GC) with gastrointestinal stromal tumor (GIST) is encountered very rarely in the clinic, and few cases have been reported in the literature. Here, we present a case involving a 72-year-old man who was diagnosed with gastric antrum adenocarcinoma accompanied by neuroendocrine differentiation and a GIST in the fundus, according to a preoperative examination and postoperative pathology. The patient then underwent a distal radical gastrectomy and GIST resection. After the operation, the patient was administered combined chemo-radiotherapy and subsequently underwent a 9-month follow-up examination. The gene mutations involved in this case were explored via high-throughput sequencing. The high-throughput gene mutation analysis indicated an exon5 mutation in the TP53 gene and copy number amplification of FGF19, CCND1, and FGFR2 in the gastric antrum adenocarcinoma. A gene sequencing analysis of the gastric fundus stromal tumor demonstrated an exon11 non-frame shift deletion mutation in the KIT gene. These findings suggested that this patient's cancer might be sensitive to AZD1775 (a TP53-targeted drug) or targeted drugs such as FGF19, CCND1 and FGFR2, and should be sensitive to imatinib.
Collapse
Affiliation(s)
- Sen Liu
- Department of Gastrointestinal Surgery, Tianjin 4th Central Hospital, Hebei District, Tianjin 300140, China
| | - Hongyu Liu
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute
| | - Yunlong Dong
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute
| | - Fengbiao Wang
- Department of Gastrointestinal Surgery, Tianjin 4th Central Hospital, Hebei District, Tianjin 300140, China
| | - Huijuan Wang
- Department of Gastrointestinal Surgery, Tianjin 4th Central Hospital, Hebei District, Tianjin 300140, China
| | - Jun Chen
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute - Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Heping District, Tianjin 300052, China
| |
Collapse
|
11
|
Aghdassi A, Christoph A, Dombrowski F, Döring P, Barth C, Christoph J, Lerch MM, Simon P. Gastrointestinal Stromal Tumors: Clinical Symptoms, Location, Metastasis Formation, and Associated Malignancies in a Single Center Retrospective Study. Dig Dis 2018; 36:337-345. [PMID: 29870973 DOI: 10.1159/000489556] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 04/18/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND AIMS Gastrointestinal stromal tumors (GISTs) are rare malignancies but the most common mesenchymal tumors of the digestive tract. Recent advances in diagnostic imaging and an increasing incidence will confront us more frequently with stromal tumors. This single center study aimed to characterize GIST patients in terms of tumor location, clinical presentation, metastasis formation, as well as associated secondary malignancies. METHODS In a retrospective study, 104 patients with a histologically confirmed diagnosis of GIST, collected between 1993 and 2011, were characterized for several clinical features. RESULTS The most common GIST location was the stomach (67.6%) followed by the small intestine (16.2%). Gastrointestinal bleeding (55.8%) and abdominal pain (38.5%) were the most frequently reported symptoms whereas about one-third of patients remained clinically asymptomatic (31.6%); 14.4% of patients had either synchronous or metachronous metastases and there was a significant prevalence also in the low risk group. The proportion of secondary malignant associated neoplasms was 31% in our GIST cohort, among which gastrointestinal, genitourinary tumors, and breast cancer were the most prevalent. CONCLUSION There was a considerable risk for metastasis formation and the development of secondary neoplasias that should encourage discussion about the appropriate surveillance strategy after surgery for GIST.
Collapse
Affiliation(s)
- Ali Aghdassi
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Agnes Christoph
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Frank Dombrowski
- Institute of Pathology, University Medicine Greifswald, Greifswald, Germany
| | - Paula Döring
- Institute of Pathology, University Medicine Greifswald, Greifswald, Germany
| | | | - Jan Christoph
- Chair of Medical Informatics, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Markus M Lerch
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Peter Simon
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| |
Collapse
|
12
|
Fan H, Lu P, Xu L, Qin Y, Li J. Synchronous occurrence of hereditary gastric adenocarcinoma, gastrointestinal stromal tumor, and esophageal small cell and squamous carcinoma in situ: an extremely rare case report. BMC Cancer 2017; 17:720. [PMID: 29115925 PMCID: PMC5678561 DOI: 10.1186/s12885-017-3736-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 10/30/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Hereditary diffuse gastric carcinoma (HDGC) accounts for 1-3% of all gastric carcinomas. Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors in the gastrointestinal (GI) tract but they comprise fewer than 1% of all GI malignancies. Small-cell carcinoma (SmCC) is a rare histological type of esophageal carcinoma, accounting for 0.4% to 2.8% of all esophageal tumors. Co-occurrence of SmCC with esophageal tumors caused by squamous carcinoma is also very uncommon. Although multiple primary malignancies are no longer rare in clinical practice, the simultaneous appearance of HDGC, GIST, esophageal small cell and squamous carcinoma in situ is extremely rare and very few cases have been reported. CASE PRESENTATION We present a case of a 53 year-old woman with synchronous occurrence of four malignancies including HDGC, GIST, esophageal small cell- and local squamous carcinoma in situ. A total gastrectomy with D2 lymph node dissection and postoperative adjuvant chemotherapy with oxaliplatin and paclitaxel liposome were performed. After a 1-year follow-up, this patient was still in good condition with no evidence of recurrence. CONCLUSION This is the unique case that describes the co-existence of the aforementioned four types of neoplasm. This case demonstrates that a diagnosis of gastric cancer does not preclude the presence of other malignancies and every case should be thoroughly analyzed to avoid missing other problems, which may worsen the prognosis.
Collapse
Affiliation(s)
- Huijie Fan
- Department of Oncology, the First Affiliated Hospital of Zhengzhou University, No.1, Jianshe Road, Zhengzhou, 450000, China
| | - Pei Lu
- Department of Oncology, the First Affiliated Hospital of Zhengzhou University, No.1, Jianshe Road, Zhengzhou, 450000, China
| | - Li Xu
- Department of Oncology, the First Affiliated Hospital of Zhengzhou University, No.1, Jianshe Road, Zhengzhou, 450000, China
| | - Yanru Qin
- Department of Oncology, the First Affiliated Hospital of Zhengzhou University, No.1, Jianshe Road, Zhengzhou, 450000, China
| | - Jing Li
- Department of Oncology, the First Affiliated Hospital of Zhengzhou University, No.1, Jianshe Road, Zhengzhou, 450000, China.
| |
Collapse
|
13
|
Clinicopathological and molecular characteristics of synchronous gastric adenocarcinoma and gastrointestinal stromal tumors. Sci Rep 2017; 7:12890. [PMID: 29018259 PMCID: PMC5635104 DOI: 10.1038/s41598-017-12622-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 08/16/2017] [Indexed: 12/29/2022] Open
Abstract
Synchronous gastric tumors that consist of both gastrointestinal stromal tumor (GIST) and adenocarcinoma are rare. We studied the clinicopathological and molecular characteristics of six cases containing both gastric adenocarcinoma and GIST. By means of immunohistochemical analysis, all GIST cells expressed CD117, CD34 and Dog1 in all six synchronous gastric adenocarcinomas with GIST, and in GIST alone. Sequencing analysis demonstrated that exon 11 c-kit mutations were present in two of six synchronous tumors and four of five GISTs. One of the two exon 11 c-kit mutations in synchronous adenocarcinomas with GISTs was an uncommon mutation of CTT > CCA at amino acid 576, and the other was a GTT deletion at amino acid 560. The mutation was a homozygous A > G mutation in exon 12 (amino acid 567) of PDGFR-α. We concluded that the exon 11 mutations were the most important in both cases of synchronous gastric adenocarcinoma with GIST and GIST alone. The mutation rate was higher in GIST alone than in synchronous adenocarcinoma with GIST.
Collapse
|
14
|
Gastrointestinal stromal tumour and second tumours: A literature review. Med Clin (Barc) 2017; 149:345-350. [PMID: 28736068 DOI: 10.1016/j.medcli.2017.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 06/01/2017] [Accepted: 06/03/2017] [Indexed: 12/14/2022]
Abstract
There are several tumours associated with gastrointestinal stromal tumour (GIST), most of them without an apparent family relationship; only 5% of them occur within the context of a family syndrome. In this article the corresponding literature about the former has been reviewed. A search in Pubmed was carried out, the methodology of which is described in detail in the body of the article. A total of 88 articles have been chosen for the review, next to the application of limits as well as a manual review. GIST patients have a twofold risk of developing a second tumour than the general population (4-33% of them develop a second neoplasm, either synchronic or metachronic). Most incident tumours associated with GIST are gastrointestinal and genitourinary tumours. In addition, patients with second tumours have a worse survival rate than those without second tumours.
Collapse
|
15
|
Miyoshi T, Mori R, Amano S, Sumitomo H, Aoyama M, Inoue S, Hino N, Wada D. Efficacy of erlotinib and imatinib in a patient with a rectal gastrointestinal stromal tumor and synchronous pulmonary adenocarcinoma: A case report. THE JOURNAL OF MEDICAL INVESTIGATION 2017; 63:144-8. [PMID: 27040071 DOI: 10.2152/jmi.63.144] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The synchronous existence of lung cancer and gastrointestinal stromal tumors (GIST) is considered to be extremely rare. To the best of our knowledge, this is the first report about the treatment of lung cancer and GIST with two kinds of molecular targeting drugs. An 83-year-old woman with a rectal GIST, which carried a c-kit mutation, and pulmonary adenocarcinoma, which exhibited an epidermal growth factor receptor (EGFR) mutation, was treated alternately with imatinib and erlotinib. Good control over both diseases was achieved for two years. The present case is not only of interest due to the rare co-occurrence of GIST and lung cancer, but also because it involved two tumors carrying different gene mutations, and both tumors were brought under control using different molecular targeting drugs.
Collapse
|
16
|
Liu Z, Liu S, Zheng G, Yang J, Hong L, Sun L, Fan D, Zhang H, Feng F. Clinicopathological features and prognosis of coexistence of gastric gastrointestinal stromal tumor and gastric cancer. Medicine (Baltimore) 2016; 95:e5373. [PMID: 27828865 PMCID: PMC5106071 DOI: 10.1097/md.0000000000005373] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The coexistence of gastric gastrointestinal stromal tumor (GIST) and gastric cancer is relatively high, and its prognosis is controversial due to the complex and variant kinds of presentation. Thus, the present study aimed to explore the clinicopathological features and prognostic factors of gastric GIST with synchronous gastric cancer.From May 2010 to November 2015, a total of 241 gastric GIST patients were retrospectively enrolled in the present study. The patients with coexistence of gastric GIST and gastric cancer were recorded. The clinicopathological features and prognoses of patients were analyzed.Among 241 patients, 24 patients had synchronous gastric cancer (synchronous group) and 217 patients did not (no-synchronous group). The synchronous group presented a higher percentage of elders (66.7% vs 39.6%, P = 0.001) and males (87.5% vs 48.4%, P < 0.001) than the no-synchronous group. The tumor diameter, mitotic index, and National Institutes of Health degree were also significantly different between the 2 groups (all P < 0.05). The 5-year disease-free survival and disease-specific survival rates of synchronous group were significantly lower than those of no-synchronous group (54.9% vs 93.5%, P < 0.001; 37.9% vs 89.9%, P < 0.001, respectively). However, the 5-year overall survival rates between synchronous and gastric cancer groups were comparable (37.9% vs 57.6%, P = 0.474).The coexistence of gastric GIST and gastric cancer was common in elder male patients. The synchronous GIST was common in low-risk category. The prognosis of gastric GIST with synchronous gastric cancer was worse than that of primary-single gastric GIST, but was comparable with primary-single gastric cancer.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Hongwei Zhang
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, Xi’an, Shaanxi Province, China
- Correspondence: Hongwei Zhang, Professor of Medicine, Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, 127 West Changle Road, 710032 Xi’an, Shaanxi Province, China (e-mail: ); 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 (e-mail: )
| | - Fan Feng
- Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, Xi’an, Shaanxi Province, China
- Correspondence: Hongwei Zhang, Professor of Medicine, Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, 127 West Changle Road, 710032 Xi’an, Shaanxi Province, China (e-mail: ); 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 (e-mail: )
| |
Collapse
|
17
|
Synchronous occurrence of gastrointestinal stromal tumors and other digestive tract malignancies in the elderly. Oncotarget 2016; 6:8397-406. [PMID: 25826075 PMCID: PMC4480761 DOI: 10.18632/oncotarget.3108] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 01/08/2015] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND/AIMS Elderly patients with gastrointestinal stromal tumors (GISTs) synchronous with other digestive tract malignancies have been rarely reported. In this study, clinicopathological characteristics were evaluated among elderly patients with GISTs with or without coexisting digestive tract malignancies. METHODS A total of 161 patients (≥65 years) were retrospectively reviewed at the West China Hospital, Sichuan University from January 2009 to June 2014. RESULTS Sixty-one patients were diagnosed with synchronous digestive tract malignancies (synchronous group), whereas 100 patients were diagnosed with no synchronous condition (no-synchronous group). The synchronous group exhibited a higher percentage of males (70.49% vs. 53.00%, P = 0.028) and poorer Eastern Cooperative Oncology Group performance status than the no-synchronous group (P = 0.029). The three-year overall survival (OS) rate was significantly lower among patients with synchronous digestive tract malignancies than that among patients without synchronous condition (64.5% vs. 84.0%, P = 0.003). Multivariate analysis showed that the presence of synchronous digestive tract malignancies (P = 0.002), co-morbidity (P = 0.004), and mitotic count ≥10 mitoses/50 high power fields (P = 0.012) were associated with poor OS. CONCLUSIONS A synchronous condition with other digestive tract malignancies is common in elderly patients with GISTs. OS primarily depends on synchronous digestive tract malignancies, mitotic count, and co-morbidity.
Collapse
|
18
|
Zhang P, Deng R, Xia Z, Shuai X, Chang W, Gao J, Wang G, Tao K. Concurrent gastrointestinal stromal tumor and digestive tract carcinoma: a single institution experience in China. Int J Clin Exp Med 2015; 8:21372-21378. [PMID: 26885079 PMCID: PMC4723924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Accepted: 10/31/2015] [Indexed: 06/05/2023]
Abstract
The aim of this study was to review the clinicopathological characteristics and survival outcomes of patients with concurrent gastrointestinal stromal tumor (GIST) and digestive tract carcinoma. Among 585 patients diagnosed with GIST from January 2005 to July 2014, 32 (5.5%) had synchronous digestive tract carcinoma, including 19 (59.4%) men and 13 (40.6%) women. The median age was 64 years (range, 43-84). GIST was located in the stomach (n=24), small intestine (n=6), duodenum (n=1) and retroperitoneum (n=1). GISTs were intra- or postoperatively discovered (n=28) or preoperatively identified (n=4). The tumor size was less than 10 mm (microGIST) in 23 (71.9%) GIST patients. The preoperatively identified GIST subgroup showed a significantly larger tumor size, more mitotic figures and a higher risk grade than the intra- or postoperatively identified GIST subgroup. Concurrent digestive tract carcinomas were most frequently located in the stomach (24 cases, 75%). The other involved sites were the esophagus (n=5), duodenum (n=2) and colon (n=1). With a median follow-up of 32 months (range, 9-80), 24 patients were alive without evidence of disease, 6 patients had died of carcinoma progression, 1 patient had died from an accident, and 1 patient experienced GIST metastasis to the liver. In summary, we discovered that 5.5% of GIST patients also developed a concurrent digestive tract carcinoma in a series of 585 GIST cases. The majority of GISTs are incidentally identified microGISTs. The concurrent carcinoma seems to have a greater unfavorable effect on prognosis than the GIST. However, for a GIST that is identified preoperatively with a high risk of progression, adjuvant therapy is warranted.
Collapse
Affiliation(s)
- Peng Zhang
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan 430022, China
| | - Rui Deng
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan 430022, China
| | - Zefeng Xia
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan 430022, China
| | - Xiaoming Shuai
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan 430022, China
| | - Weilong Chang
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan 430022, China
| | - Jinbo Gao
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan 430022, China
| | - Guobin Wang
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan 430022, China
| | - Kaixiong Tao
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan 430022, China
| |
Collapse
|
19
|
Kakkar A, Gupta RK, Dash NR, Afshan I, Suri V. Lymphoepithelioma-like carcinoma of the stomach with incidental gastrointestinal stromal tumor (GIST)--a rare synchrony of two tumors. J Gastrointest Cancer 2015; 45 Suppl 1:120-4. [PMID: 24567007 DOI: 10.1007/s12029-014-9581-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Aanchal Kakkar
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | | | | | | | | |
Collapse
|
20
|
Murphy JD, Ma GL, Baumgartner JM, Madlensky L, Burgoyne AM, Tang CM, Martinez ME, Sicklick JK. Increased risk of additional cancers among patients with gastrointestinal stromal tumors: A population-based study. Cancer 2015; 121:2960-7. [PMID: 25930983 DOI: 10.1002/cncr.29434] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 02/22/2015] [Accepted: 02/25/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Most gastrointestinal stromal tumors (GISTs) are considered nonhereditary or sporadic. However, single-institution studies suggest that GIST patients develop additional malignancies at increased frequencies. It was hypothesized that greater insight could be gained into possible associations between GISTs and other malignancies with a national cancer database inquiry. METHODS Patients diagnosed with GISTs (2001-2011) in the Surveillance, Epidemiology, and End Results database were included. Standardized prevalence ratios (SPRs) and standardized incidence ratios (SIRs) were used to quantify cancer risks incurred by GIST patients before and after GIST diagnoses, respectively, in comparison with the general US population. RESULTS There were 6112 GIST patients, and 1047 (17.1%) had additional cancers. There were significant increases in overall cancer rates: 44% (SPR, 1.44) before the GIST diagnosis and 66% (SIR, 1.66) after the GIST diagnosis. Malignancies with significantly increased occurrence both before and after diagnoses included other sarcomas (SPR, 5.24; SIR, 4.02), neuroendocrine-carcinoid tumors (SPR, 3.56; SIR, 4.79), non-Hodgkin lymphoma (SPR, 1.69; SIR, 1.76), and colorectal adenocarcinoma (SPR, 1.51; SIR, 2.16). Esophageal adenocarcinoma (SPR, 12.0), bladder adenocarcinoma (SPR, 7.51), melanoma (SPR, 1.46), and prostate adenocarcinoma (SPR, 1.20) were significantly more common only before the GIST diagnosis. Ovarian carcinoma (SIR, 8.72), small intestine adenocarcinoma (SIR, 5.89), papillary thyroid cancer (SIR, 5.16), renal cell carcinoma (SIR, 4.46), hepatobiliary adenocarcinoma (SIR, 3.10), gastric adenocarcinoma (SIR, 2.70), pancreatic adenocarcinoma (SIR, 2.03), uterine adenocarcinoma (SIR, 1.96), non-small cell lung cancer (SIR, 1.74), and transitional cell carcinoma of the bladder (SIR, 1.65) were significantly more common only after the GIST diagnosis. CONCLUSIONS This is the first population-based study to characterize the associations and temporal relations between GISTs and other cancers by both site and histological type. These associations may carry important clinical implications for future cancer screening and treatment strategies.
Collapse
Affiliation(s)
- James D Murphy
- Department of Radiation and Applied Sciences, Moores Cancer Center, University of California San Diego, La Jolla, California
| | - Grace L Ma
- Division of Surgical Oncology, Department of Surgery, Moores Cancer Center, University of California San Diego, La Jolla, California.,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joel M Baumgartner
- Division of Surgical Oncology, Department of Surgery, Moores Cancer Center, University of California San Diego, La Jolla, California
| | - Lisa Madlensky
- Department of Family and Preventive Medicine, Moores Cancer Center, University of California San Diego, La Jolla, California
| | - Adam M Burgoyne
- Division of Medical Oncology, Department of Internal Medicine, Moores Cancer Center, University of California San Diego, La Jolla, California
| | - Chih-Min Tang
- Division of Surgical Oncology, Department of Surgery, Moores Cancer Center, University of California San Diego, La Jolla, California
| | - Maria Elena Martinez
- Department of Family and Preventive Medicine, Moores Cancer Center, University of California San Diego, La Jolla, California
| | - Jason K Sicklick
- Division of Surgical Oncology, Department of Surgery, Moores Cancer Center, University of California San Diego, La Jolla, California
| |
Collapse
|
21
|
Rodríguez-González D, Delgado-Plasencia L, Hernández-León C, Torres-Monzón E, Castro-Peraza ME, Cruz-Jurado J, Bravo-Gutiérrez A, Medina-Arana V. [C-KIT in gastrointestinal stromal tumors and associated malignancies: A Study in a population with genetic isolation]. GASTROENTEROLOGIA Y HEPATOLOGIA 2015; 38:484-90. [PMID: 25843813 DOI: 10.1016/j.gastrohep.2015.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Revised: 02/05/2015] [Accepted: 02/05/2015] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastrointestinal tract. Numerous studies have reported the association between GIST and other neoplasms. OBJECTIVES The aim of this study was to investigate the possible association between GIST and other tumors in a genetically isolated population. METHODS A retrospective study was conducted of patients with GIST between 2002 and 2009 at our center. Epidemiological, pathological and family data in patients with GIST alone (group A) were compared with those in patients with GIST associated with other neoplasms (group B). A possible common genetic mechanism was investigated between GIST and associated malignancies by testing the detection of the immunohistochemical marker, CD117, in all tumors. RESULTS Twenty-two patients with GIST were identified, 10 in group A (45%) and 12 in group B (55%). In group B, the associated tumor was malignant in 6 patients (50%) and benign in another 6 (50%). Of the 22 patients with GIST, 8 (36%) had a family history of malignancies. Of these 8 patients, 7 (87.5%) were in group B (p=0.03) and 3 (37.5%) showed the same pathological type of neoplasm as their relatives. All GIST were positive for CD117 whereas associated malignancies were negative for this marker. CONCLUSION We did not find immunohistochemical positivity for CD117 in malignancies associated with GIST. Given the special characteristics of the study population, the association between GIST and associated malignancies may be incidental.
Collapse
Affiliation(s)
- Diana Rodríguez-González
- Servicio de Cirugía General y Digestiva, Hospital Universitario de Canarias, Santa Cruz de Tenerife, España
| | - Luciano Delgado-Plasencia
- Servicio de Cirugía General y Digestiva, Hospital Universitario de Canarias, Santa Cruz de Tenerife, España.
| | - Carmen Hernández-León
- Servicio de Anatomía Patológica, Hospital Universitario de Canarias, Santa Cruz de Tenerife, España
| | - Esther Torres-Monzón
- Servicio de Radiología, Hospital Universitario de Canarias, Santa Cruz de Tenerife, España
| | - María Elisa Castro-Peraza
- Servicio de Cirugía General y Digestiva, Hospital Universitario de Canarias, Santa Cruz de Tenerife, España
| | - Josefina Cruz-Jurado
- Servicio de Oncología Médica, Hospital Universitario de Canarias, La Cuesta, Santa Cruz de Tenerife, España
| | - Alberto Bravo-Gutiérrez
- Servicio de Cirugía General y Digestiva, Hospital Universitario de Canarias, Santa Cruz de Tenerife, España
| | - Vicente Medina-Arana
- Servicio de Cirugía General y Digestiva, Hospital Universitario de Canarias, Santa Cruz de Tenerife, España
| |
Collapse
|
22
|
Abstract
PURPOSE OF REVIEW Knowledge related to gastrointestinal stromal tumor (GIST) in the setting of nonhereditary and hereditary multiple tumor syndromes continues to expand. This review describes associations between sporadic GIST and second malignancies, as well as new contributions to our knowledge about hereditary GIST multiple tumor syndromes. RECENT FINDINGS Sporadic GIST patients have increased risk of developing synchronous/metachronous cancers, including nonhematologic and hematologic malignancies. Data suggest these associations are nonrandom, more prevalent in men and increase with age. New adrenal tumors have also been associated with nonhereditary Carney's triad. Meanwhile, understanding of the molecular basis of heritable GIST syndromes has improved. Several new familial GIST kindreds have been reported, including those with germline KIT and PDGFRα mutations. Knowledge about succinate dehydrogenase (SDH) deficiency and mutations in hereditary GIST syndromes has expanded. It is now known that neurofibromatosis-1-associated GISTs are SDHB-positive, whereas Carney-Stratakis syndrome-associated GISTs are SDHB-deficient with underlying germline mutations in SDH subunits A-D. SUMMARY Recognition and early diagnosis of GIST syndromes allows for improved comprehensive medical care. With additional understanding of the molecular pathogenesis of GIST multiple tumor syndromes, we can refine our screening programs and management of these patients and their families.
Collapse
|
23
|
Fiore M, de Stefano G, Coppola N, Giorgio A. Synchronous and metachronous gastric gist with pancreatic adenocarcinoma: report of 2 cases and a review of literature. GASTROENTEROLOGY AND HEPATOLOGY FROM BED TO BENCH 2015; 8:298-301. [PMID: 26468351 PMCID: PMC4600521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 02/19/2015] [Indexed: 11/12/2022]
Abstract
We report two cases of a Gastrointestinal Stromal Tumor (GIST) synchronous and metachronous, respectively, with pancreatic adenocarcinoma. To our knowledge, this is the first report of a GIST involved 3 years after a ductal pancreatic adenocarcinoma. Data from the literature and our cases seem to suggest that incidental GIST may occur synchronously and metachronously with other cancers more frequently than expected. Thus, the patients with a diagnosis of pancreatic adenocarcinoma may have undergone a strict follow up for GIST.
Collapse
Affiliation(s)
- Marco Fiore
- Infectious Disease Unit, University Hospital of Trieste, Italy Piazzale Ospitale 1, 34100, Trieste, Italy
| | - Giorgio de Stefano
- Ultrasound Unit for Infectious Diseases, AORN dei Colli, Cotugno Hospital, Via G. Quagliarello 54, 80131 Naples, Italy
| | - Nicola Coppola
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, Second University of Naples, Via L. Armanni 5, Naples, 80133, Italy.
| | - Antonio Giorgio
- Interventional Ultrasound Unit, Tortorella Clinical Institute, ISSMES Consortium, Via Nicola Aversano 1, 84124 Salerno , Italy
| |
Collapse
|
24
|
Ding J, Sun P, Cai XY, Fei SH, Wu J, Qi YK, Liu ZB, Yuan L, He YJ, Song H, Chen WX. Synchronous poorly-differentiated neuroendocrine carcinoma and gastrointestinal stromal tumor of the stomach: a case report with immunohistochemical and molecular genetic analyses of KIT and PDGFRA. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2014; 7:9076-9080. [PMID: 25674291 PMCID: PMC4313951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 11/01/2014] [Indexed: 06/04/2023]
Abstract
Although the stomach is the most common location for gastrointestinal stromal tumor (GIST) with co-primary tumors, the synchronous appearance of a poorly differentiated neuroendocrine carcinoma (NEC) and GIST in the stomach is extremely rare. To the best of our knowledge, this is the first case of gastric GIST coexisting with gastric NEC to be reported in the literature. The current study reports the case of a 71-year-old male with gastric poorly differentiated NEC and GIST discovered incidentally during surgical treatment of the NEC. Immunohistochemistry analysis showed that the NEC tumor cells were positive for CK (cytokeratin), CD57, synaptophysin, chromogranin, CD117 (KIT protein), Dog-1 (discovered on GIST-1 protein) and CD34. The synchronous GIST immunophenotype showed positivity for CD117, Dog-1 and CD34 (100%), whereas staining for CK, SMA, desmin and S100 was negative. Ki-67 labeling of proliferating cells was 90% in NEC and 1% in GIST. An accurate diagnosis was confirmed by immunohistochemical findings. Furthermore, genetic analysis using PCR direct sequencing identified no mutations in the KIT (exons 9, 11, 13 and 17) and PDGFRA (exons 12 and 18) genes. The patient developed lymph node metastases and underwent cisplatin-based chemotherapy after the operation. This is the first documented case of synchronous gastric GIST and NEC with the examination of protein expression and gene mutations in KIT and PDGFRA, which will help to further understand the etiology and pathogenesis of NEC coexisting with GIST in a gastric location.
Collapse
MESH Headings
- Aged
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Biopsy
- Carcinoma, Neuroendocrine/chemistry
- Carcinoma, Neuroendocrine/diagnosis
- Carcinoma, Neuroendocrine/genetics
- Carcinoma, Neuroendocrine/pathology
- Carcinoma, Neuroendocrine/therapy
- Cell Differentiation
- Chemotherapy, Adjuvant
- Cisplatin/administration & dosage
- DNA Mutational Analysis
- Exons
- Gastrectomy
- Gastrointestinal Stromal Tumors/chemistry
- Gastrointestinal Stromal Tumors/diagnosis
- Gastrointestinal Stromal Tumors/genetics
- Gastrointestinal Stromal Tumors/pathology
- Gastrointestinal Stromal Tumors/therapy
- Humans
- Immunohistochemistry
- Incidental Findings
- Lymphatic Metastasis
- Male
- Mutation
- Neoplasms, Multiple Primary/chemistry
- Neoplasms, Multiple Primary/diagnosis
- Neoplasms, Multiple Primary/genetics
- Neoplasms, Multiple Primary/pathology
- Neoplasms, Multiple Primary/therapy
- Predictive Value of Tests
- Proto-Oncogene Proteins c-kit/analysis
- Proto-Oncogene Proteins c-kit/genetics
- Receptor, Platelet-Derived Growth Factor alpha/analysis
- Receptor, Platelet-Derived Growth Factor alpha/genetics
- Stomach Neoplasms/chemistry
- Stomach Neoplasms/diagnosis
- Stomach Neoplasms/genetics
- Stomach Neoplasms/pathology
- Stomach Neoplasms/therapy
- Treatment Outcome
Collapse
Affiliation(s)
- Jun Ding
- Department of Pathology, Shanghai Gongli Hospital Shanghai, People's Republic of China
| | - Ping Sun
- Department of Gastroenterology, Shanghai Gongli Hospital Shanghai, People's Republic of China
| | - Xiao-Yan Cai
- Department of Gastroenterology, Shanghai Gongli Hospital Shanghai, People's Republic of China
| | - Shao-Hua Fei
- Department of Pathology, Shanghai Gongli Hospital Shanghai, People's Republic of China
| | - Jian Wu
- Department of Pathology, Shanghai Gongli Hospital Shanghai, People's Republic of China
| | - Yu-Kai Qi
- Department of Pathology, Shanghai Gongli Hospital Shanghai, People's Republic of China
| | - Ze-Bin Liu
- Department of Pathology, Fudan University Shanghai Cancer Center Shanghai, People's Republic of China
| | - Lin Yuan
- Department of Pathology, Shanghai Jiaotong University Affiliated First People's Hospital Shanghai, People's Republic of China
| | - Yu-Jie He
- Department of Pathology, Shanghai Gongli Hospital Shanghai, People's Republic of China
| | - Hui Song
- Department of Pathology, Shanghai Gongli Hospital Shanghai, People's Republic of China
| | - Wei-Xiang Chen
- Department of Pathology, Shanghai Gongli Hospital Shanghai, People's Republic of China
| |
Collapse
|
25
|
Nam SJ, Choi HS, Kim ES, Keum B, Jeen YT, Chun HJ. Synchronous occurrence of gastrointestinal stromal tumor and intrahepatic cholangiocarcinoma: A case report. Oncol Lett 2014; 9:165-168. [PMID: 25435952 PMCID: PMC4247007 DOI: 10.3892/ol.2014.2703] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Accepted: 08/15/2014] [Indexed: 12/17/2022] Open
Abstract
Various cases of gastrointestinal stromal tumor (GIST) coinciding with other gastrointestinal malignancies have been reported to date, however, the synchronous occurrence of GIST and intrahepatic cholangiocarcinoma (ICC) is exceptionally rare and, to the best of our knowledge, has only been reported once. The coinciding malignancy has usually been encountered incidentally during surgical exploration. Thus, this is the first report where a targeted biopsy of the clinically suspicious lesion was used to determine the diagnosis of ICC concurrent with GIST. The liver is the most frequent metastatic site of GIST, therefore, additional hepatic masses may be mistakenly diagnosed as metastatic disease, rather than the presentation of multiple primary tumors. This subsequently delays the accurate diagnosis and complicates the performance of a curable resection. The current study reports a case of advanced synchronous GIST and ICC, which was operable at initial presentation, but progressed to become surgically unresectable.
Collapse
Affiliation(s)
- Seung-Joo Nam
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul 136-705, Republic of Korea
| | - Hyuk Soon Choi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul 136-705, Republic of Korea
| | - Eun Sun Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul 136-705, Republic of Korea
| | - Bora Keum
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul 136-705, Republic of Korea
| | - Yoon Tae Jeen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul 136-705, Republic of Korea
| | - Hoon Jai Chun
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul 136-705, Republic of Korea
| |
Collapse
|
26
|
Lin M, Lin JX, Huang CM, Zheng CH, Li P, Xie JW, Wang JB, Lu J. Prognostic analysis of gastric gastrointestinal stromal tumor with synchronous gastric cancer. World J Surg Oncol 2014; 12:25. [PMID: 24479763 PMCID: PMC3917900 DOI: 10.1186/1477-7819-12-25] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 01/18/2014] [Indexed: 12/22/2022] Open
Abstract
Background Many patients with gastric gastrointestinal stromal tumor (GIST) and synchronous gastric cancer have been described, most in single case studies. We retrospectively investigated the clinicopathologic features and prognostic effects of gastric GIST in patients with synchronous gastric cancer. Methods The study enrolled 170 patients with gastric GIST, who had undergone complete surgical resection (R0) from January 2000 to December 2011. Forty-two patients had synchronous gastric cancer (CA Group), whereas 128 did not (Non-CA Group). The clinicopathologic features and potential prognostic factors in the two groups were compared. Results Patients in the CA Group had more obvious symptoms, but a lower rate of preoperative diagnosis of gastric GIST (P <0.05). The two groups differed significantly in gender, age, greatest tumor diameter, risk stratification, tumor-associated ulcers, and CD117 and CD34 expression (P <0.05 each). Univariate analysis showed that age, risk stratification, postoperative oral imatinib and synchronous gastric cancer were predictive factors of survival (P <0.05). Cox regression analysis showed that risk stratification, postoperative oral imatinib and synchronous gastric cancer were independent predictors of survival (P <0.05). Stratified analysis showed that the 5-year overall survival rate was lower in patients with synchronous gastric cancer than in those without synchronous gastric cancer. Conclusions Gastric GIST with synchronous gastric cancer had a lower rate of preoperative diagnosis, with correct diagnosis often missed. Survival, however, depended primarily on the gastric cancer.
Collapse
Affiliation(s)
| | | | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No,29 Xinquan Road, Fuzhou 350001, Fujian Province, China.
| | | | | | | | | | | |
Collapse
|
27
|
Concomitant gastrointestinal stromal tumor of the stomach and gastric adenocarcinoma in a patient with billroth 2 resection. Case Rep Surg 2013; 2013:583856. [PMID: 24455386 PMCID: PMC3881520 DOI: 10.1155/2013/583856] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 11/26/2013] [Indexed: 12/28/2022] Open
Abstract
Background. With this study we focus on the etiopathogenesis and on the therapy of the simultaneous occurrence of Gastric gastrointestinal stromal tumor (gGIST) and adenocarcinoma of the stomach in a patient with Billroth II gastric resection (BIIGR). We report the first case of this event and a review of the literature. Methods. A 70-year-old man with a BIIGR, affected by adenocarcinoma of the stomach, was successfully treated with total gastrectomy. The histological examination showed a gastric adenocarcinoma with a synchronous GIST sized 2 cm and S-100, CD117, and CD34 positive. The mutation of PDGFR gene was detected. Discussion. This tumor is a rare mesenchymal neoplasm of the gastrointestinal tract. Few cases of synchronous gastric adenocarcinoma and GIST are observed in the literature and no case in patients with BIIGR. Various hypotheses have been proposed to explain this occurrence. It is frequently attributed to Metallothioneins genes mutations or embryological abnormalities, but this has not been proven yet. We suggest a hypothesis about the etiopathogenesis of this event in a BIIGR patient. Conclusion. GIST may occur synchronously with gastric adenocarcinoma. This simultaneous occurrence needs more studies to be proven. The study of Cajal cells' proliferation signalling is crucial to demonstrate our hypotesis.
Collapse
|
28
|
Cai R, Ren G, Wang DB. Synchronous adenocarcinoma and gastrointestinal stromal tumors in the stomach. World J Gastroenterol 2013; 19:3117-3123. [PMID: 23716992 PMCID: PMC3662952 DOI: 10.3748/wjg.v19.i20.3117] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Revised: 03/28/2013] [Accepted: 05/10/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To review the clinicopathological characteristics of concurrent gastrointestinal stromal tumors (GISTs) and gastric adenocarcinoma.
METHODS: We retrospectively analyzed eight cases of synchronous adenocarcinoma and GIST in the stomach that had been surgically resected with curative intent between March 2003 and December 2008 in Xinhua hospital and Ruijin hospital. The adenocarcinoma was determined to be the primary tumor based on the histological features. The GIST cells were diffusely and strongly positive for CD34 and CD117.
RESULTS: The patients were six men and two women aged 47-80 years (average, 68.6 years). GIST was preoperatively detected in only one patient. The average sizes of the gastric adenocarcinomas and GISTs were 6.000 ± 2.6186 cm and 1.825 ± 1.4370 cm, respectively. All GISTs were very low- or low-risk lesions that were detected during evaluation, staging, operation or follow-up for gastric adenocarcinoma.
CONCLUSION: We hypothesized that the stomach was influenced by the same unknown carcinogen, resulting in a simultaneous proliferation of different cell lines (epithelial and stromal cell).
Collapse
|
29
|
Pata F, Sengodan M, Tang CB, Kadirkamanathan SS, Harvey M, Zaitoun A, Petkar M, Rotundo A. Concomitant jejunal sarcomatoid carcinoma and gastric GIST in patient with polymyalgia rheumatica: A case report. Int J Surg Case Rep 2013; 4:449-52. [PMID: 23548706 DOI: 10.1016/j.ijscr.2013.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 02/16/2013] [Accepted: 02/18/2013] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Sarcomatoid carcinoma (SCA) of the small bowel is an extremely rare tumor with only 21 cases reported in literature and GISTs are relatively rare gastrointestinal neoplasms. PRESENTATION OF CASE We report a case of an 85 year-old female admitted with intestinal obstruction in June 2010. She suffered from polymyalgia rheumatica and was under surveillance for a presumed gastric GIST. A laparotomy was performed with resection of the jejunal obstruction and complete excision of the gastric mass. Histology confirmed a gastric GIST and sarcomatoid carcinoma of the small bowel. The patient was discharged 21 days after the operation and died on the 88th post-operative day. DISCUSSION Synchronous GISTs and other malignancies have been reported over the last years with increasing frequency. Sarcomatoid carcinoma of the small bowel is an aggressive neoplasm with poor survival rates and surgery is the cornerstones of treatment. Given its unpredictable clinical behaviour and concomitant association with other malignancies, GISTs require adequate surgical resection with careful, long-term follow-up. CONCLUSION This is the first case of concomitant gastric GIST with Sarcomatoid carcinoma of the small bowel, and the first report of sarcomatoid small bowel carcinoma in association with polymyalgia rheumatica.
Collapse
Affiliation(s)
- Francesco Pata
- Department of General Surgery, Upper Gastrointestinal Unit, Broomfield Hospital, Court Road, Chelmsford CM1 7ET, United Kingdom.
| | | | | | | | | | | | | | | |
Collapse
|
30
|
Chan CHF, Cools-Lartigue J, Marcus VA, Feldman LS, Ferri LE. The impact of incidental gastrointestinal stromal tumours on patients undergoing resection of upper gastrointestinal neoplasms. Can J Surg 2013; 55:366-70. [PMID: 22992402 DOI: 10.1503/cjs.009111] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Emerging data suggest asymptomatic gastrointestinal stromal tumours (GISTs) of the upper gastrointestinal (UGI) tract are not uncommon. We sought to determine their incidence in patients undergoing resection for UGI neoplasms and their impact on surgical and adjuvant treatment. METHODS We accessed a database prospectively listing all patients undergoing resection of non-GIST neoplasms of the stomach and esophagus at a single university centre over a 4.5-year period and reviewed pathology reports for the presence of synchronous GISTs in the UGI tract. We compared patient demographic and tumour characteristics, operative procedures and postoperative outcomes. RESULTS In all, 207 patients undergoing gastrectomy or esophagectomy for non- GIST neoplasms were included. We identified 15 synchronous GISTs in the UGI tract of 11 (5.3%) patients (1 preoperatively, 4 intraoperatively and 10 on final pathology), with an average age of 67 years. Most patients were men. Additional resections were required for GISTs identified pre- or intraoperatively. Final pathology revealed completely resected c-kit positive tumours of an average size of 0.5 (range 0.1-4.0) cm with low or very low risk of malignant potential. No patients received adjuvant therapy for the GISTs. After a median follow-up of 11 (range 2-36) months, 5 patients died from their primary cancer, 3 were alive with primary cancer recurrence, and 3 were alive without disease. No patients experienced GIST recurrence. CONCLUSION Incidentally finding a synchronous GIST during resection of UGI neoplasms is not uncommon; it may alter surgical treatment but is unlikely to impact longterm survival.
Collapse
Affiliation(s)
- Carlos H F Chan
- The Department of Surgery, McGill University Health Centre, Montréal, Que
| | | | | | | | | |
Collapse
|
31
|
He JJ, Ding KF, Zheng L, Xu JH, Li J, Wu YL, Sun LF, Zhou DE, Zheng S. Adenosquamous carcinoma of the uncinate process of the pancreas with synchronous gastrointestinal stromal tumor of the stomach: Case report and review of the literature. Oncol Lett 2012. [PMID: 23197997 DOI: 10.3892/ol.2012.902] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Recently, the coexistence of gastrointestinal stromal tumors (GISTs) with other neoplasms has been studied with increasing frequency. Coexistence of pancreatic cancer with GISTs remains a rarity; however, here, we report a very rare case of adenosquamous carcinoma (ASC) of the uncinate process of the pancreas with synchronous GISTs of the stomach in a 62-year-old female. The patient presented with epigastric discomfort and vomiting. Radiographic imaging revealed two masses; one located at the body of the stomach and the other located at the uncinate process of the pancreas. Intraoperatively, a fine needle aspiration biopsy was conducted in the uncinate process of the pancreas, which revealed the malignancy of the masses. A pancreaticoduodenectomy and partial gastrectomy were then conducted, and subsequent pathological examinations identified an ASC of the pancreas and a GIST of the stomach. In our case, contrary to the majority of previous cases of synchronous GISTs and other malignancies, GIST was not an incidental finding. The initial suspicion on the GIST as the underlying cause of clinical symptoms led to the discovery of the ASC of the uncinate process of the pancreas.
Collapse
Affiliation(s)
- Jin-Jie He
- Department of Surgical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Pancreas-preserving segmental duodenectomy for gastrointestinal stromal tumor of the duodenum and splenectomy for splenic angiosarcoma. Hepatobiliary Pancreat Dis Int 2012; 11:325-9. [PMID: 22672829 DOI: 10.1016/s1499-3872(12)60169-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Gastrointestinal stromal tumors are the most common mesenchymal tumors of the gastrointestinal tract and occur rarely in the duodenum. Splenic angiosarcoma is an aggressive neoplasm with an extremely poor prognosis. METHODS We report a case of a 70-year-old man hospitalized for abdominal pain in the upper quadrants, dyspepsia and nausea, previously treated for Hodgkin lymphoma 30 years ago. Abdominal CT showed a solid nodular lesion in the third portion of the duodenum, the presence of retropancreatic, aortic and caval lymph nodes, and four nodular splenic masses. (111)In-octreotide scintigraphy revealed pathological tissue accumulation in the duodenal region, and in the retropancreatic, retroduodenal, aortic and caval lymph nodes, suggesting a nonfunctioning neuroendocrine peripancreatic tumor. RESULTS At exploratory laparotomy, an exophytic soft tumor was found originating from the third portion of the duodenum. Pancreas-preserving duodenectomy with duodenojejunostomy, splenectomy and lymphnodectomy of retropancreatic aortic and caval lymph nodes were performed. Pathological evaluation and immunohistochemical studies showed the presence of a duodenal gastrointestinal stromal tumor with low mitotic activity and a well-differentiated angiosarcoma localized to the spleen and invading lymph nodes. CONCLUSIONS We speculated that the angiosarcoma and duodenal gastrointestinal stromal tumors of this patient were due to the treatment of Hodgkin lymphoma with radiotherapy 30 years ago. Pancreas-preserving segmental duodenectomy can be used to treat non-malignant neoplasms of the duodenum and avoid extensive surgery. Splenectomy is the treatment of choice for localized angiosarcomas but a strict follow-up is mandatory because of the possibility of recurrence.
Collapse
|
33
|
Wada Y, Koizumi T, Yokoyama T, Urushihata K, Yamamoto H, Hanaoka M, Kubo K. Synchronous gastrointestinal stromal tumor and primary lung adenocarcinoma. Intern Med 2012; 51:2407-10. [PMID: 22975558 DOI: 10.2169/internalmedicine.51.7888] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Although rare, gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastrointestinal tract. The asynchronous occurrence of other malignancies in patients with GIST during the clinical course is relatively common. However, the synchronous coexistence of GIST and lung cancer has only rarely been reported. We experienced a case of coincidental primary lung adenocarcinoma and intestinal GIST. The present case is not only of interest due to the rare coincidence of GIST and lung cancer, but also because there was an epidermal growth factor receptor gene mutation in the lung cancer and a c-kit mutation in the GIST.
Collapse
Affiliation(s)
- Yousuke Wada
- The First Department of Internal Medicine, Shinshu University School of Medicine, Japan
| | | | | | | | | | | | | |
Collapse
|
34
|
Mrowiec S, Jabłońska B, Liszka L, Pająk J, Leidgens M, Szydło R, Sandecka A, Lampe P. Prognostic factors for survival post surgery for patients with gastrointestinal stromal tumors. ACTA ACUST UNITED AC 2011; 48:3-9. [PMID: 22179138 DOI: 10.1159/000334172] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 08/15/2011] [Indexed: 01/18/2023]
Abstract
BACKGROUND Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms located in the alimentary tract. Our aim was to assess the influence of prognostic factors on survival in patients surgically treated for GISTs. STUDY One hundred and five patients treated between January 1989 and December 2008 were available for study. A retrospective analysis of prognostic factors (age, gender, mitotic index, tumor location, tumor size, risk of malignant behavior, and coexisting other neoplasm) was performed. Univariate and multivariate survival analyses were undertaken. RESULTS Univariate analyses revealed the importance of patient gender (p = 0.007), disease location (p = 0.055), mitotic index (p = 0.054) and coexistence with other neoplasms (p = 0.004). However, multivariate analysis showed 3 independently statistically significant factors: coexistence with other neoplasm (RR = 3.53, p = 0.004), male gender (RR = 2.60, p = 0.011) and mitotic index ≥10/50 HPF, (RR = 2.60, p = 0.042). CONCLUSIONS Our study has shown that male gender, a high mitotic index ≥10/50 HPF, and coexistence with other malignant neoplasms were independent poor prognostic factors in patients with GIST. The presence of middle or lower gut disease location leads to an increased risk of mortality when compared with the upper gut.
Collapse
Affiliation(s)
- Sławomir Mrowiec
- Department of Digestive Tract Surgery, University Hospital of the Medical University of Silesia, Katowice, Poland
| | | | | | | | | | | | | | | |
Collapse
|
35
|
Dasanu CA, Mesologites T, Trikudanathan G. Synchronous tumors: adenosquamous carcinoma of pancreas and GIST of stomach. J Gastrointest Cancer 2011; 42:186-9. [PMID: 20623381 DOI: 10.1007/s12029-010-9187-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
We report herein a unique case of an adenosquamous carcinoma (ASC) of the pancreas and a synchronous gastrointestinal stromal tumor (GIST) of stomach in a 75-year-old Caucasian male. He presented with painless jaundice and generalized pruritus and was found to have a pancreatic head mass. Whipple's procedure was performed and yielded the above diagnoses. Ductal pancreatic adenocarcinoma, not a much rarer and more aggressive ASC subtype, has previously been shown to co-exist with GIST in some surgical series. In addition, the incidentally discovered GIST in our patient involved the stomach and not the small intestine, which is the predominant GIST location when concurrently diagnosed with other GI tumors. At the time of this publication, our patient, who received adjuvant chemoradiotherapy, remains disease-free 14 months after the abdominal surgery.
Collapse
|
36
|
Sandvik OM, Søreide K, Kvaløy JT, Gudlaugsson E, Søreide JA. Epidemiology of gastrointestinal stromal tumours: Single-institution experience and clinical presentation over three decades. Cancer Epidemiol 2011; 35:515-20. [DOI: 10.1016/j.canep.2011.03.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2010] [Revised: 02/27/2011] [Accepted: 03/11/2011] [Indexed: 02/08/2023]
|
37
|
Shariq O, Odedra A, Alexopoulos AS, Gould S, Soobrah R. Synchronous occurrence of gastrointestinal stromal tumour and ovarian neoplasm in a patient presenting with acute cholecystitis. J Gastrointest Cancer 2011; 43:113-6. [PMID: 21360271 DOI: 10.1007/s12029-011-9265-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Omair Shariq
- Imperial College London, South Kensington Campus, Eastcote, Middlesex HA5 1PP, UK.
| | | | | | | | | |
Collapse
|
38
|
Caterino S, Lorenzon L, Petrucciani N, Iannicelli E, Pilozzi E, Romiti A, Cavallini M, Ziparo V. Gastrointestinal stromal tumors: correlation between symptoms at presentation, tumor location and prognostic factors in 47 consecutive patients. World J Surg Oncol 2011; 9:13. [PMID: 21284869 PMCID: PMC3039617 DOI: 10.1186/1477-7819-9-13] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Accepted: 02/01/2011] [Indexed: 12/15/2022] Open
Abstract
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. Aim Primary aim of this study was to report our experience regarding GIST patients, correlating symptoms at presentation with tumor localization and risk factors. Patients and methods 47 consecutive patients undergone to surgical resection for GISTs were enrolled in a prospective study from December 1999 to March 2009. Patient's clinical and pathological features were collected and analysed. Results The most common symptom was abdominal pain. Bleeding in the digestive tract and abdominal pain were more frequent in gastric GISTs (58% and 61%); acute abdominal symptoms were more frequent in jejunal and ileal GISTs (40% and 60%), p < 0.05. We reported a mild correlation between the mitotic rate index and symptoms at presentation (p 0.074): this correlation was stronger if GISTs causing "acute abdominal symptoms" were compared with GISTs causing "abdominal pain" as main symptom (p 0.039) and with "incidental" GISTs (p 0.022). We observed an higher prevalence of symptomatic patients in the "high risk/malignant group" of both the Fletcher's and Miettines's classification (p < 0.05). Conclusion According with our findings symptoms correlate to tumor location, to class risk criteria as mitotic index and risk classifications, however we cannot conclude that symptoms are per se predictive of survival or patient's outcome.
Collapse
Affiliation(s)
- Salvatore Caterino
- Surgical and Medical Department of Clinical Sciences, Biomedical Technologies and Translational Medicine, Faculty of Medicine and Psychology University of Rome La Sapienza, Italy
| | | | | | | | | | | | | | | |
Collapse
|
39
|
Burgess P, O'Shea M, Gaskin D, Jonnalagadda R. Coexistence of colonic carcinoma, renal cell carcinoma and gastrointestinal stromal tumour-A case report. Int J Surg Case Rep 2010; 1:16-8. [PMID: 22096666 DOI: 10.1016/j.ijscr.2010.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Accepted: 06/26/2010] [Indexed: 10/19/2022] Open
Abstract
The occurrence of synchronous primary neoplasms remains an issue of great interest to surgeons and oncologists in particular, and the medical field in general. The question of common genetic pathways in the pathogenesis of such neoplasms is always raised when such associations are seen-whether metachronously or synchronously. The possibility of the coexistence of multiple tumours in the same patient must be taken into consideration when preparing patients for operation and a thorough search of the intraperitoneal organs for such coexistence remains important.A case of synchronously resected caecal carcinoma, jejunal gastrointestinal stromal tumour and renal cell carcinoma is presented here, along with a literature review on synchronous tumour resection.
Collapse
Affiliation(s)
- Philip Burgess
- Department of Surgery, Queen Elizabeth Hospital, Martindales Road, Bridgetown, St. Michael, Barbados
| | | | | | | |
Collapse
|
40
|
Mou YP, Xu XW, Xie K, Zhou W, Zhou YC, Chen K. Laparoscopic wedge resection of synchronous gastric intraepithelial neoplasia and stromal tumor: A case report. World J Gastroenterol 2010; 16:5005-8. [PMID: 20954290 PMCID: PMC2957612 DOI: 10.3748/wjg.v16.i39.5005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Synchronous occurrence of epithelial neoplasia and gastrointestinal stromal tumor (GIST) in the stomach is uncommon. Only rare cases have been reported in the literature. We present here a 60-year-old female case of synchronous occurrence of gastric high-level intraepithelial neoplasia and GIST with the features of 22 similar cases and detailed information reported in the English-language literature summarized. In the present patient, epithelial neoplasia and GIST were removed en bloc by laparoscopic wedge resection. To the best of our knowledge, this is the first reported case treated by laparoscopic wedge resection.
Collapse
|
41
|
|
42
|
Kleist B, Lasota J, Miettinen M. Gastrointestinal stromal tumor and gastric adenocarcinoma collision tumors. Hum Pathol 2010; 41:1034-9. [PMID: 20381123 DOI: 10.1016/j.humpath.2009.11.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Revised: 11/14/2009] [Accepted: 11/19/2009] [Indexed: 12/17/2022]
Abstract
Gastrointestinal stromal tumors sometimes occur together with gastric carcinoma, but true collision tumors featuring these 2 components are very rare. The authors describe here 2 collision tumors containing a gastrointestinal stromal tumor with intermingling elements of gastric adenocarcinoma. The gastrointestinal stromal tumors were 5.5 to 6 cm spindle cell tumors, and one patient had an additional prepyloric stromal tumor (2.5 cm). All gastrointestinal stromal tumors had low mitotic counts less than 5/50 high-power fields and were positive for KIT, DOG1, and CD34. Different KIT exon 11 mutations (single nucleotide substitution, complex insertion-duplication) in all tumors indicated that the 2 gastrointestinal stromal tumors in one patient were independent primary tumors. The adenocarcinoma components displayed gland-forming intestinal type to signet ring cell morphology with focally accompanying dysplastic epithelium, immunohistochemical positivity for CDX2, and varying keratin 7/20 expression. We hypothesize that development of gastric adenocarcinoma within a gastrointestinal stromal tumor may be based on displaced gastric epithelium in a long-standing stromal tumor with events of intermittent ulceration and epithelial regeneration.
Collapse
Affiliation(s)
- Britta Kleist
- Department of Pathology, Soerlandet sykehus HF, Serviceboks 416, N-4604 Kristiansand, Norway.
| | | | | |
Collapse
|
43
|
Ferreira SS, Werutsky G, Toneto MG, Alves JM, Piantá CD, Breunig RC, Brondani da Rocha A, Grivicich I, Garicochea B. Synchronous gastrointestinal stromal tumors (GIST) and other primary cancers: case series of a single institution experience. Int J Surg 2010; 8:314-7. [PMID: 20380900 DOI: 10.1016/j.ijsu.2010.03.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Accepted: 03/29/2010] [Indexed: 12/13/2022]
Abstract
BACKGROUND Gastrointestinal stromal tumors (GISTs) are rare mesenchymal neoplasm affecting the gastrointestinal tract. The incidental occurrence of mesenchymal tumors and other primary tumors has not been well described in literature. OBJECTIVE The aim of this study was to evaluate the clinical and pathologic features of GIST occurring synchronously with other primary tumors. METHODS Forty-three patients with diagnosis of GIST treated surgically with curative intent at our institution from 1998 to 2006 were included. The patient clinical data and pathological reports were reviewed. RESULTS Of the 43 patients, there were 6 (14%) cases of synchronous GIST and other primary tumors discovered as coincidental findings. The synchronous GISTs analyzed were located in the stomach (50%) and small intestine (50%), size ranging from 0.7 to 7.6 cm (median 3.35 cm). Five (83%) of the concurrent primary tumors were from gastrointestinal origin and only one (17%) patient presented with concurrent breast cancer and GIST. The synchronous GISTs immunofenotype shows positivity for CD117 and CD34 (100%), smooth-muscle actin (SMA) (67%), S100 (50%) and desmin (33%). Whereas staining for cytokeratin AE1/AE3 and PDGF were all negative. According to GIST risk category for aggressive behavior three were classified as very low, one intermediate and two high. CONCLUSIONS The synchronous occurrence of GISTs and other primary neoplasm is not an uncommon entity and usually they are discovery incidentally. Epithelial tumors of the gastrointestinal tract are the most associated with concomitant GISTs. Further studies are required to clarify the molecular and genetic mechanisms of carcinogenesis and progression associating GIST and synchronous tumors.
Collapse
Affiliation(s)
- Sheila S Ferreira
- Department of Medical Oncology, Pontifical Catholic University of Rio Grande do Sul, São Lucas Hospital, 6690 Ipiranga av, 90610-000 Porto Alegre, Brazil.
| | | | | | | | | | | | | | | | | |
Collapse
|