1
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Feng Y, Liu L. Clinicopathological characteristics and long-term prognosis of peritoneal and retroperitoneal gastrointestinal stromal tumors. Surg Endosc 2025; 39:2911-2924. [PMID: 40102271 PMCID: PMC12040990 DOI: 10.1007/s00464-025-11600-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2024] [Accepted: 01/29/2025] [Indexed: 03/20/2025]
Abstract
BACKGROUND Peritoneal and retroperitoneal gastrointestinal stromal tumors (PRGISTs) are exceedingly uncommon, and their clinicopathological characteristics and long-term prognosis remain unreported. Therefore, our objective is to analyze these aspects of patients with PRGISTs using the Surveillance, Epidemiology, and End Results (SEER) database. METHODS Patients diagnosed with PRGISTs and small intestine stromal tumors (SISTs) between 2000 and 2019 were included in the study. Differences between groups were compared using Chi-square tests. Kaplan-Meier analysis and Cox proportional hazards models were used to evaluate overall survival (OS) and cancer-specific survival (CSS). RESULTS A total of 3817 patients were enrolled, with 3513 diagnosed with SISTs and 304 with PRGISTs. Compared to SISTs, PRGISTs patients were older, with larger tumors, higher mitotic rates, and greater risk of lymph node (5.3%) and distant (30.6%) metastasis (P < 0.001). Multivariate analysis identified N stage and mitotic rate as risk factors for distant metastasis in PRGISTs. In comparison to SISTs, PRGISTs patients exhibited a significantly worse OS (hazard ratio [HR] 1.83, 95% confidence interval [CI] 1.57-2.15, P < 0.001) and CSS (HR 2.11, 95% CI 1.73-2.58, P < 0.001). Subgroup analyses by age, sex, surgical status, chemotherapy, and marital status consistently demonstrated poorer OS and CSS for PRGISTs patients compared to SISTs patients (P < 0.05). The 1-, 3-, 5-, and 10-year OS rates for PRGISTs patients were 77.9%, 61.6%, 51.6%, and 32.8%, respectively, with corresponding CSS rates of 84.5%, 71.7%, 63.3%, and 49.0%. Multivariate Cox regression analysis identified age, race, surgical status, and mitotic rate as risk factors influencing OS, while race, surgical status, and mitotic rate were identified as risk factors affecting CSS. CONCLUSIONS In comparison to SISTs, PRGISTs patients exhibit distinct clinicopathological features and have a worse prognosis. However, surgical intervention can improve the prognosis of PRGISTs patients.
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Affiliation(s)
- Yunfu Feng
- Department of Endoscopy Center, The First People's Hospital of Kunshan, Suzhou, China
| | - Luojie Liu
- Department of Gastroenterology, Changshu Hospital Affiliated to Soochow University, Suzhou, China.
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2
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Yao M, Zhou X, Tan Y. The first case of primary extragastrointestinal stromal tumor of the kidney: a case description. Quant Imaging Med Surg 2025; 15:3723-3728. [PMID: 40235742 PMCID: PMC11994494 DOI: 10.21037/qims-24-1678] [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: 08/14/2024] [Accepted: 02/13/2025] [Indexed: 04/17/2025]
Affiliation(s)
- Meijuan Yao
- Department of Radiology, First Hospital of Shanxi Medical University, Taiyuan, China
- Department of College of Medical Imaging, Shanxi Medical University, Taiyuan, China
| | - Xin Zhou
- Key Laboratory of Cellular Physiology, Ministry of Education, Taiyuan, China
- Department of Physiology, Shanxi Medical University, Taiyuan, China
| | - Yan Tan
- Department of Radiology, First Hospital of Shanxi Medical University, Taiyuan, China
- Department of Shanxi Key Laboratory of Intelligent Imaging and Nanomedicine, First Hospital of Shanxi Medical University, Taiyuan, China
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3
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Jia G, Li X. Establishment and validation of a prognostic nomogram for extra-gastrointestinal stromal tumors. Front Oncol 2025; 15:1527237. [PMID: 40182036 PMCID: PMC11965124 DOI: 10.3389/fonc.2025.1527237] [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: 11/13/2024] [Accepted: 02/25/2025] [Indexed: 04/05/2025] Open
Abstract
Background Extra-gastrointestinal stromal tumor (EGIST) is a rare subtype of gastrointestinal stromal tumor, with limited information on its clinical characteristics and prognostic factors. This study aims to identify the risk factors affecting survival in EGIST patients and to develop a prognostic nomogram for predicting EGIST-specific survival (TSS). Methods Patients diagnosed with EGIST, aged 18 to 80, were enrolled from the Surveillance, Epidemiology, and End Results (SEER) Research Plus database, covering the years 2000 to 2019. Univariate and multivariate analyses were conducted to identify risk factors for developing a nomogram. The predictive accuracy of the nomogram was evaluated using time-dependent receiver operating characteristic curves, calibration plots, and the concordance index. Decision curve analysis (DCA) was performed to assess the nomogram's clinical utility and net benefit for application in clinical practice. Additionally, the nomogram's performance was compared with the tumor SEER stage. Results A total of 389 patients were included in this study. Univariate and multivariate analyses identified age, household income, surgery, tumor grade, tumor size, and tumor SEER stage as significant predictors of TSS (all P<0.05). These factors were incorporated into the prognostic nomogram. The nomogram demonstrated superior prognostic value compared to the tumor SEER stage alone, as evidenced by the area under the curve and concordance index. The calibration plot indicated a high level of accuracy in forecasting survival probabilities. Furthermore, DCA highlighted the nomogram's clinical applicability and positive net benefit. The nomogram also proved more effective than the tumor SEER stage alone in identifying patients with poorer prognoses. Conclusions Age, household income, surgery, tumor grade, tumor size, and tumor SEER stage were identified as risk factors for TSS in patients with EGIST. We have developed and validated a prognostic nomogram to predict TSS in EGIST patients, which may improve patient management and guide personalized medical treatment for EGIST.
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Affiliation(s)
| | - Xiangpan Li
- Department of Head and Neck Oncology (including Lymphoma and Pediatric Oncology),
Renmin Hospital of Wuhan University, Wuhan, China
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4
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Velayutham B, Malla HS, Ali SM, Sahoo AK, Chaudhary S, Ayyanar P. Extragastrointestinal Gastrointestinal Stromal Tumor Presenting as Paratesticular Mass - A Diagnostic Conundrum. Int J Surg Pathol 2025:10668969251324534. [PMID: 40017178 DOI: 10.1177/10668969251324534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2025]
Abstract
Extragastrointestinal gastrointestinal stromal tumors are uncommon in the paratesticular region and pose a diagnostic challenge. A 47-year-old man presented with a painless testicular mass for three months. Ultrasonography showed a solid lesion in the right distal spermatic cord region. Excision of the mass showed an encapsulated solid, firm tumor of size 5 cm. Microscopic examination showed a spindle cell tumor arranged in fascicles, nodular and storiform patterns. The mitotic rate was 17-19/5 mm². The mesothelial lining of the tunica vaginalis was noted. Using immunohistochemistry, the tumor cells were positive for KIT, DOG1, and CD34, while negative for SMA, desmin, S100, STAT6, and EMA. H3K27me3 was retained in the tumor cells. The MIB-1 labeling index was 25% in the area of greatest labeling. We report an additional example of paratesticular EGIST and discuss the diagnostic approach and literature review. Knowledge about this tumor at rare sites and the clinicopathological features are needed for the definitive diagnosis and prognosis.
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Affiliation(s)
- Bakialakshmi Velayutham
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | - Hari Siddardha Malla
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | - S Manwar Ali
- Department of General Surgery, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | - Ashok Kumar Sahoo
- Department of General Surgery, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | - Shalini Chaudhary
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | - Pavithra Ayyanar
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
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5
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Makker S, Rammal R, Gu P, Dalbagni G, Al-Ahmadie H, Agaram NP, Iyer G, Kotecha RR. Case report: Clinical and molecular features of renal gastrointestinal tumor. Front Oncol 2025; 15:1508600. [PMID: 40018405 PMCID: PMC11865245 DOI: 10.3389/fonc.2025.1508600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2024] [Accepted: 01/17/2025] [Indexed: 03/01/2025] Open
Abstract
While gastrointestinal stromal tumors (GISTs) often arise within the GI tract, it is well known that GISTs may also rarely emanate outside of the digestive system. Prior case reports have documented various primary sites in non-GI organs [extra-intestinal GIST (EGIST)], yet only one report has described a localized GIST of renal origin. Here, we describe a patient who presented with bilateral renal masses who was found to have a large unresectable renal GIST tumor treated with imatinib. We discuss treatment experience and response with systemic therapy and describe molecular data to contextualize this ultra-rare presentation within the landscape of EGIST tumors.
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Affiliation(s)
| | - Rayan Rammal
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Ping Gu
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Guido Dalbagni
- Department of Surgery, Sloan Kettering Cancer Center, New York, NY, United States
| | - Hikmat Al-Ahmadie
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Narasimhan P. Agaram
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Gopa Iyer
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Ritesh R. Kotecha
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
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6
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Sonaiya S, Patel R, Parikh C, Dahiya D, Yagnik K, Barnechea Alvarado NA, Lo CH, Chow K, Hussain AA, Parikh A, Patel P, Mohan BP. Trends and Financial Burden of Gastrointestinal Stromal Tumors in the United States: A Comprehensive Analysis of United States Hospitalizations. Gastroenterology Res 2025; 18:12-22. [PMID: 40051888 PMCID: PMC11882225 DOI: 10.14740/gr2009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2024] [Accepted: 01/27/2025] [Indexed: 03/09/2025] Open
Abstract
Background Gastrointestinal stromal tumors (GISTs) are associated with a substantial economic burden to the healthcare system despite their relatively low incidence and prevalence compared to other more common malignancies. This study aimed to evaluate trends in GIST-related hospitalizations, inpatient mortality, and the financial burden of GISTs in the United States. Methods The National Inpatient Sample (NIS) database from 2016 to 2020 was used to identify adult hospitalizations (age > 18 years) with a primary diagnosis of GIST. A multivariate logistic regression along with Chi-square and t-tests was performed using SAS 9.4 software to analyze inpatient GIST-associated mortality, inflation-adjusted total hospital charge (THC), and length of stay (LOS) during the study period. Results The study analyzed 48,690 hospitalizations (49.2% female, mean age 64.2 years, 38.2% elective admissions) with a primary diagnosis of GIST between 2016 and 2020. Annual GIST-related hospitalizations increased from 2,645 in 2016 to 11,565 in 2020 (P = 0.1208). The most common tumor location was stomach (48.5%), followed by small intestine (18.7%), large intestine (3.6%), and rectum (1.6%). There was a non-significant reduction in inpatient mortality from 4.16% in 2016 to 3.29% in 2020 (P = 0.807). Overall, 36.2% of patients had THC between $10,000 and $20,000 (36.5% in 2016 vs. 34.7% in 2020, P = 0.0001), and 9.8% of patients had a THC > $40,000 (8.3% in 2016 vs. 12.6% in 2020, P = 0.0001). Furthermore, 61.5% of patients had LOS of fewer than 5 days (59.16% in 2016 vs. 61.39% by 2020, P = 0.0001), and 38.5% had LOS of 5 days or more (40.84% in 2016 vs. 38.61% in 2020, P = 0.0001). The proportion of GISTs treated with endoscopic resection has remained stable with 13.02% in 2016 and 13.01% in 2020 (P = 0.08). Additionally, the proportion of surgical excisions decreased from 26.8% in 2016 to 21.4% in 2020 with a statistically significant trend (P = 0.004). Conclusions GIST-related inpatient mortality between 2016 and 2020 has remained stable, and endoscopic and surgical interventions have become more common for the management of GISTs. This has been accompanied by a significant rise in overall inflation-adjusted hospitalization costs in the study period. These findings highlight the need for continued optimization of care and resource allocation for GIST management.
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Affiliation(s)
- Sneh Sonaiya
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at UNLV, University of Nevada Las Vegas, Las Vegas, NV 89102, USA
| | - Raj Patel
- Department of Internal Medicine, St Mary Medical Center, Langhorne, PA 19047, USA
| | - Charmy Parikh
- Department of Internal Medicine, Mercy Catholic Medical Center, Darby, PA 19023, USA
| | - Dushyant Dahiya
- Department of Gastroenterology and Hepatology, The University of Kansas School of Medicine, Kansas City, KS 66103, USA
| | - Karan Yagnik
- Department of Internal Medicine, Monmouth Medical Center, Long Branch, NJ 07740, USA
| | - Nicolas Alonso Barnechea Alvarado
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at UNLV, University of Nevada Las Vegas, Las Vegas, NV 89102, USA
| | - Chun-Han Lo
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at UNLV, University of Nevada Las Vegas, Las Vegas, NV 89102, USA
| | - Kenneth Chow
- Department of Gastroenterology and Hepatology, Kirk Kerkorian School of Medicine at UNLV, University of Nevada Las Vegas, Las Vegas, NV 89102, USA
| | - Abbas Ali Hussain
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at UNLV, University of Nevada Las Vegas, Las Vegas, NV 89102, USA
| | - Anushri Parikh
- Department of Internal Medicine, Baroda Medical College, Vadodara, GJ 390001, India
| | - Pranav Patel
- Department of Gastroenterology and Hepatology, Geisinger Health, Danville, PA 17822, USA
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Lu Q, Jiang Y. Diagnosis of Unresectable Primary Hepatic Gastrointestinal Stromal Tumor by Positron Emission Tomography/Computed Tomography Combined With Ultrasound-Guided Fine Needle Aspiration Biopsy. Gastroenterol Nurs 2024; 47:303-307. [PMID: 39087997 DOI: 10.1097/sga.0000000000000788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/31/2023] [Indexed: 08/02/2024] Open
Affiliation(s)
- Qingqing Lu
- Qingqing Lu, MD, is from the Department of Gastroenterology, Hangzhou Red Cross Hospital/Integrated Traditional Chinese and Western Medicine Hospital of Zhejiang Province, Zhejiang Chinese Medical University, Hangzhou, China
- Yang Jiang, MD, is from the Department of Nuclear Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yang Jiang
- Qingqing Lu, MD, is from the Department of Gastroenterology, Hangzhou Red Cross Hospital/Integrated Traditional Chinese and Western Medicine Hospital of Zhejiang Province, Zhejiang Chinese Medical University, Hangzhou, China
- Yang Jiang, MD, is from the Department of Nuclear Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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8
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Takahashi A, Inada K, Kitani Y, Koseki T, Maeshiro T. Laparoscopic-Assisted Resection for an Extra-gastrointestinal Stromal Tumor Arising From the Mesentery of the Small Intestine: A Case Report. Cureus 2024; 16:e60897. [PMID: 38784684 PMCID: PMC11112530 DOI: 10.7759/cureus.60897] [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] [Accepted: 05/23/2024] [Indexed: 05/25/2024] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors that arise in the muscular or submucosal layers of the gastrointestinal tract. Extra-gastrointestinal stromal tumors (EGISTs) are rare primary entities that develop outside the digestive tract which are histologically and immunologically similar to GISTs. We present the case of a 52-year-old female diagnosed with a primary EGIST arising in the small bowel mesentery four months after undergoing hormone therapy for multiple uterine myomas. Transvaginal ultrasonography and MRI revealed a pelvic mass suspected to be a GIST. The patient was treated with laparoscopic-assisted partial resection of the small bowel. Histopathological examination of the surgical specimen confirmed the diagnosis of an EGIST. Imatinib treatment was initiated, and no clinical evidence of recurrence or metastasis was detected postoperatively. Because EGISTs are extremely rare, the differences between EGISTs and GISTs, the degree of malignancy, and prognosis have not been fully investigated. Further studies are needed to accumulate additional cases. The present case shows that laparoscopic-assisted excision can be successfully used to manage EGISTs.
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Affiliation(s)
- Ayano Takahashi
- Department of Gastrointestinal Surgery, Saitama Prefectural Cancer Center, Saitama, JPN
- Department of Surgery, Tokyo Metropolitan Bokutoh Hospital, Tokyo, JPN
| | - Kentaro Inada
- Department of Surgery, Tokyo Metropolitan Bokutoh Hospital, Tokyo, JPN
| | - Yusuke Kitani
- Department of Surgery, Tokyo Metropolitan Bokutoh Hospital, Tokyo, JPN
| | - Takayoshi Koseki
- Department of Surgery, Tokyo Metropolitan Bokutoh Hospital, Tokyo, JPN
| | - Tsuyoshi Maeshiro
- Department of Surgery, Tokyo Metropolitan Bokutoh Hospital, Tokyo, JPN
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9
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Almeida M, Sousa F, Resende F, Devesa V, Ferrão A, Carneiro S, Canão P, Barbosa E, Barbosa J. Primary EGIST of the greater omentum - a rare presentation. Acta Chir Belg 2024; 124:137-142. [PMID: 37027318 DOI: 10.1080/00015458.2023.2201084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 04/04/2023] [Indexed: 04/21/2023]
Abstract
Extragastrointestinal stromal tumors (EGISTs) are rare mesenchymal neoplasms, which develop in the retroperitoneum, mesentery, and omentum, lacking continuity to the stomach or intestines. Authors hereby present a female patient with a large heterogeneous abdominal mass as a case of an omental EGIST. A 46-year-old woman was referred to our hospital due to an insidious enlargement and colicky pain in the right iliac fossa. Abdominal palpation revealed a voluminous, freely mobile, and non-pulsatile mesoabdominal bulge expanding to the hypogastrium. On exploratory midline laparotomy, the tumor was densely fused to the greater omentum, not connected to the stomach, without gross involvement of adjacent structures. The large mass was completely excised after adequate mobilization. Immunohistochemical techniques showed strong and diffuse expression of WT1, actin and DOG-1, as well as multifocal c-KIT marking. Mutational study concluded a double mutation of KIT exon 9 and a mutation of PDGFRA exon 18. The patient was submitted to adjuvant treatment with imatinib mesylate 800 mg/day. Despite an extremely diverse presentation, omental EGISTs often remain clinically silent for a long time having enough space to grow before becoming symptomatic. These tumors have a consistent pattern of metastasis that typically spares lymph nodes unlike epithelial gut neoplasms. Surgery remains the preferred treatment for non-metastatic EGISTs of the greater omentum. It is possible that DOG-1 will supplant KIT as the leading marker in the future. The scarcity of knowledge on omental EGISTs implies a close monitoring of these patients to detect local relapse or distant metastasis.
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Affiliation(s)
- Miguel Almeida
- General Surgery Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Fabiana Sousa
- General Surgery Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Fernando Resende
- General Surgery Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Vítor Devesa
- General Surgery Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - António Ferrão
- General Surgery Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Silvestre Carneiro
- General Surgery Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Pedro Canão
- Pathology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Elisabete Barbosa
- General Surgery Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - José Barbosa
- General Surgery Department, Centro Hospitalar Universitário de São João, Porto, Portugal
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10
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Song T, Hong Q, Wu Y. Pancreatic Extragastrointestinal Stromal Tumor: A Case Report. Cureus 2024; 16:e54514. [PMID: 38516419 PMCID: PMC10955504 DOI: 10.7759/cureus.54514] [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] [Accepted: 02/19/2024] [Indexed: 03/23/2024] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are soft tissue sarcomas that originate from the mesenchymal cells of the gastrointestinal tract. Extra-GISTs (EGISTs) are caused by sites outside the gastrointestinal tract. We reported a case of EGIST of the pancreas in a 51-year-old woman. Enhanced CT scan showed a rounded, slightly hypointense focus in the head of the pancreas and the right pars compacta of the descending duodenum. Routine laboratory and endocrine tests were unremarkable. The patient underwent laparoscopic surgery. The diagnosis of EGIST was confirmed through histopathological and immunohistochemical examination. The tumor was found to be CD117+, CD34+, and DOG+ with a high risk of malignancy. No recurrence was observed during the nine-month postoperative follow-up.
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Affiliation(s)
- Tianyu Song
- Department of Surgery, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, CHN
| | - Qiang Hong
- Department of Surgery, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, CHN
| | - Yulian Wu
- Department of Surgery, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, CHN
- Department of Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, CHN
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11
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Mohamed N, Khan M, Hosler G, Tumminello K. Primary vulvar extragastrointestinal stromal tumor in a 77-year-old woman. J Cutan Pathol 2023. [PMID: 37127848 DOI: 10.1111/cup.14432] [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: 10/26/2022] [Revised: 03/07/2023] [Accepted: 03/23/2023] [Indexed: 05/03/2023]
Abstract
Extragastrointestinal stromal tumors (EGISTs) carry the same morphological, immunohistochemical and molecular features as gastrointestinal stromal tumors (GISTs) and involve extragastrointestinal tract soft tissue. The majority of reported EGIST cases arise from intraabdominal, retroperitoneal, or pelvic soft tissue. A significant subset of such tumors originates from the gastrointestinal muscle layer, grows in an exophytic manner, then loses attachment to the gastrointestinal tract. Consequently, true EGISTs are exceedingly rare. Herein, we are reporting a case of a vulvar EGIST. A 77-year-old woman presented with a painless subcutaneous nodule on the right perineum. An excisional biopsy showed a fairly circumscribed bland spindle cell lesion in the dermis. The tumor cells were positive for CD117 and ANO1/DOG-1 and negative for smooth muscle myosin, smooth muscle actin, STAT6, low- and high-molecular-weight cytokeratins, SOX10, MART-1, CD10, S-100 protein, and estrogen and progesterone receptors. A diagnosis of EGIST was made and complete excision was recommended. Superficial/subcutaneous EGISTs are extremely rare, and it is important for dermatopathologists to be aware of this entity as it can be misdiagnosed as more common spindle cell neoplasms, both benign and malignant, including but not limited to smooth muscle neoplasms (leiomyoma/leiomyosarcoma), spindle cell melanoma, and sarcomatoid squamous cell carcinoma.
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Affiliation(s)
- Nada Mohamed
- Department of Pathology, Texas A&M College of Medicine-Baylor Scott & White Health, Temple, Texas, USA
| | | | - Gregory Hosler
- ProPath, Dallas, Texas, USA
- Department of Dermatology, University of Texas Southwestern, Dallas, Texas, USA
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12
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Wood D, Janssen G, Aljanabi I. Extragastrointestinal stromal tumour of the transverse mesocolon mimicking giant ovarian cystic neoplasm. BMJ Case Rep 2023; 16:e253816. [PMID: 36731947 PMCID: PMC9896349 DOI: 10.1136/bcr-2022-253816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2023] [Indexed: 02/04/2023] Open
Abstract
Gastrointestinal stromal tumours (GISTs) are mesenchymal tumours which are most commonly found along the gastrointestinal tract. They are more rarely found in an extragastrointestinal location and typically present late due to only vague symptoms from mass effect. There are very few case reports of GIST arising within the transverse mesocolon. We report a case of a large cystic transverse mesocolic GIST which preoperative imaging concluded was likely of ovarian origin. This resulted in an abrupt change in the surgical management intraoperatively, but fortunately, an R0 resection was still achieved. This serves as an important lesson to keep the differential diagnosis broad when dealing with large cystic abdominal masses. The tumour was found to be KIT wild type, with a platelet-derived growth factor receptor alpha D842V mutation identified, conferring intrinsic resistance to imatinib.
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Affiliation(s)
- Douglas Wood
- General Surgery, Wellington Regional Hospital, Wellington, New Zealand
| | - Greer Janssen
- General Surgery, Wellington Regional Hospital, Wellington, New Zealand
| | - Imad Aljanabi
- General Surgery, Wellington Regional Hospital, Wellington, New Zealand
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13
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Ye LJ, Li K, Xu KM, Yuan J, Ran F. Multiple Metastatic Extra-gastrointestinal Stromal Tumors with Plasmoid Differentiation: A Case Report and Review of Literature. Intern Med 2023; 62:393-398. [PMID: 36725066 PMCID: PMC9970808 DOI: 10.2169/internalmedicine.9727-22] [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: 02/03/2023] Open
Abstract
Extra-gastrointestinal stromal tumors (EGISTs) are rare mesenchymal tumors that arise from the abdominal, pelvic or retroperitoneal region, unrelated to the gastrointestinal tract. However, cases with a plasmoid morphology are extremely rare. we hererin report a 49-year-old man with abdominal pain who underwent magnetic resonance imaging that revealed an irregular tumor (103×71 mm) in size, in the space between stomach and pancreas, diagnosed as an EGISIT, we also reviewed the clinicopathological characteristics and immunohistochemical characteristics, molecular genetic features and differential diagnoses previously reported in the literature.
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Affiliation(s)
- Li-Juan Ye
- Department of Pathology, the Third Affiliated Hospital of Kunming Medical University, China
| | - Kun Li
- Department of Imaging, the Third Affiliated Hospital of Kunming Medical University, China
| | - Kai-Min Xu
- Department of Pathology, the Third Affiliated Hospital of Kunming Medical University, China
| | - Jing Yuan
- Department of Pathology, the Third Affiliated Hospital of Kunming Medical University, China
| | - Fengming Ran
- Department of Pathology, the Third Affiliated Hospital of Kunming Medical University, China
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Muacevic A, Adler JR, Vagha SJ. KIT (CD117) Positive Huge Primary Malignant Extra Gastrointestinal Stromal Tumors (EGISTs) Arising From Jejunal Mesentery: A Rare Case Report. Cureus 2022; 14:e33168. [PMID: 36742272 PMCID: PMC9891314 DOI: 10.7759/cureus.33168] [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: 07/23/2022] [Accepted: 12/31/2022] [Indexed: 01/01/2023] Open
Abstract
Tumors arising outside gastrointestinal systems are known as extra gastrointestinal stromal tumors (EGISTs). Outside gastrointestinal sites include the mesentery, omentum, peritoneum, pancreas, and liver. Our case highlights a rare occurrence of an EGIST in jejunal mesentery in a 45-year-old male with an asymptomatic large abdominal growth and weight loss. A contrast-enhanced multi-dimensional computed tomography scan showed a large heterogeneous mass in the left hypochondrium. lumbar, and paraumbilical regions. Later, the patient underwent surgical resection of the tumor along with the involved jejunal segment and small tumor masses in the mesentery. Histopathological examination reported a malignant EGIST of mesentery and invasion into the jejunum, further confirmed by immunohistochemistry (IHC) markers like CD117 and smooth muscle actin with a high proliferative index (Ki67). One should be aware that these are different from other malignancies arising from the mesentery. Their cell of origin is different and needs a specific type of treatment. The clinical history, radiological findings, histopathology, and IHC help in diagnosing especially when they are arising from unusual areas like jejunal mesentery. Surgical intervention and chemotherapy are mainstay treatments.
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Clinical Features of Extragastrointestinal Stromal Tumor Compared with Gastrointestinal Stromal Tumor: A Retrospective, Multicenter, Real-World Study. JOURNAL OF ONCOLOGY 2021; 2021:1460131. [PMID: 34938335 PMCID: PMC8687840 DOI: 10.1155/2021/1460131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/15/2021] [Indexed: 12/28/2022]
Abstract
Objective This study aimed to compare the tumor characteristics and long-term outcomes between EGIST and GIST. The confounding function was applied to improve the result credibility in the case of small sample size. Design, Setting, and Participants. This cohort study enrolled 55 patients with EGIST who underwent surgery and were selected from four high-volume hospitals in China and 221 GIST patients who were collected from one of the four hospitals between January 2006 and September 2017. We used propensity score matching (PSM) and subgroup analysis to compare EGIST with GIST in terms of prognosis. The confounding function was used for sensitivity analysis to reduce unmeasured confounding. Results We matched 43 patients in each of the GIST and EGIST groups by PSM. We compared EGIST data with GIST data to explore the prognostic factors between them. In the multivariate Cox regression model, tumor location of EGIST was negatively correlated with overall survival (after PSM: HR, 4.32; 95% CI, 1.22–15.26) or disease-free survival (after PSM: HR, 9.79; 95% CI, 2.22–43.31), which was also intuitively shown in the Kaplan–Meier survival curves (all P values < 0.05). In the subgroup analysis, EGIST with high risk factors had a worse prognosis than GIST. In unmeasured confounding analysis, the overall curve tends to show all combinations of c(0) of c(1) up to 2.0, none of which would bring the corrected relative risk to 1 for OS and DFS. Conclusions and Relevance. EGIST was associated with worse prognosis compared with GIST patients, particularly in EGIST patients with high risk factors, while there was a similar prognosis without those high risk factors.
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Kataoka M, Saitoh T, Kawashima K, Yazaki T, Sonoyama H, Okimoto E, Oka A, Mishima Y, Mishiro T, Oshima N, Shibagaki K, Tobita H, Moriyama I, Ishimura N, Nagase M, Hirahara N, Tajima Y, Ishihara S. Primary Extragastrointestinal Stromal Tumor of Greater Omentum with Intraperitoneal Bleeding. Intern Med 2021; 60:3413-3419. [PMID: 34024850 PMCID: PMC8627809 DOI: 10.2169/internalmedicine.6519-20] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 03/26/2021] [Indexed: 11/06/2022] Open
Abstract
Gastrointestinal stromal tumors (GISTs) develop in the digestive tract, mainly in the stomach, small intestine, colon, or esophagus. However, primary tumors with the same pathologic features as GISTs have been reported to occur outside of the digestive tract and are called extragastrointestinal stromal tumor (EGIST). We herein report a rare case of EGIST arising from the greater omentum in a patient with abdominal pain caused by intraperitoneal bleeding from the tumor.
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Affiliation(s)
- Masatoshi Kataoka
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
- Division of Hepatology, Shimane University Hospital, Japan
| | - Tsukasa Saitoh
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
- Division of Gastroenterology, Matsue Red Cross Hospital, Japan
| | - Kousaku Kawashima
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
- Inflammatory Bowel Disease Center, Shimane University Hospital, Japan
| | - Tomotaka Yazaki
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
- Division of Hepatology, Shimane University Hospital, Japan
| | - Hiroki Sonoyama
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
| | - Eiko Okimoto
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
| | - Akihiko Oka
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
| | - Yoshiyuki Mishima
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
| | - Tsuyoshi Mishiro
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
| | - Naoki Oshima
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
| | - Kotaro Shibagaki
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
- Division of Endoscopy, Shimane University Hospital, Japan
| | - Hiroshi Tobita
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
- Division of Hepatology, Shimane University Hospital, Japan
| | - Ichiro Moriyama
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
- Cancer Center, Shimane University Hospital, Japan
| | - Norihisa Ishimura
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
| | - Mamiko Nagase
- Department of Organ Pathology, Shimane University Faculty of Medicine, Japan
| | - Noriyuki Hirahara
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Japan
| | - Yoshitsugu Tajima
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Japan
| | - Shunji Ishihara
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Japan
- Inflammatory Bowel Disease Center, Shimane University Hospital, Japan
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Kadel D, Bhuju S, Thapa BR, Chalise S, Kumar Sah S. Curative intent treatment of late presented extragastrointestinal stromal tumor: two identical case reports with literature review. J Surg Case Rep 2021; 2021:rjab220. [PMID: 34104404 PMCID: PMC8177904 DOI: 10.1093/jscr/rjab220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 05/05/2021] [Accepted: 05/08/2021] [Indexed: 12/24/2022] Open
Abstract
Gastrointestinal stromal tumors (GISTs) occurring outside the gastrointestinal tract are known as extragastrointestinal stromal tumors (EGIST). They share some common histopathologic and molecular characteristics. This report describes two female patients who were suspected of having a mesenteric GIST, but opted for surveillance rather than definitive treatment. Upon reassessment, both patients demonstrated increased tumor mass with no evidence of distant metastasis. The intraoperative findings confirmed the conclusion of clinical and imaging studies performed preoperatively and radical excisions were performed. Histopathological examination (spindle cell neoplasm) and immunohistochemistry (CD117) confirmed EGIST. Both patients underwent Imatinib therapy following surgery with no evidence of disease recurrence or metastasis upon follow up. Although sharing histologic features with GIST, EGIST frequently demonstrates distinct characteristics that facilitate the proper diagnosis and management of EGIST. Since it is a rare and aggressive disease with a poor outcome, early detection and curative surgical resection remains the mainstay of treatment.
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Affiliation(s)
- Dhruba Kadel
- Department of General Surgery, Scheer Memorial Adventist Hospital, Banepa, Nepal
| | - Shashinda Bhuju
- Department of General Surgery, Scheer Memorial Adventist Hospital, Banepa, Nepal
| | - Bikash Raj Thapa
- Department of Radiology, National Academy of Medical Sciences, National Trauma Center, Kathmandu, Nepal
| | - Sanat Chalise
- Department of Pathology, Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal
| | - Sandeep Kumar Sah
- Department of General Surgery, Scheer Memorial Adventist Hospital, Banepa, Nepal
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18
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Li L, Hu ZQ, Yang CG, Gan JH, Tian JH, Ke CJ, Zeng X. Current knowledge of primary prostatic extra-gastrointestinal stromal tumor: a case report and review of the literature. J Int Med Res 2021; 49:3000605211013172. [PMID: 33983064 PMCID: PMC8127774 DOI: 10.1177/03000605211013172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The patient was a 62-year-old man diagnosed as having prostatic extra-gastrointestinal stromal tumor (EGIST) who was treated with imatinib. No recurrence or metastasis was found after a 6-month follow-up. We identified 14 cases of prostatic primary EGIST in PubMed and summarized these cases with our case. The patients' ages ranged from 31 to 78 years (average: 53.6 years), and most patients' prostate-specific antigen (PSA) concentrations were within normal limits (92.9%, 13/14). All patients underwent imaging examinations; prostatic masses measured 6 to 14.2 cm (mean: 9.43 cm), and imaging excluded secondary prostatic masses from the intestinal tract. By immunohistochemical staining, the tumors were positive for cluster of differentiation (CD)117 (71.4%, 10/14), DOG1 (100%, 7/7), and CD34 (100%, 14/14), and negative for smooth muscle actin (SMA) (71.4%, 10/14), desmin (100%, 11/11), and S100 (100%, 12/12). Treatment depended on the results of the gene mutation detection as well as the risk estimation according to tumor size and microscopic mitotic rates (>5 per 50 high-power fields: 60%, 6/10). Among the 12 patients with reported outcomes, nine achieved good results (no recurrence or metastasis), one achieved reduced mass volume, one experienced recurrence, and one died.
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Affiliation(s)
- Le Li
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhi Quan Hu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chun Guang Yang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jia Hua Gan
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ji Hua Tian
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chun Jin Ke
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xing Zeng
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Primary Hepatic Gastrointestinal Stromal Tumour (GIST): Unusual Presentation and Diagnosis. J Gastrointest Cancer 2021; 51:1061-1064. [PMID: 32335810 DOI: 10.1007/s12029-020-00405-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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20
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Khobragade KH, Patkar S, Goel M, Sahay A. Primary retroperitoneal GIST: Case report and review of literature. Indian J Cancer 2020; 57:334-336. [PMID: 32675441 DOI: 10.4103/ijc.ijc_556_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Extraintestinal gastrointestinal stromal tumors (EGISTs) are mesenchymal tumor with no connection to tubular gastrointestinal system. They commonly arise from omentum and mesentry. Retroperitoneum is a rare primary site. We herein report a case of a 33 year old woman who underwent upfront surgery for primary retroperitoneal gastrointestinal stromal tumor and is now disease-free on adjuvant Imatinib.
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Affiliation(s)
- Krunal H Khobragade
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Shraddha Patkar
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Mahesh Goel
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Ayushi Sahay
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Kang A, Cho SH, Park BS, Son GM, Kim HS, Kim JJ, Kim SJ, Shin DH, Kim TU. Perianal extragastrointestinal stromal tumor. KOREAN JOURNAL OF CLINICAL ONCOLOGY 2020; 16:138-141. [PMID: 36945718 PMCID: PMC9942734 DOI: 10.14216/kjco.20021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/26/2020] [Accepted: 12/08/2020] [Indexed: 11/07/2022]
Abstract
An extragastrointestinal stromal tumor (EGIST) is a gastrointestinal stromal tumor that arises outside of the gastrointestinal tract. Most EGISTs are located in the omentum, mesentery, and retroperitoneum. The occurrence of an EGIST at the perianal region is very rare. Herein, we report our experience with EGISTs in the perianal area and review the literature. A 70-year-old man presented to our hospital with a 2-year history of anal discomfort. A pelvic magnetic resonance imaging scan showed a homogenous, well-defined, soft tissue density mass. The patient underwent mass excision, and the pathological examination confirmed that the mass was an EGIST. The size of the tumor was 4.3×3.2 cm, and the mitotic count was 1 per 50 high-power fields. The tumor cells were immunohistochemically positive for KIT and CD34 but were negative for S-100 and alpha-smooth muscle actin. There were no other abnormal findings in the gastrointestinal tract; upon pathological review, this case was confirmed as perianal EGIST. Therefore, EGIST should be considered as a differential diagnosis of perianal masses.
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Affiliation(s)
- Ayoung Kang
- Department of General Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Sung Hwan Cho
- Department of General Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Byung-Soo Park
- Department of General Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Gyung Mo Son
- Department of General Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hyun Sung Kim
- Department of General Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jae-Joon Kim
- Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Su Jin Kim
- Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Dong Hoon Shin
- Pathology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Tae Un Kim
- Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea
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22
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Palacios Huatuco RM, Pantoja Pachajoa DA, Palencia R, Parodi M, Doniquian AM, Mandojana FI. Metachronous extragastrointestinal stromal tumor (EGIST) in utero: Report of an unusual case. Int J Surg Case Rep 2020; 77:935-940. [PMID: 33279439 PMCID: PMC7775967 DOI: 10.1016/j.ijscr.2020.11.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/06/2020] [Accepted: 11/07/2020] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION The gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor in the digestive tract. Currently, GIST is the name given to CD117 positive mesenchymal tumors, primary of the digestive tract, mesentery, and retroperitoneum. Nevertheless, they have been reported in the mesentery, omentum, gallbladder, bladder wall, and few cases in the uterus; known as extragastrointestinal stromal tumors (EGIST). PRESENTATION OF CASE Seventy-six-year-old woman with a history of the third recurrence of pelvic tumor located in the uterus initially diagnosed as uterine leiomyosarcoma. CT and MRI showed a tumor in the uterine corpus of approximately 10 cm. It was decided to perform the surgical rescue. The immunohistochemistry and anatomic pathology report revealed a tumor compatible with a uterine EGIST. It was decided to perform adjuvant treatment with imatinib. Currently, the patient continues to be disease-free 20 months after the surgery. DISCUSSION For years, GIST has often been confused with leiomyosarcoma, given that they are histologically almost indistinguishable. The IHC analysis for KIT (CD117) has become essential in the GIST diagnosis. On the other hand, stromal tumors arising outside the gastrointestinal tract are rare (5%), which have a histological and biological behavior similar to that of GISTs. CONCLUSION EGISTs are extremely rare and often incidentally detected. Currently, evidence about this location is scarce. According to the literature, this is the first case of uterine EGIST with a metachronous presentation.
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Affiliation(s)
- René M Palacios Huatuco
- Oncology Surgery Sector, General Surgery Service, Clínica Universitaria Reina Fabiola, Universidad Católica de Córdoba, Oncativo 1248, Córdoba Capital, Argentina.
| | - Diana A Pantoja Pachajoa
- Oncology Surgery Sector, General Surgery Service, Clínica Universitaria Reina Fabiola, Universidad Católica de Córdoba, Oncativo 1248, Córdoba Capital, Argentina
| | - Rafael Palencia
- Oncology Surgery Sector, General Surgery Service, Clínica Universitaria Reina Fabiola, Universidad Católica de Córdoba, Oncativo 1248, Córdoba Capital, Argentina
| | - Matias Parodi
- Oncology Surgery Sector, General Surgery Service, Clínica Universitaria Reina Fabiola, Universidad Católica de Córdoba, Oncativo 1248, Córdoba Capital, Argentina
| | - Alejandro M Doniquian
- Oncology Surgery Sector, General Surgery Service, Clínica Universitaria Reina Fabiola, Universidad Católica de Córdoba, Oncativo 1248, Córdoba Capital, Argentina
| | - Facundo I Mandojana
- Oncology Surgery Sector, General Surgery Service, Clínica Universitaria Reina Fabiola, Universidad Católica de Córdoba, Oncativo 1248, Córdoba Capital, Argentina
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23
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Arellano-Gutiérrez G, Martínez-Aldrete LF, Pérez-Fabián A, Maldonado-García EL. Primary extra-gastrointestinal stromal tumor (EGIST) of the mesentery: Case report and review of literature. Ann Med Surg (Lond) 2020; 60:480-483. [PMID: 33294179 PMCID: PMC7691126 DOI: 10.1016/j.amsu.2020.11.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/02/2020] [Accepted: 11/04/2020] [Indexed: 02/07/2023] Open
Abstract
Introduction Gastrointestinal stromal tumors (GISTs) represent <1% of all gastrointestinal (GI) tumors. Extra-gastrointestinal stromal tumors (EGISTs) are mesenchymal tissue neoplasm arising outside the GI tract. This rare group comprises only 5% of all GISTs. This case demonstrates a rare entity in a patient with non-specific symptoms, a large tumor size and unremarkable past personal and family history. Presentation of case We present a 45-year old man with non-specific symptoms who was diagnosed with a primary EGIST arising in the small bowel mesentery after surgery. The tumor was not compromising the GI tract and it was completely resected. The tumor was sent for pathological examination that confirmed the diagnosis. Histological examination revealed a 15 cm in diameter mass, comprised of spindle cells and high mitotic activity. Treatment with imatinib mesylate was initiated. Discussion There have been only a few previous reports of EGISTs arising from the small bowel mesentery. It is believed that EGISTs originate from cells with similar pathological characteristics and biological behaviour as the intestinal cells of Cajal. Such tumors are associated with poorer prognosis, lager tumor size and younger presentation than their GI counterparts. The preferred treatment is complete surgical resection. The addition of specific tyrosine kinase inhibitors such as imatinib mesylate is recommended for high risk patients. Even though morphological and immunohistochemical similarities between GISTs and EGISTs are described, their pathogenesis, incidence, genetic background, complications and prognosis are not completely known because they are extremely rare. Conclusion EGISTs are very rare tumors which originate from cells outside the GI tract and are associated with a more aggressive biological behavior than their GI counterparts. These tumors may grow without any clinical implications and should be kept in mind in the differential diagnosis for patients presenting with an abdominal mass. Further studies are needed due to lack of large patient cohort studies and long-term follow-up regarding the prognosis and management of this rare pathology. EGISTs are extremely rare. They represent only 5% of all GISTs, which comprises only <0.05% of all GI tumors. High index of suspicion in patients with nonspecific symptoms and the presence of an abdominal mass is necessary. The preferred treatment is a complete surgical resection in low-risk patients. Clinicopathologic parameters and clinical implications are not yet described in literature.
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Affiliation(s)
- Gregorio Arellano-Gutiérrez
- Department of Surgery, Hospital General de Zona No. 16, Instituto Mexicano del Seguro Social, Torreón, Coahuila, México
| | | | - Abraham Pérez-Fabián
- Department of Surgery, Hospital General de Zona No. 16, Instituto Mexicano del Seguro Social, Torreón, Coahuila, México
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24
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Ambrosio M, Testa AC, Moro F, Franchi D, Scifo MC, Rams N, Epstein E, Alcazar JL, Hidalgo JJ, Van Holsbeke C, Burgetova A, Dundr P, Cibula D, Fischerova D. Imaging in gynecological disease (19): clinical and ultrasound features of extragastrointestinal stromal tumors (eGIST). ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 56:749-758. [PMID: 31909545 DOI: 10.1002/uog.21968] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 12/18/2019] [Accepted: 12/20/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To describe the clinical and sonographic characteristics of extragastrointestinal stromal tumors (eGISTs). METHODS This was a retrospective multicenter study. The data of patients with a histological diagnosis of eGIST who had undergone preoperative ultrasound examination were retrieved from the databases of nine large European gynecologic oncology centers. One investigator from each center reviewed stored images and ultrasound reports, and described the lesions using the terminology of the International Ovarian Tumor Analysis and Morphological Uterus Sonographic Assessment groups, following a predefined ultrasound evaluation form. Clinical, surgical and pathological information was also recorded. RESULTS Thirty-five women with an eGIST were identified; in 17 cases, the findings were incidental, and 18 cases were symptomatic. Median age was 57 years (range, 21-85 years). Tumor marker CA 125 was available in 23 (65.7%) patients, with a median level of 23 U/mL (range, 7-403 U/mL). The vast majority of eGISTs were intraperitoneal lesions (n = 32 (91.4%)); the remaining lesions were retroperitoneal (n = 2 (5.7%)) or preperitoneal (n = 1 (2.9%)). The most common site of the tumor was the abdomen (n = 23 (65.7%)), and less frequently the pelvis (n = 12 (34.3%)). eGISTs were typically large (median largest diameter, 79 mm) solid (n = 31 (88.6%)) tumors, and were less frequently multilocular-solid tumors (n = 4 (11.4%)). The echogenicity of solid tumors was uniform in 8/31 (25.8%) cases, which were all hypoechogenic. Twenty-three solid eGISTs were non-uniform, either with mixed echogenicity (9/23 (39.1%)) or with cystic areas (14/23 (60.9%)). The tumor shape was mainly lobular (n = 19 (54.3%)) or irregular (n = 10 (28.6%)). Tumors were typically richly vascularized (color score of 3 or 4, n = 31 (88.6%)) with no shadowing (n = 31 (88.6%)). Based on pattern recognition, eGISTs were usually correctly classified as a malignant lesion in the ultrasound reports (n = 32 (91.4%)), and the specific diagnosis of eGIST was the most frequent differential diagnosis (n = 16 (45.7%)), followed by primary ovarian cancer (n = 5 (14.3%)), lymphoma (n = 2 (5.7%)) and pedunculated uterine fibroid (n = 2 (5.7%)). CONCLUSIONS On ultrasound, eGISTs were usually solid, non-uniform pelvic or abdominal lobular tumors of mixed echogenicity, with or without cystic areas, with rich vascularization and no shadowing. The presence of a tumor with these features, without connection to the bowel wall, and not originating from the uterus or adnexa, is highly suspicious for eGIST. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- M Ambrosio
- Department of Obstetrics and Gynecology, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - A C Testa
- Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Dipartimento Scienze della Vita e Sanità pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - F Moro
- Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - D Franchi
- Division of Gynecology, European Institute of Oncology, Milan, Italy
| | - M C Scifo
- Department of Obstetrics and Gynecology, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - N Rams
- Hospital Santa Cruz y San Pablo, Barcelona, Spain
| | - E Epstein
- Department of Clinical Science and Education, Karolinska Institutet & Department of Obstetrics and Gynecology, Södersjukhuset, Stockholm, Sweden
| | - J L Alcazar
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain
| | - J J Hidalgo
- Department of Obstetrics and Gynecology, Clinic Hospital Valencia, Valencia, Spain
| | | | - A Burgetova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - P Dundr
- Department of Pathology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - D Cibula
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - D Fischerova
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
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Hu W, Zheng C, Li R, Feng X, Zheng G, Zheng Z, Xiong W, Lin G, Zhou Y, Wang W, Zhao Y, Li Y. Retroperitoneal Extragastrointestinal Stromal Tumors Have a Poor Survival Outcome: A Multicenter Observational Study. Cancer Manag Res 2020; 12:10491-10504. [PMID: 33122948 PMCID: PMC7591066 DOI: 10.2147/cmar.s278612] [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: 08/27/2020] [Accepted: 10/01/2020] [Indexed: 12/16/2022] Open
Abstract
Purpose Gastrointestinal stromal tumors (GISTs) are commonly known to be derived from the gastrointestinal (GI) tract, but recently there have been more and more literature describing lesions with similar pathological and immunohistochemical resembling GISTs but located outside the GI tract, and they have been termed as extra-GISTs (eGISTs). However, due to the rare incidence of eGISTs, its association with survival outcomes is poorly understood, especially in the Chinese population. Here, we aimed to identify the risk factors of eGISTs and to assess their association with overall survival (OS) and disease-free survival (DFS). Patients and Methods Data of pathologically confirmed eGISTs cases, without radiological and perioperative evidence of other primary lesions, and with no microscopically identified adhesion between the tumor and the gastrointestinal serosa, which were surgically treated between January 2006 and September 2017 were retrieved from the database of four high-volume hospitals. Immunohistochemical and genetic testing were performed on the postoperative lesions and were staged using the National Institutes of Health (NIH) criteria. Results A total of 55 cases were retrieved. eGISTs were identified from the retroperitoneum (36.4%), mesocolon (25.5%), small bowel mesentery (12.7%), abdominopelvic cavity (12.7%), lesser omental sac (5.5%), ovary (3.6%), pancreatic capsule (1.8%), or urinary bladder (1.8%). Based on the NIH risk classification, majority of the lesion were classified as high risk (85.5%). KIT 11 was the most common mutation site (76.5%) and 25.0% of the cases were wild-type eGISTs. Multivariate analyses showed that tumor location and size were independent factors affecting prognoses. Patients with tumors in the retroperitoneum had significantly poorer OS and DFS as compared to those in the non-retroperitoneum (HR [95% CI] for OS and DFS: 2.546 [1.023–6.337] [P = 0.037] and 2.475 [0.975–6.273] [P = 0.049], respectively). Similar findings were found for tumors of size >15 cm, compared to ≤15 cm (HR [95% CI] for OS and DFS: 5.350 [2.022–14.156] [P < 0.001] and 3.861 [1.493–9.988] [P = 0.003], respectively). Conclusion eGISTs were predominantly found from the retroperitoneum and mostly classified as high risk. Those located in the retroperitoneum and of size >15 cm had the poorer OS and DFS as compared to those in the non-retroperitoneum and of size <15 cm.
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Affiliation(s)
- Weixian Hu
- Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, People's Republic of China
| | - Chengbin Zheng
- Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, People's Republic of China
| | - Renjie Li
- Department of Bariatric and Metabolic Surgery, Klinikum Ernst von Bergmann, Potsdam 14467, Germany
| | - Xingyu Feng
- Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, People's Republic of China
| | - Guoliang Zheng
- Department of Gastric Cancer, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, Liaoning 110042, People's Republic of China
| | - Zhichao Zheng
- Department of Gastric Cancer, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, Liaoning 110042, People's Republic of China
| | - Wenjun Xiong
- Department of Gastrointestinal Surgery, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510120, People's Republic of China
| | - Guosheng Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian 350001, People's Republic of China
| | - Yongjian Zhou
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian 350001, People's Republic of China
| | - Wei Wang
- Department of Gastrointestinal Surgery, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510120, People's Republic of China
| | - Yan Zhao
- Department of Gastric Cancer, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, Liaoning 110042, People's Republic of China
| | - Yong Li
- Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, People's Republic of China
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Qian XH, Yan YC, Gao BQ, Wang WL. Prevalence, diagnosis, and treatment of primary hepatic gastrointestinal stromal tumors. World J Gastroenterol 2020; 26:6195-6206. [PMID: 33177793 PMCID: PMC7596635 DOI: 10.3748/wjg.v26.i40.6195] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 05/27/2020] [Accepted: 09/22/2020] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal stromal tumors (GIST), which is the most common mesenchymal tumor of the digestive tract, account for 1%-3% of gastrointestinal tumors. Primary stromal tumors outside the gastrointestinal tract are collectively referred to as extra GISTs, and stromal tumors in different regions often have different prognoses. A primary hepatic GIST is a rare tumor with an unknown origin, which may be related to interstitial Cajal-like cells. Although primary hepatic GIST has certain characteristics on imaging, it lacks specific symptoms and signs; thus, the final diagnosis depends on pathological and genetic evidence. This review summarizes all cases of primary hepatic GIST described in the literature and comprehensively analyzes the detailed clinical data of all patients. In terms of treatment, local resection alone or with adjuvant therapy was the prioritized choice to obtain better disease-free survival and longer survival time. For advanced unresectable cases, imatinib mesylate was applied as the first-line chemotherapy agent. Moreover, transcatheter arterial chemoembolization, radiofrequency ablation, and microwave ablation were shown to improve overall survival for selected patients. Liver transplantation was a final treatment option after resistance to chemotherapy developed.
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Affiliation(s)
- Xiao-Hui Qian
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou 310009, Zhejiang Province, China
- Research Center of Diagnosis and Treatment Technology for Hepatocellular Carcinoma of Zhejiang Province, Hangzhou 310009, Zhejiang Province, China
- Clinical Medicine Innovation Center of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Disease of Zhejiang University, Hangzhou 310009, Zhejiang Province, China
- Clinical Research Center of Hepatobiliary and Pancreatic Diseases of Zhejiang Province, Hangzhou 310009, Zhejiang Province, China
| | - Ying-Cai Yan
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
| | - Bing-Qiang Gao
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou 310009, Zhejiang Province, China
- Research Center of Diagnosis and Treatment Technology for Hepatocellular Carcinoma of Zhejiang Province, Hangzhou 310009, Zhejiang Province, China
- Clinical Medicine Innovation Center of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Disease of Zhejiang University, Hangzhou 310009, Zhejiang Province, China
- Clinical Research Center of Hepatobiliary and Pancreatic Diseases of Zhejiang Province, Hangzhou 310009, Zhejiang Province, China
| | - Wei-Lin Wang
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
- Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou 310009, Zhejiang Province, China
- Research Center of Diagnosis and Treatment Technology for Hepatocellular Carcinoma of Zhejiang Province, Hangzhou 310009, Zhejiang Province, China
- Clinical Medicine Innovation Center of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Disease of Zhejiang University, Hangzhou 310009, Zhejiang Province, China
- Clinical Research Center of Hepatobiliary and Pancreatic Diseases of Zhejiang Province, Hangzhou 310009, Zhejiang Province, China
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27
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Nguyen TTMH, Dang CT, Pham AV, Nguyen TT. Retroperitoneal gastrointestinal stromal tumor: A case report and literature review. Radiol Case Rep 2020; 15:1823-1828. [PMID: 32793324 PMCID: PMC7415774 DOI: 10.1016/j.radcr.2020.07.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 07/15/2020] [Indexed: 11/16/2022] Open
Abstract
Retroperitoneal gastrointestinal tumor is the rarest subtype among 3 subtypes of extragastrointestinal tumors, which are uncommon stromal tumors. We herein report a case of a 55-year-old man with retroperitoneal gastrointestinal tumor detected by magnetic resonance imaging and confirmed by postoperative histology and immunohistochemistry.
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Affiliation(s)
- Thai Thi My Hanh Nguyen
- Department of Radiology, Hue University of Medicine and Pharmacy, Hue University, Hue, Viet Nam
| | - Cong Thuan Dang
- Department of Histology, Embryology, Pathology and Forensic Medicine, Hue University of Medicine and Pharmacy, Hue University, Hue, Viet Nam
| | - Anh Vu Pham
- Department of Surgery, Hue University of Medicine and Pharmacy, Hue University, Hue, Viet Nam
| | - Thanh Thao Nguyen
- Department of Radiology, Hue University of Medicine and Pharmacy, Hue University, Hue, Viet Nam
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Kanamori K, Yamagata Y, Honma Y, Date K, Wada T, Hayashi T, Otsuki S, Sekine S, Yoshikawa T, Katai H, Nishida T. Extra-gastrointestinal stromal tumor arising in the lesser omentum with a platelet-derived growth factor receptor alpha (PDGFRA) mutation: a case report and literature review. World J Surg Oncol 2020; 18:183. [PMID: 32703220 PMCID: PMC7379776 DOI: 10.1186/s12957-020-01961-1] [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: 04/11/2020] [Accepted: 07/17/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Gastrointestinal stromal tumors (GIST) arising from sites other than the gastrointestinal (GI) tract, termed extra-gastrointestinal stromal tumors (EGIST), are rare. Among EGIST, those with platelet-derived growth factor receptor alpha (PDGFRA) mutations are even rarer, with only a few cases reported. About 80% of GIST has KIT mutations, and 10% of GIST have PDGFRA mutations, which commonly affect the TK2 domain (exon 18). Among the exon 18 mutations, the D842V substitution is limited to gastric GIST. In EGIST, the degree of KIT and PDGFRA mutations varies on where the location of the tumor is, and it is suggested that omental EGIST is similar to gastric GIST. Adjuvant imatinib therapy is recommended for high-risk GIST; however, it is known that imatinib is less effective against GIST with a PDGFRA D842V mutation. CASE PRESENTATION A 75-year-old man was referred to our hospital with an extrinsic tumor of the lesser curvature of the gastric body. Intraoperative findings showed a tumor located outside of the lesser omentum with no connection between the tumor and the gastric wall. The tumor was subsequently resected. Pathological examination indicated a GIST arising in the lesser omentum measuring 70 mm in its longer dimension. Because the tumor had a PDGFRA mutation (D842V substitution), imatinib was suspected to lack efficacy to the tumor. Thus, although the tumor was considered clinically to have a high risk of recurrence, adjuvant imatinib therapy was not indicated. The patient has been free of recurrence for 29 months since the surgery. CONCLUSION We described a case of EGIST with a PDGFRA mutation arising in the lesser omentum. And we reviewed 57 cases of omental EGIST and showed that the clinicopathological characteristics and mutation status in omental EGIST were very similar to gastric GIST. In particular, PDGFAR D842V mutation rate in omental EGIST seemed as high as that in gastric GIST. These results suggested that omental EGIST is strongly related to gastric GIST, so the behavior of omental EGIST might be akin to gastric GIST. However, further studies are required to determine the prognosis and the necessity of adjuvant therapy for EGIST with a PDGFRA mutation.
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Affiliation(s)
- Kohei Kanamori
- Gastric Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Yukinori Yamagata
- Gastric Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
| | - Yoshitaka Honma
- Head and Neck Medical Oncology Division and Gastrointestinal Medical Oncology Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Keiichi Date
- Gastric Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Takeyuki Wada
- Gastric Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Tsutomu Hayashi
- Gastric Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Sho Otsuki
- Gastric Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Shigeki Sekine
- Division of Pathology and Clinical Laboratories, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Takaki Yoshikawa
- Gastric Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Hitoshi Katai
- Gastric Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Toshiro Nishida
- Gastric Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
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Costa Almeida C, Caroço TV, Albano M, Carvalho L. Extragastrointestinal stromal tumour (EGIST) presented as a mesenteric and retroperitoneal mass. BMJ Case Rep 2019; 12:12/12/e232481. [PMID: 31796439 DOI: 10.1136/bcr-2019-232481] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Extragastrointestinal stromal tumour (EGIST) occurs outside the gastrointestinal tract and has histopathological and molecular characteristics similar to gastrointestinal stromal tumour (GIST). This tumour is rare and aggressive. A male patient was admitted with anaemia and lower limb oedema. CT scan showed a tumour in the mesentery and retroperitoneum, suspected to be a small bowel GIST. During laparotomy an unresectable mass was found compressing the retroperitoneal structures. Pathology and immunohistochemistry (CD117) confirmed an EGIST. EGIST arises from Cajal-like cells or from pluripotent stem cells outside the gastrointestinal tract. It is aggressive and has a worse prognosis than GIST. Immunohistochemistry is crucial for diagnosis. Surgery aimed at debulking as much of a tumour mass as possible is the cornerstone of treatment. The role of imatinib is not clear. EGIST is rare and has a bad prognosis, and there is no consensus on grading and management. A low threshold of suspicion is crucial for early diagnosis.
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Affiliation(s)
- Carlos Costa Almeida
- General Surgery, Hospital Geral (Covões), Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | - Teresa Vieira Caroço
- General Surgery, Instituto Portugues de Oncologia de Coimbra Francisco Gentil EPE, Coimbra, Portugal
| | - Miguel Albano
- General Surgery, Hospital Geral (Covões), Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | - Luís Carvalho
- General Surgery, Hospital Geral (Covões), Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
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30
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Extragastrointestinal Stromal Tumor: A Differential Diagnosis of Compressive Upper Abdominal Tumor. Case Rep Surg 2018; 2018:1052960. [PMID: 29854540 PMCID: PMC5966673 DOI: 10.1155/2018/1052960] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 02/18/2018] [Indexed: 12/04/2022] Open
Abstract
Introduction Extragastrointestinal stromal tumors (EGIST) are rare mesenchymal tumor lesions located outside the gastrointestinal tract. A rare compressing tumor with difficult diagnosis is reported. Presentation of the Case A male patient, 63 years old, was admitted in the emergency room complaining of stretching and continuous abdominal pain for one day. He took Hyoscine, with partial improvement of symptoms, but got worse due to hyporexia, and the abdominal pain persisted. The patient also reported early satiety and ten-pound weight loss over the last month. Discussion EGIST could be assessed by CT-guided biopsy, leading to diagnosis and proper treatment with surgical resection or Imatinib. Conclusion This case report highlights the importance of considering EGIST an important differential diagnosis of compressing upper abdominal tumors.
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Hatipoğlu E. Extragastrointestinal Stromal Tumor (EGIST): A 16-Year Experience of 13 Cases Diagnosed at a Single Center. Med Sci Monit 2018; 24:3301-3306. [PMID: 29777611 PMCID: PMC5987612 DOI: 10.12659/msm.907654] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background Gastrointestinal stromal tumor (GISTs) rarely occurs outside the GI tract as extragastrointestinal stromal tumor (EGIST). The aim of this study was to review the clinical presentation, diagnosis, and outcome of EGIST at a single center. Material/Methods The study was a retrospective study performed at Istanbul University Hospital in a 16-year period and included patients with a histopathological diagnosis of EGIST confirmed to arise outside the GI tract. The patients’ available medical records included patient demographics, imaging and surgical data, and diagnostic histopathology reports. Cases of EGIST underwent follow-up for several years and the medical files of patients were well maintained. Results Thirteen cases of EGIST included six women and seven men, with a mean age of 59.6 years (range, 33–83 years). Eleven patients had EGISTs located in the intra-abdominal cavity, one patient’s tumor was in the retroperitoneum, and in the jejunal mesentery in one patient. The mean diameter of the EGISTs was 15.6 cm (range, 4–30 cm). Immunohistochemistry showed that all cases were negative for desmin, with positive immunostaining for CD34 (n=6), smooth muscle actin (SMA) (n=3), and Ki67 (n=6), without specific diagnostic markers. Following surgical resection, tumor recurrence occurred in three patients, and metastasis in two patients. The mean overall survival (OS) was 45.66 months (56.44 months for women; 32.57 months for men); the 5-year survival rate of our patients was 38%. Conclusions EGIST presented with a large tumor size at diagnosis, was mainly intra-abdominal, and had a low mean patient survival time with no specific diagnostic tissue immunomarkers.
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Affiliation(s)
- Engin Hatipoğlu
- Department of General Surgery, Cerrahpaşa Faculty of Medicine, Istanbul University, İstanbul, Turkey
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32
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Mucinous Carcinomatosis: A Rare Association between an Ovarian Tumor and an E-GIST. Case Rep Surg 2018; 2018:6897372. [PMID: 29593930 PMCID: PMC5821968 DOI: 10.1155/2018/6897372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 12/03/2017] [Indexed: 12/29/2022] Open
Abstract
Pseudomyxoma peritonei (PMP) and extragastrointestinal stromal tumors (E-GISTs) are both rare entities. Most of the time, PMP is associated with an appendiceal tumor. An ovarian mucinous tumor can mimic appendiceal metastases. E-GIST is a mesenchymal tumor that can arise from the omentum, retroperitoneum, mesentery, or pleura. We present a case of an 87-year-old woman with mucinous carcinomatosis and acute intestinal occlusion submitted to an emergency laparotomy. She has found to have a borderline mucinous tumor of the ovary from the intestinal type with several lesions of pseudomyxoma peritonei and an E-GIST from the epiploons retrocavity (intermediated risk). In the literature, no relation was found between these two rare tumors. E-GIST was an incidental finding in the context of a mucinous carcinomatosis.
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33
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Wang JL, Wu JH, Hong C, Wang YN, Zhou Y, Long ZW, Zhou Y, Qin HS. Involvement of Bmi-1 gene in the development of gastrointestinal stromal tumor by regulating p16 Ink4A /p14 ARF gene expressions: An in vivo and in vitro study. Pathol Res Pract 2017; 213:1542-1551. [DOI: 10.1016/j.prp.2017.09.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 09/05/2017] [Accepted: 09/15/2017] [Indexed: 12/31/2022]
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Erin R, Şahinler A, Baki Erin K, Güven S, Aran T, Burkankulu Ağirbaş D, Kemal Okatan B, Öte EO. Retroperitoneal extragastrointestinal giant stromal tumour: A case report. J OBSTET GYNAECOL 2017; 37:955-957. [PMID: 28578618 DOI: 10.1080/01443615.2017.1312305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Recep Erin
- a Department of Obstetrics and Gynecology , Trabzon Research hospital , Trabzon , Turkey
| | - Ayhan Şahinler
- a Department of Obstetrics and Gynecology , Trabzon Research hospital , Trabzon , Turkey
| | - Kübra Baki Erin
- a Department of Obstetrics and Gynecology , Trabzon Research hospital , Trabzon , Turkey
| | - Süleyman Güven
- b Department of Obstetrics and Gynecology , Karadeniz Technical University , Trabzon , Turkey
| | - Turhan Aran
- b Department of Obstetrics and Gynecology , Karadeniz Technical University , Trabzon , Turkey
| | | | - Burcu Kemal Okatan
- c Department of Pathology , Trabzon Research hospital , Trabzon , Turkey
| | - Enver Okan Öte
- d Department of Medical Genetics , Ankara Etlik Zübeyde Hanım Maternity and Woman's Health Training and Research Hospital , Ankara , Turkey
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35
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Carrillo Colmenero AM, Serradilla Martín M, Redondo Olmedilla MDD, Ramos Pleguezuelos FM, López Leiva P. Giant primary extra gastrointestinal stromal tumor of the liver. Cir Esp 2017; 95:547-550. [PMID: 28153448 DOI: 10.1016/j.ciresp.2016.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Revised: 12/05/2016] [Accepted: 12/15/2016] [Indexed: 12/28/2022]
Affiliation(s)
| | - Mario Serradilla Martín
- Unidad de Cirugía Hepatobiliopancreática, Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Miguel Servet, Zaragoza, España.
| | | | | | - Pedro López Leiva
- Unidad de Gestión Clínica de Oncología Médica, Complejo Hospitalario de Jaén, Jaén, España
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Laroia ST, Yadav T, Rastogi A, Sarin S. Malignant Retroperitoneal Extra-Gastrointestinal Stromal Tumor: A Unique Entity. World J Oncol 2016; 7:45-50. [PMID: 28983363 PMCID: PMC5624696 DOI: 10.14740/wjon926w] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2015] [Indexed: 12/13/2022] Open
Abstract
Extra-gastrointestinal stromal tumors (EGISTs) are a recently described group of tumors. A handful of less than 70 cases have been reported in English literature, so far, to the best of our knowledge. Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the alimentary canal. EGISTs are a unique entity, which require distinction from GISTs because, even though, they exhibit similar histology and immunohistochemistry to GISTs, they occur outside the gastrointestinal tract, i.e. in omentum, mesentery, retroperitoneum, etc. and have different behavior patterns as far as their prognosis and management are concerned. Retroperitoneal sub-group of EGISTs is extremely rare and we report such a case of primary malignant EGIST of the retroperitoneum which presented as a soft tissue mass on radiological evaluation. The tumor turned out to be a histopathological surprise, and could be distinctively labeled as EGIST only after morphological and immunohistochemical studies. It is imperative for radiologists, pathologists and oncologists, among other clinicians, to be able to recognize and understand the presentation of this group of tumors due to their rapid progression and poor prognosis, so that an early diagnosis and management may be able to improve the final disease outcome.
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Affiliation(s)
- Shalini Thapar Laroia
- Department of Radiology, Institute of Liver and Biliary Sciences, Sector D-1, Vasant Kunj, New Delhi 110070, India
| | - Taruna Yadav
- Department of Radiology, Institute of Liver and Biliary Sciences, Sector D-1, Vasant Kunj, New Delhi 110070, India
| | - Archana Rastogi
- Department of Hepato-Pathology, Institute of Liver and Biliary Sciences, Sector D-1, Vasant Kunj, New Delhi 110070, India
| | - Shiv Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, Sector D-1, Vasant Kunj, New Delhi 110070, India
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Tarchouli M, Bounaim A, Essarghini M, Aitidir B, Lomdo M, Benmoussa M, Oukabli M, Ait-Ali A, Sair K. Extra-Gastrointestinal Stromal Tumor of the Greater Omentum: Unusual Case Report. J Gastrointest Cancer 2015; 47:489-493. [PMID: 26596853 DOI: 10.1007/s12029-015-9784-2] [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] [Indexed: 12/28/2022]
Abstract
Gastrointestinal stromal tumors are the most common mesenchymal tumors of the gastrointestinal tract, originating from the interstitial cells of Cajal and most frequently expressing CD-117, a C-kit proto-oncogene, which can be detected immunohistochemically. Extra-gastrointestinal stromal tumors are neoplasms with similar immunohistological features arising outside the gastrointestinal tract with no connection to the gastric or intestinal wall.We report the case of a 61-year-old Moroccan man who presented with chronic abdominal pain along with progressive abdominal distension for the past last year. The clinical examination demonstrated a large abdominal mass and an abdominal computed tomography scan revealed a voluminous intraperitoneal mass measuring 30 cm in its greatest diameter. At laparotomy, this mass seemed to be arising from the greater omentum without continuity to the gastrointestinal tract. The mass was completely removed with clear margins and pathological examination was suggestive for high-risk gastrointestinal stromal tumor of the greater omentum. Due to the aggressive nature of this patient's tumor, he was assigned to receive imatinib as adjuvant chemotherapy for 3 years. He remains alive without any sign of recurrence after 4 years of follow-up.Extra-gastrointestinal stromal tumors of the greater omentum can grow slowly and remain clinically silent despite the large size of the tumor. Complete surgical resection is the only effective treatment approach. Nevertheless, adjuvant therapy following resection with imatinib has become a standard of care in cases of high risk disease.
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Affiliation(s)
- Mohamed Tarchouli
- Department of Digestive Surgery, Faculty of Medicine and Pharmacy, Mohammed V Military Hospital, Mohammed V University, Rabat, Morocco.
| | - Ahmed Bounaim
- Department of Digestive Surgery, Faculty of Medicine and Pharmacy, Mohammed V Military Hospital, Mohammed V University, Rabat, Morocco
| | - Mohamed Essarghini
- Department of Digestive Surgery, Faculty of Medicine and Pharmacy, Mohammed V Military Hospital, Mohammed V University, Rabat, Morocco
| | - Badr Aitidir
- Department of Digestive Surgery, Faculty of Medicine and Pharmacy, Mohammed V Military Hospital, Mohammed V University, Rabat, Morocco
| | - Massama Lomdo
- Department of Digestive Surgery, Faculty of Medicine and Pharmacy, Mohammed V Military Hospital, Mohammed V University, Rabat, Morocco
| | - Mustapha Benmoussa
- Department of Digestive Surgery, Faculty of Medicine and Pharmacy, Mohammed V Military Hospital, Mohammed V University, Rabat, Morocco
| | - Mohamed Oukabli
- Department of Pathology, Faculty of Medicine and Pharmacy, Mohammed V Military Hospital, Mohammed V Military Hospital, Rabat, Morocco
| | - Abdelmounaim Ait-Ali
- Department of Digestive Surgery, Faculty of Medicine and Pharmacy, Mohammed V Military Hospital, Mohammed V University, Rabat, Morocco
| | - Khalid Sair
- Department of Digestive Surgery, Faculty of Medicine and Pharmacy, Mohammed V Military Hospital, Mohammed V University, Rabat, Morocco
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DU Y, Zhang H, Jiang Z, Huang G, Lu W, Wang H. Expression of L1 protein correlates with cluster of differentiation 24 and integrin β1 expression in gastrointestinal stromal tumors. Oncol Lett 2015; 9:2595-2602. [PMID: 26137113 DOI: 10.3892/ol.2015.3096] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 01/29/2015] [Indexed: 12/11/2022] Open
Abstract
The present study examined 66 cases of gastrointestinal stromal tumors (GISTs), 20 cases of smooth muscle tumors, 20 cases of schwannomas and 20 cases of normal gastric tissues in order to analyze the expression of L1, cluster of differentiation (CD)24 and integrin β1 by immunohistochemical staining. Patients were subjected to follow-up, and survival data were evaluated. L1 expression was detected in 57.6% of GIST cases; this was a significantly higher percentage compared with that found in the smooth muscle tumor cases or the normal control group. CD24 and integrin β1 were also expressed at significantly higher levels in the GIST cases than in the normal control group, although no significant difference was found in the expression levels of these proteins in smooth muscle tumor or schwannoma cases. These higher levels of L1 and integrin β1 expression were associated with an increased risk of invasive GIST, and were significantly positively correlated with Ki-67 expression. CD24 expression was not associated with the risk of GIST invasion or Ki-67 expression. There were positive correlations between L1, CD24 and integrin β1 expression; however, these had no significant association with patient survival. Therefore, L1 alone or in conjunction with CD24 (L1 + CD24), or integrin β1 (L1 + integrin β1) can be considered a valuable indicator for the differential diagnosis of GIST. Furthermore, L1 and integrin β1 can be used alone or in combination to evaluate the biological behavior of GISTs. Future studies are required to evaluate the prognostic value of these markers.
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Affiliation(s)
- Yue DU
- Department of Public Health, Tianjin Medical University, Tianjin 300070, P.R. China
| | - Haihong Zhang
- Department of Public Health, Tianjin Medical University, Tianjin 300070, P.R. China
| | - Zhongmin Jiang
- Department of Pathology, Tianjin Fifth Central Hospital, Tianjin 300450, P.R. China
| | - Guowei Huang
- Department of Public Health, Tianjin Medical University, Tianjin 300070, P.R. China
| | - Wenli Lu
- Department of Public Health, Tianjin Medical University, Tianjin 300070, P.R. China
| | - Hesheng Wang
- Department of Public Health, Tianjin Medical University, Tianjin 300070, P.R. China
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