Clinical, Radiologic and Pathologic Evaluation of Gastrointestinal Stromal Tumors

Abstract

Objective: Gastrointestinal stromal tumors (GISTs) are the most common nonepithelial tumors of the gastrointestinal tract. GISTs occur anywhere along the gastrointestinal tract. Due to using radiological modalities often, we see the GİSTs more in our daily practice. We use radiologic modalities for not only making the diagnosis, also following the therapy and tumor progressions-relaps. Material and Method: In this study, 23 GISTs whose diagnosis and therapeutic surgical operations were made in our hospital between January 2007-January 2013, were evaluated retrospectively. Results: The ages of the cases ranged between 32 and 76 and the mean age were 58.70±13.67 years. 52.2% of the cases (n=12) were male and 47.8% of them (n=11) were female. 91.3% of the cases (n=21) were located at GIS and 8.7% of the cases (n=2) were located at non-GIS location. 30.4% of the cases (n=7) were metastatic. When the cases were evalulated in terms of their pathologic risk stratification systems, 39.1% of the cases (n=9) were in high risk group, 34.8% of the cases (n=8) were in intermediate risk group, 26.1% of the cases (n= 6) were in low risk group. The maximum diameter of the masses was 10.22 cm. 69.1% of the cases (n=13) showed luminal growth pattern and 38.1% (n=8) showed extraluminal growth pattern. 86.9% of the cases (n=20) had smooth borders, 13.1% of the cases (n=3) had irregular-invasive borders. Conclusion: Imaging is important for diagnosis, theraphy and follow -up. Computed tomography is the first choice for the radiologic evaluation. Also ultrasonography (US), magnetic resonance (MRI) and Flor18-deoxy-glucose positron emission tomography (FDG-PET) can be used in some cases.

Keywords

• Gastrointestinal stromal tumor, Computed tomography, Growth pattern, Central necrosis.

Gastrointestinal Stromal Tümörlerin Klinik, Radyolojik ve Patolojik Bulgularının Değerlendirilmesi

Öz

Amaç: Gastrointestinal stromal tümör (GİST) gastrointestinal kanalın en sık görülen mezenkimal tümörüdür. Özofagustan rektuma kadar tüm gastrointestinal kanal boyunca izlenebilir. Günlük pratikte hastalara uygulanan radyolojik tetkiklerin artışıyla birlikte GİST'lere daha sıklıkla rastlanmaktadır. Sadece tümör tanısını koyarken değil tedavi etkilerini izlemede ve tümör progresyon-nükslerini takip etmede radyolojik modalitelere sıkça ihtiyaç duyulmaktadır. Gereç ve Yöntem: Bu çalışmada Ocak 2007- Ocak 2013 yılları arasında hastanemizde tanı konulan ve cerrahi tedavileri yapılan 23 GİST olgusu retrospektif olarak değerlendirildi. Bulgular: Olguların yaş dağılımları 32 ile 76 arasında değişmekte olup ortalama yaş 58.70±13.67'dir. Çalışmaya katılan hastaların % 52.2'si (n=12) erkek, % 47.8'i (n=11) kadındır. Lokalizasyon yeri incelendiğinde; 21 (% 91.3) olguda GİS, 2 (% 8.7) olguda ise GİS dışı olduğu görülmektedir. En sık lokalizasyon midedir. Araştırmaya katılan hastaların % 30.4'ünde (n=7) metastaz saptanmıştır. Omentum en sık metastaz yeri olarak izlenmiştir. Olguların risk grupları incelendiğinde; % 39.1'inin (n=9) yüksek, % 34.8'inin (n=8) orta ve % 26.1'inin (n=6) ise düşük risk grubunda olduğu saptanmıştır. Kitlelerin maksimum çapı 10.2 cm'dir. Kitlelerin % 69.1'i (n=13) lüminal büyüme paterni gösterirken, % 38.1'i (n=8) ekstralüminal büyüme paterni göstermiştir. Kitlelerin % 86.9'u (n=20) düzgün kenarlı iken % 13.1'i (n=3) düzensiz ve invaziv kenarlı izlenmiştir. Sonuç: Görüntüleme yöntemleri GİST'lerin tanı, tedavi ve takibinde önemlidir. Bilgisayarlı tomografi radyolojik değerlendirmede ilk seçenektir. Ayrıca ultrasonografi (US), manyetik rezonans (MRG) ve flor18-deoksi-glukoz pozitron emisyon tomografinin (FDG-PET) bazı durumlarda kullanılabilir.

Anahtar Kelimeler

• Gastrointestinal stromal tümör, Bilgisayarlı tomografi, Büyüme paterni, Santral nekroz.

References

1. Sturgeon C, Chejfec G,Espat N. Gastrointestinal stromal tumors: a spectrum of diseases. Surg Oncol 2003; 12: 21-6.
2. Miettinen M,Majidi M,Lasota J. Pathology and diagnostic criteria of gastrointestinal stromal tumors (GISTs): a review.Eur J Cancer 2002; 38: 39-51.
3. Joensuu H, Fletcher C, Dimitrijevic S, Silberman S, Roberts P, Demetri G. Management of malignant gastrointestinal stromal tumours. Lancet Oncol 2002; 3: 655-64.
4. Silva MV, Reid R. Gastrointestinal stromal tumors (GIST):ckit mutations, CD117 expression, differential diagnosis and targeted cancer therapy with imatinib. Pathol Oncol Res 2003; 9: 13Miettinen M, El-Rifai W, Sobin HL, Lasota J. Evaluation of malignancy and prognosis of gastrointestinal stromal tumors: a review. Hum Pathol 2002; 33: 478-83.
5. Roberts PJ, Eisenberg B. Clinical presentation of gastrointestinal stromal tumors and treatment of operable disease. Eur J Cancer 2002; 38: 37-8.
6. Buchdunger E, O’Reilly T, Wood J. Pharmacology of imatinib (STI571). Eur J Cancer 2002; 38: 28-36.
7. Siberman S, Joensuu H. Overview of issues related to imatinib therapy of advanced gastrointestinal stromal tumors: a discussion among the experts. Eur J Cancer 2002; 38: 66-9.
8. Stratakis CA, Carney JA. The triad of paragangliomas, gastric stromal tumours and pulmonary chondromas (Carney triad), and the dyad of paragangliomas and gastric stromal sarcomas (Carney-Stratakis syndrome): molecular genetics and clinical implications. J Intern Med 2009; 266: 43-52.

9. Duffaud F, Blay JY. Gastrointestinal stromal tumors: biology and treatment. Oncol 2003; 65: 187-97.
10. Sturgeon C, Cheifec G, Espat NJ. Gastrointestinal stromal tumors: a spectrum of disease. Surg Oncol 2003; 12: 21-6.
11. Connolly EM, Gaffney E, Reynolds JV. Gastrointestinal stromal tumors. Br J Surg 2003; 90: 1178-86.
12. Fletcher CDM, Berman JJ, Corless C, et al. Diagnosis of gastrointestinal stromal tumors: a consensus approach. Human Pathology 2002; 33: 459-65.
13. Wong NACS, Young R, Malcomson RDG, et al. Prognostic indicators for gastrointestinal stromal tumors: a clinipathological and immunohistochemical study of 108 resected cases of the stomach. Histopathology 2003; 43: 118-26.
14. Bucher P, Villiger P, Egger JF, et al. Management of gastrointestinal stromal tumours: from diagnosis to treatment. Swiss Med Wkly 2004; 134: 145-53.
15. Crosby JA, Catton CN, Davis A, et al. Malignant gastrointestinal stromal tumours of the small intestine: a review of 50 cases from a prospective database. Ann Surg Oncol 2001; 8: 50
16. Neuhaus SJ, Clark MA, Hayes AJ, et al. Surgery for gastrointestinal stromal tumour in the post-imatinib era. ANZ J Surg 2005; 75: 165-72.
17. Demetri GD, von Mehren M, Antonescu CR, et al. NCCN Task Force report: update on the management of patients with gastrointestinal stromal tumors. J Natl Compr Canc Netw 2010; 8: 1-41.
18. Andtbacka RHI, Ng CS, Scaife CL, et al. Surgical resection of gastrointestinal stromal tumors after treatment with imatinib. Ann Surg Oncol 2007; 14: 14-24.
19. Holdsworth CH, Badawi RD, Manola JB. CT and PET: early prognostic indicators of response to imatinib mesylate in patients with gastrointestinal stromal tumor. AJR Am J Roentgenol 2007; 189: 324-30.