scholarly journals Immunohistochemical features of gastrointestinal stromal tumors and their role for differential diagnosis and prognosis

2021 ◽  
pp. 10-16
Author(s):  
Yana Miroshnichenko
Keyword(s):  
Differential Diagnosis ◽  
Tumor Cells ◽  
Gastrointestinal Stromal Tumors ◽  
Spindle Cell ◽  
Prognostic Markers ◽  
Mitotic Rate ◽  
Mesenchymal Tumors ◽  
Ki 67 ◽  
Stromal Tumors ◽  
Strong Expression

The aim. To clarify all most important immunohistochemical features of gastrointestinal stromal tumors with different histological patterns and analyze the role of expression of Ki-67, MMP-9, VEGF and p16ink4A as a predictive markers of tumor progression. Materials and methods. The study is based on analysis of 100 primary GISTs for description of their morphological features and 36 GISTs taken from this 100 for study of prognostic markers. Results. All spindle cell GISTs have shown diffuse expression of CD117 in tumor cells. The levels of CD117 expression varied from strong expression (3+) until mild expression (1+). Strong expression were seen in 75,8 % of spindle cell GISTs. Epithelioid GISTs demonstrated heterognous moderate or mild expression of CD117. All primary epithelioid GISTs from patients that had relapse of tumor in period from 1 till 3 years demonstrated focal mild expression of CD 117 in tumor cells. Expression of DOG-1 were seen in all 100 cases of GISTs, that were included in our study. The strong expression of DOG-1 (3+) were seen in all 45 GISTs that had low mitotic rate (≤5 mitoses per 50HPF) and not associated with their histological pattern. GISTs with high mitotic rate demonstrated heterogeneous expression of DOG-1 in tumors: moderate expression (2+) with patchy areas of strong expression (3+). Expression of CD56 was not found in spindle cell GISTs, but single tumor cells of epithelioid GISTs that had high mitotic rate demonstrated expression of this marker. The average expression of p16ink4A were higher in tumors that gave relapses compared with tumors without relapses (50,3 % versus 5,7 % respectively, U-test=16.5; p≤0,01).The average expression of MMP-9 also were significantly higher in GISTs that gave relapses: 63,2 % compared with 13,4 % in GISTs without relapse (U-test=16; p≤0 ,01).The strong VEGF expression was found in 66,7 % of GISTs that had relapses and only in 8,3 % of GISTs without relapses. 50 % of GISTs without relapses was negative for VEGF. Finally, the average expression of Ki-67 were 13,4 % in GISTs with relapses and 8,7 % in GISTs without them (U-test=16; p≤0,01). Conclusion. We highly recommend using DOG-1 for epithelioid GISTs. Additionally in epithelioid GISTs can be used CD56 that can give focal positive reaction in some tumour cells. The following minimal panel of markers for differential diagnosis of spindled GISTs from other mesenchymal tumors of gastrointestinal tract is proposed: CD117, DOG-1 and SMA, where the first too markers will demonstrated the moderate or strong diffuse expression and SMA can be occasionally positive in some tumor cells. p16ink4A, ki-67, VEGF and MMP-9 can be used as additional prognostic markers in GISTs.

scholarly journals Gastric schwannoma: a benign tumor often misdiagnosed as gastrointestinal stromal tumor

2015 ◽  
Vol 5 (3) ◽  
Author(s):  
Apurva S. Shah ◽  
Pravin M. Rathi ◽  
Vaibhav S. Somani ◽  
Astha M. Mulani
Keyword(s):  
Differential Diagnosis ◽  
Gastrointestinal Stromal Tumor ◽  
Gastrointestinal Stromal Tumors ◽  
Rare Case ◽  
Benign Tumor ◽  
Stromal Tumor ◽  
Mesenchymal Tumors ◽  
Stromal Tumors ◽  
Gastric Schwannoma ◽  
Gastric Mass

Gastric schwannomas are rare mesenchymal tumors that arise from the nerve plexus of gut wall. They present with nonspecific symptoms and are often detected incidentally. Preoperative investigation is not pathognomic and many are therefore misdiagnosed as gastrointestinal stromal tumors. We report a rare case of a 37-year old woman who underwent laparotomy for complex bilateral ovarian cyst with resection of gastric-gastrointestinal stromal tumor preoperatively, but confirmed to have a gastric schwannomas postoperatively. This case underscores the differential diagnosis of submucosal, exophytic gastric mass as schwannoma.

scholarly journals Robust linear regression model of Ki-67 for mitotic rate in gastrointestinal stromal tumors

2014 ◽  
Vol 7 (3) ◽  
pp. 745-749 ◽  
Author(s):  
RALF KEMMERLING ◽  
DENIS WEYLAND ◽  
TOBIAS KIESSLICH ◽  
ROMANA ILLIG ◽  
ECKHARD KLIESER ◽  
...  
Keyword(s):  
Linear Regression ◽  
Regression Model ◽  
Linear Regression Model ◽  
Gastrointestinal Stromal Tumors ◽  
Mitotic Rate ◽  
Ki 67 ◽  
Stromal Tumors ◽  
Robust Linear Regression

scholarly journals Synchronous Occurrence of Ileal Stromal Tumor (GIST) and Colonic Adenocarcinoma: A Case Report/ Синхроно Јавување На Илеален Стромален Тумор (Гист) И Аденокарцином На Колон – Приказ На Случај

PRILOZI ◽  
2015 ◽  
Vol 36 (1) ◽  
pp. 219-223
Author(s):  
Elizabeta Trajkovska ◽  
Vesna Janevska ◽  
Liljana Spasevska ◽  
Vlado Janevski ◽  
Julija Zhivadinovik ◽  
...  
Keyword(s):  
Case Report ◽  
Gastrointestinal Stromal Tumors ◽  
Spindle Cell ◽  
Tnm Classification ◽  
Colonic Adenocarcinoma ◽  
Mesenchymal Tumors ◽  
Gastrointestinal Malignancies ◽  
Stromal Tumors ◽  
Low Malignant Potential ◽  
The Relationship

Abstract Introduction: Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the digestive tract. There is an increasing number of literature reports on synchronous occurrence of gastrointestinal stromal tumors and another malignancy of distinct etiology and evolution. The most reported cases include gastric synchronous occurrence of gastrointestinal stromal tumors and adenocarcinoma and gastric gastrointestinal stromal tumors and colonic adenocarcinoma. Case report: We present a case of a 77-old female, with synchronous cecal moderately differentiated adenocarcinoma in Stage IIA according to the TNM classification and ileal spindle cell type GIST with low malignant potential, positive for c-Kit, CD34, vimentin, Actin, and negative for S100. Conclusion: The synchronous occurrence of small bowel gastrointestinal stromal tumors and other primary gastrointestinal malignancies has been rarely reported. There is a need of further investigations to identify the relationship between gastrointestinal stromal tumors and colorectal cancers.

scholarly journals Gastric Schwannoma mimicking gastrointestinal stromal tumors: a rare case with review of literature

2020 ◽  
Vol 7 (5) ◽  
pp. 1691
Author(s):  
Nagari Bheerappa ◽  
Digvijoy Sharma ◽  
Gangadhar Rao Gondu ◽  
Nirjhar Raj ◽  
Kamal Kishore Bishnoi ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Gastrointestinal Stromal Tumors ◽  
Malignant Potential ◽  
Review Of Literature ◽  
Mesenchymal Tumors ◽  
Submucosal Tumors ◽  
Stromal Tumors ◽  
Gastric Schwannoma ◽  
Gastric Mass ◽  
Slow Growing

Gastric schwannoma (GS) is a rare neoplasm of the stomach. It accounts for 0.2% of all gastric tumors and is mostly benign, slow-growing, and asymptomatic. Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors and up to 60-70% of GIST occur in the stomach. Schwannoma and GIST have similar radiological and endoscopic features making it extremely difficult to differentiate them preoperatively. Differential diagnosis of these two submucosal tumors is important because of the malignant potential of GIST and the relatively benign course of gastric schwannomas. This case stresses on the importance of including gastric schwannomas in the differential diagnosis of a submucosal gastric mass as it has the ability to mimic a gastrointestinal stromal tumor, which is a leading differential diagnosis because of its common occurrence at this site.

Incidence of gastrointestinal stromal tumors (GISTs) in France: Results of the PROGIST survey conducted among pathologists

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 10047-10047 ◽  
Author(s):  
G. Monges ◽  
J. Coindre ◽  
J. Scoazec ◽  
A. Bouvier ◽  
J. Blay ◽  
...  
Keyword(s):  
Gastrointestinal Stromal Tumors ◽  
Epidemiologic Study ◽  
Mitotic Rate ◽  
Annual Incidence ◽  
Mesenchymal Tumors ◽  
True Incidence ◽  
Stromal Tumors ◽  
One Year ◽  
First Time ◽  
Risk Categories

10047 Background: GISTs are the most common mesenchymal tumors of the gastrointestinal tract but data on the annual incidence of this tumor is scarce due to previous lack of well-defined pathologic criteria. The aim of this study was to investigate the incidence of GISTs in France and describe the distribution according to age, sex, circumstances of discovery, localization and risk categories. Methods: This prospective epidemiologic study was performed among pathologists who were asked to declare all the cases of GIST over a one year period. All pathology centers (330 centers) in France were proposed to participate and asked to report exhaustively the cases diagnosed from 1 December 2004 to 30 November 2005. Results: 591 cases of GISTs were reported, 535 new cases and 56 cases of relapse. However, some large centers were not able to participate. So, the annual estimated incidence was 12 cases/million inhabitants in France. The main characteristics of the new cases of GIST were as follows: mean age 65 (± 13.2) (range: 16–93) years, 48.6% men and 51.4% women, circumstances of discovery: fortuitous 163 (30.5%), symptomatic 249 (46.5%), unknown 123 (23%). The primary tumor locations were: stomach 341 (63.7 %), small intestine 115 (21.5%), mesentery 35 (6.5%), colon/rectum 17 (3.2%), esophagus 4 (0.7%), unknown 23 (4.3%). 95.3% of GISTs were cKIT (CD117) + and 3.7 % were cKIT -. According to the Fletcher consensus criteria, based on tumor size and mitotic rate, among the 490 localized GISTs 14.7% were considered to be at very low prognostic risk, 25.5% at low-risk, 23.1 % at intermediate risk and 23.1 % at high-risk. For 13.6 % data were missing. Conclusions: This study is providing for the first time an estimation of the annual incidence of GISTs and a description of the characteristics of these tumors in France based on pathology registration. The true incidence may be slightly higher as some large centers were not able to reported their cases. These results are comparable to what has been reported in recent studies in other European countries. No significant financial relationships to disclose.

Resection of esophageal gastrointestinal stromal tumors.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e20503-e20503
Author(s):  
Vladimir Trifanov ◽  
Oleg I Kit ◽  
Liubov Yu Vladimirova ◽  
Dmitriy Trifanov ◽  
Vadim Kasatkin
Keyword(s):  
Gastrointestinal Tract ◽  
Gastrointestinal Stromal Tumors ◽  
Kinase Inhibitors ◽  
Mitotic Rate ◽  
Endoscopic Biopsy ◽  
Surrounding Tissue ◽  
Mesenchymal Tumors ◽  
Management Guidelines ◽  
Stromal Tumors ◽  
Right Lobe

e20503 Background: Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of gastrointestinal tract. GISTs account for 0,1% to 0,3% of all tumors in the gastrointestinal tract. Two thirds of these tumors arise from the stomach, 25% arise from the small intestine and less than 5% arise from esophagus. Use of tyrosine kinase inhibitors has revolutionized therapy for GISTs but complete resection remains the treatment of choice. Methods: We report our experience (from 2005 to 2011) with five patients who underwent resection of esophageal GIST. Reviewed consensus management guidelines and performed a literature review for reported cases. Results: All five patients underwent surgery intervention at our institute. Four patients had no metastasis and they underwent tumor enucleation. Due to submucosal location only one of them was diagnosed with GIST by endoscopic biopsy before surgery. One patient had a giant liver metastasis invading totally all segments of right lobe of liver. He underwent transhiatal extirpation simultaneously combined with extended right-sided hemihepatectomy. That patient suffered from total dysphagia, 15 kg weight loss, gastrointestinal bleeding and a big lump in his right hypochondrium. After laparotomy we diagnosed big metastatic nodule invading the whole right lobe of liver 25 cm in diameter. After diaphragmotomy we diagnosed tumor of the lower third of esophagus. Consequently, we performed extended right-sided hemihepatectomy and transhiatal esophagus extirpation. Two months later esophageal plastics by means of ileocaecal segment of colon was performed. The pathological diagnosis was confirmed in all five cases by microscopic examination (KIT+; CD17+, mitotic rate). In adjuvant regime imatinib (400 mg/body/day) was administered for a year for all five patients. The patients are alive now, they were followed up every six months with CT for two years. Fortunately, no new tumors were observed during this period of time. Conclusions: Esophagectomy is the treatment of choice for esophageal GISTs but requires attention to operative details that emphasize complete en block excision of surrounding tissue and metastatic nodules.

scholarly journals Tumor Digital Masking Allows Precise Patient Triaging: A Study Based on Ki-67 Scoring in Gastrointestinal Stromal Tumors

Scanning ◽  
2018 ◽  
Vol 2018 ◽  
pp. 1-8
Author(s):  
Piotr Lewitowicz ◽  
Jaroslaw Matykiewicz ◽  
Magdalena Chrapek ◽  
Dorota Koziel ◽  
Agata Horecka-Lewitowicz ◽  
...  
Keyword(s):  
Image Analysis ◽  
Digital Image ◽  
Gastrointestinal Stromal Tumors ◽  
Digital Image Analysis ◽  
Tumor Location ◽  
Mitotic Figure ◽  
High Grade ◽  
Mesenchymal Tumors ◽  
Ki 67 ◽  
Stromal Tumors

Background. Technological advances constantly provide cutting-edge tools that enhance the progress of diagnostic capabilities. Gastrointestinal stromal tumors belong to a family of mesenchymal tumors where patient triaging is still based on traditional criteria such as mitotic count, tumor size, and tumor location. Limitations of the human eye and randomness in choice of area for mitotic figure counting compel us to seek more objective solutions such as digital image analysis. Presently, the labelling of proliferative activity is becoming a routine task amidst many cancers. The purpose of the present study was to compare the traditional method of prediction based on mitotic ratio with digital image analysis of cell cycle-dependent proteins. Methods. Fifty-seven eligible cases were enrolled. Furthermore, a digital analysis of previously performed whole tissue section immunohistochemical assays was executed. Digital labelling covered both hotspots and not-hotspots equally. Results. We noted a significant diversity of proliferative activities, and consequently, the results pointed to 6.5% of Ki-67, counted in hotspots, as the optimal cut-off for low–high-grade GIST. ROC analysis (AUC = 0.913; 95% CI: 0.828–0.997, p<0.00001) and odds ratio (OR = 40.0, 95% CI: 6.7–237.3, p<0.0001) pointed to Ki-67 16% as the cut-off for very high-grade (groups 5–6) cases. With help of a tumor digital map, we revealed possible errors resulting from a wrong choice of field for analysis. We confirmed that Ki-67 scores are in line with the level of intracellular metabolism that could be used as the additional biomarker. Conclusions. Tumor digital masking is very promising solution for repeatable and objective labelling. Software adjustments of nuclear shape, outlines, size, etc. are helpful to omit other Ki-67-positive cells especially small lymphocytes. Our results pointed to Ki-67 as a good biomarker in GIST, but concurrently, we noted significant differences in used digital approaches which could lead to unequivocal results.

Multislice imaging of gastrointestinal stromal tumors

2018 ◽  
pp. 3-14
Keyword(s):  
Computed Tomography ◽  
Key Words ◽  
Gold Standard ◽  
Gastrointestinal Stromal Tumors ◽  
Mesenchymal Tumors ◽  
Stromal Tumors ◽  
Preferential Localization ◽  
Multislice Imaging ◽  
Computed Tomography Diagnosis

Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the digestive tract (1%). These tumors express the CD 117 in 95% of cases. The stomach is the preferential localization (70%). Diagnosis is difficult and sometimes late. Progress of imaging has greatly improved the management and the prognosis. Computed tomography (CT) is the gold standard for diagnosis, staging, and treatment follow-up. The increasing recognition of GIST’s histopathology and the prolonged survival revealed some suggestive imaging aspects. Key words: gastro-intestinal stromal tumors; computed tomography; diagnosis

scholarly journals Gastrointestinal Stromal Tumors (GISTs): Novel Therapeutic Strategies with Immunotherapy and Small Molecules

2021 ◽  
Vol 22 (2) ◽  
pp. 493
Author(s):  
Christos Vallilas ◽  
Panagiotis Sarantis ◽  
Anastasios Kyriazoglou ◽  
Evangelos Koustas ◽  
Stamatios Theocharis ◽  
...  
Keyword(s):  
Tyrosine Kinase ◽  
Tyrosine Kinase Inhibitors ◽  
Gastrointestinal Stromal Tumors ◽  
Kinase Inhibitors ◽  
Checkpoint Inhibitors ◽  
Survival Rates ◽  
Cancer Therapeutics ◽  
Gastrointestinal Neoplasms ◽  
Mesenchymal Tumors ◽  
Stromal Tumors

Gastrointestinal stromal tumors (GISTs) are the most common types of malignant mesenchymal tumors in the gastrointestinal tract, with an estimated incidence of 1.5/100.000 per year and 1–2% of gastrointestinal neoplasms. About 75–80% of patients have mutations in the KIT gene in exons 9, 11, 13, 14, 17, and 5–10% of patients have mutations in the platelet-derived growth factor receptor a (PDGFRA) gene in exons 12, 14, 18. Moreover, 10–15% of patients have no mutations and are classified as wild type GIST. The treatment for metastatic or unresectable GISTs includes imatinib, sunitinib, and regorafenib. So far, GIST therapies have raised great expectations and offered patients a better quality of life, but increased pharmacological resistance to tyrosine kinase inhibitors is often observed. New treatment options have emerged, with ripretinib, avapritinib, and cabozantinib getting approvals for these tumors. Nowadays, immune checkpoint inhibitors form a new landscape in cancer therapeutics and have already shown remarkable responses in various tumors. Studies in melanoma, non-small-cell lung cancer, and renal cell carcinoma are very encouraging as these inhibitors have increased survival rates. The purpose of this review is to present alternative approaches for the treatment of the GIST patients, such as combinations of immunotherapy and novel inhibitors with traditional therapies (tyrosine kinase inhibitors).

scholarly journals Skeletal Muscle Metastasis of a GIST: A Case Report and Review of the Literature

2016 ◽  
Vol 2016 ◽  
pp. 1-5
Author(s):  
Olga D. Savvidou ◽  
George D. Chloros ◽  
Georgios D. Agrogiannis ◽  
Penelope Korkolopoulou ◽  
Georgios N. Panagopoulos ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Case Report ◽  
Soft Tissue ◽  
Gastrointestinal Stromal Tumors ◽  
Review Of The Literature ◽  
Soft Tissue Metastasis ◽  
Mesenchymal Tumors ◽  
Stromal Tumors ◽  
Skeletal Muscle Metastasis ◽  
Muscle Metastasis

Gastrointestinal stromal tumors (GISTs) are the most common malignant mesenchymal tumors of the gastrointestinal tract. The most common sites of metastasis are the liver and the peritoneum, whereas metastasis to soft tissue is rare. The authors present the case of a 78-year-old male with a soft tissue metastasis of a GIST and the current literature is reviewed.

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