Clinicopathological characteristics and prognosis of gastrointestinal stromal tumors containing air-fluid levels

Abstract

An air-fluid level within a gastrointestinal stromal tumor (GIST) is unusual and indicates the presence of a fistula within the lumen of the GI tract. Until recently, the optimal management of such patients was not clear-cut. This retrospective study investigated the clinicopathological characteristics, surgical procedures, pre-and post-operative management, and prognosis of patients with GIST containing an air-fluid level. Data of GIST patients, spanning 5 years, including 17 GIST patients with air-fluid levels in the experimental group and 34 GIST patients without air-fluid levels in the control group, were retrieved from two hospitals in China. The clinicopathological characteristics, types of surgery, management, and clinical outcomes of GIST patients were compared between the two groups. GISTs containing air-fluid levels were significantly different from GISTs without air-fluid levels regarding tumor morphology, NIH risk category, invasion of adjacent organs, and necrosis or ulceration. Most GIST patients with air-fluid levels (14/17, 82.4%) received open surgery, significantly higher than the 20.6% in the control group. Targeted therapy with Imatinib mesylate (IM) was implemented in all GIST patients in the experimental group (17/17, 100%); markedly higher than those (3/34, 8.8%) in the control group. During follow-up, recurrence and death rates (5.9% and 5.9%) in the experimental group were higher than those (2.9% and 0%) in the control group. Open surgery is commonly performed in GIST patients with air-fluid levels who also require targeted therapy with IM. The Torricelli-Bernoulli sign could be a risk factor, adversely affecting the patient’s prognosis.

Factors associated with gastrointestinal stromal tumor rupture and pathological risk: A single-center retrospective study

“…Moreover, the clinical presentation of GISTs, such as an unclear tumor boundary, irregular tumor shape, and the presence of a gas-liquid interface in imaging scans, can indicate aggressive behavior and malignancy. Gas-liquid interface detection in GISTs is currently uncommon, but researchers believe that it predicts severe disease in GIST patients[ 25 - 27 ]. Our study found that necrosis and rupture were more likely to occur when an air-liquid interface was present, and these factors were important indicators of poor prognosis in GIST patients.…”

Gastrointestinal Stromal Tumor Complicated by Fistula Formation

“…Radiographic evidence of fistulization may include the presence of air fluid levels within the suspected mass. 5 Despite being clinically asymptomatic, fistulization between the GIST and the intestinal lumen is important to recognize because it may serve as a conduit for bacterial translocation, leading to infectious complications.…”

Gastrointestinal Stromal Tumors. Course Prediction and Diagnostic Algorithms

“…Жодна з схем для прогнозування ризику рецидиву або метастазування хірургічно видаленої первинної стромальної пухлини не передбачає чіткого поділу доброякісних і злоякісних СПШКТ [6,[26][27][28][29][30]. Експерти вважають за краще не використовувати слово «доброякісний» для будь-яких СПШКТ адже ж навіть дуже маленькі GIST з низьким потенціалом злоякісності рецидивують або метастазують через роки після хірургічної резекції.…”