Computed tomography in gastrointestinal stromal tumors

Abstract

The aim of this study was to define the imaging characteristics of primary and recurrent gastrointestinal stromal tumors (GIST) in computed tomography with respect to the tumor size. Computed tomography was performed in 35 patients with histologically confirmed gastrointestinal stromal tumors and analyzed retrospectively by two experienced and independent radiologist. The following morphologic tumor characteristics of primary ( n=20) and ( n=16) recurrent tumors were evaluated according to tumor size, shape, homogeneity, density compared with liver, contrast enhancement, presence of calcifications, ulcerations, fistula or distant metastases and the anatomical relationship to the intestinal wall, and the infiltration of adjacent visceral organs. Small GIST (<5 cm) showed a sharp tumor margin with homogeneous density and structure on unenhanced and contrast-enhanced images, and were characterized by an intraluminal tumor growth. Intermediate sized GIST (>5-10 cm) demonstrated an irregular shape, inhomogeneous density on unenhanced and contrast-enhanced images, a combined intra- and extraluminal tumor growth with aggressive findings, and infiltration of adjacent organs in 9 primary diagnosed and 2 recurrent tumors. Large GIST (>10 cm), which were observed in 8 primary tumors and 11 recurrent tumors, showed an irregular margin with inhomogeneous density and aggressive findings, and were characterized by signs of malignancy such as distant and peritoneal metastases. Small recurrent tumors had a similar appearance as compared with large primary tumors. Computed tomography gives additional information with respect to the relationship of gastrointestinal stromal tumor to the gastrointestinal wall and surrounding organs, and it detects distant metastasis. Primary and recurrent GIST demonstrate characteristic CT imaging features which are related to tumor size. Aggressive findings and signs of malignancy are found in larger tumors and in recurrent disease. Computed tomography is useful in detection and characterization of primary and recurrent tumors with regard to tumor growth pattern, tumor size, and varied appearances of gastrointestinal stromal tumors, and indirectly gives hints regarding dignity and therefore prognostic outcome.

Multislice Computed Tomography Imaging Of Gastrointestinal Stromal Tumors

“…There have been various results in various studies on exophytic or endophytic extension of small lesions in the literature. The small GIST lesions have been shown to have greater tendency to endoluminal extension in a study (13). An interesting finding of our study was that the dimensions of GIST lesions originating from outside of luminal gastrointestinal structures, called extraluminal in this study, were quite large compared to other lesions ( Figure 6).…”

“…There have been various results with this regard in the literature. While there was calcification in about 23% of small GIST lesions in one study, there was no calcification in any of the cases in another study (13)(14)(15). In a study including 19 cases, there was calcification only in one leiomyoma case (16).…”

Tomographic Findings of Gastric Gastrointestinal Stromal Tumor and Correlation With the Mitotic Index

“…Other characteristics can still be found especially in tumors of high histological degree, such as mucosa ulceration (3%-88%), cavitation and areas of central hypodensity (20%-49%) which can correspond to cystic degeneration, hemorrhage or necrosis (9,16,23,29,32) . Presence of gas or contrast in the interior of the lesion can suggest presence of mucosa ulceration and fistula formation (18) .…”

Plexiform Angiomyxoid Myofibroblastic Tumor (PAMT) of Stomach with Synchronous Bilateral Cystic Ovarian Neoplasms, a Rare Case Presentation

“…The mucosa may be intact, dimpled or ulcerated [3,9]. Imaging has a difficult role to distinguish it from other stromal tumours [7]. Although this case was diagnosed upon post-surgical histopathology, we recommend that, when myxoid spindle cell lesion is observed in endoscopic biopsy, PAMT should be included in diferential diagnosis [9].…”