Gastrointestinal Stromal Tumor, or Another Tumor Type?

Abstract

Question: A 53-year-old man was evaluated for nausea, progressive weakness, and loss of energy. He had a history of pituitary adenoma resected approximately 8 months prior, Barrett's esophagus without dysplasia and most relevantly, a history of a 20-cm (Figure A, computed tomography scan of the abdomen) stage IIIb gastric high-grade, predominantly epithelioid, gastrointestinal stromal tumor (GIST; Figure B, note the epithelioid appearing GIST within the black arrows, the oxyntic mucosa within the blue arrows, and the muscularis separating the 2 areas) extirpated by partial gastrectomy and Billroth II approximately 18 months prior. Family history was remarkable for thyroid cancer in a maternal uncle. He denied any history of alcohol use, tobacco use, or illicit drug use. The patient was later noted to have a 3-cm left upper quadrant abdominal mass on surveillance imaging 12 months later while being treated with adjuvant tyrosine kinase inhibitors (imatinib followed by sorafenib). Subsequent laboratory values and physical examination were unremarkable. Repeat imaging demonstrated an enlarging 6.7 Â 7.0-cm mass within the abdominal mesentery anterior to the left kidney (Figure C, repeat computed tomography scan of the abdomen). He was referred for laparoscopic partial small bowel resection and excision of a 10-cm mesenteric mass at the level of the efferent jejunal limb, a 3-cm nodule at the level of the proximal ileum, and 6 smaller nodules within the small bowel mesentery. What is the diagnosis? See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI.

APASL HCV guidelines of virus-eradicated patients by DAA on how to monitor HCC occurrence and HBV reactivation

“…Although more recent clinical studies and real-world studies have reported that DAA therapy decreased the risk of both de novo HCC and recurrent HCC in both cirrhotic and non-cirrhotic patients with HCV infection, several preliminary studies have dealt with the risk factors for the occurrence of HCC [29, 32, 34, 35]. These studies revealed that male gender, older age, alcohol abuse, diabetes mellitus, and the existence of cirrhosis are associated with the occurrence of HCC (Table 1) [29, 32, 34, 35]. Most of these studies were conducted 1–2 years after DAA treatment [11, 33].…”

“…However, in addition to the abovementioned parameters, there is some dispute regarding the difference in occurrence of HCC between patients with and without previous HCC history [19–21, 38]. Thus, we conducted a literature search, investigating the occurrence of HCC in DAA-treated patients with and without previous HCC history (Table 2) [18–35]. A summary of the collected data is described in the following sections.…”

“…Thus, we conducted a literature search, investigating the occurrence of HCC in DAA-treated patients with and without previous HCC history (Table 2) [18–35]. A summary of the collected data is described in the following sections.…”

“…The mean follow-up period of those studies was 18.2 months (range 9–36 months) post-DAA initiation. The overall occurrence rate of HCC after SVR in 45,870 patients without previous HCC history was 604 (1.3%) (range 0.9–7.4%) (Table 3) [21, 23, 26, 28–30, 32–35]. Thus, the annual occurrence rate of SVR patients by DAA without previous HCC history is no different from that of the interferon era [3–5, 39–41].…”

“…Now, in the age of DAAs, extremely high SVR rates, sometimes even 100%, have been reported [7–17]. However, there have been several reports on the unexpectedly high rate of early HCC occurrence despite the virus eradication [18–35]. In real-life settings, if these are actual cases, this incidence could be a shocking event to patients as well to attending physicians.…”