Gastrointestinal Stromal Tumors: Clinical, Radiologic, and Pathologic Features

Sandrasegaran, Kumaresan; Arora, Rajesh; Rydberg, Jonas; Rushing, Daniel A.; Akisik, Fatih; Henley, John

doi:10.2214/ajr.184.3.01840803

Cited by 116 publications

(109 citation statements)

References 21 publications

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“…Many series do not present any case with this finding (3,22,29,30,32) , which is described in up to 2.5% of cases (16) . In our cases, we found one case presenting lymphadenopathy, with mitotic index lower than five mitosis per HPF.…”

Section: Discussionmentioning

confidence: 92%

“…Clinical manifestations are unspecific and depend on the lesion site. Digestive hemorrhage and abdominal pain are the most frequent symptoms found (16,21,23,30,32) . Our case comprised 14 (66.7%) female patients and 7 (33.3%) male patients, with average age of 61.6 years old, presenting pain or abdominal discomfort as the most frequent symptom.…”

Section: Discussionmentioning

confidence: 99%

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

Pelandré

Djahjah

Gasparetto

et al. 2013

Arq. Gastroenterol.

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-Context -Gastrointestinal stromal tumors are uncommon abdominal neoplasms and can affect any portion of the gastrointestinal tract. Objectives -Describe the tomographic findings of the gastrointestinal stromal tumor of gastric origin, correlating it with the mitotic index. Methods -Twenty-one patients were selected within the period of January 2000 and 2008, with histopathological and immunohistochemical diagnosis of gastric gastrointestinal stromal tumors, who presented computed tomography done before the treatment. The tomographic variables analyzed were lesion topography, dimensions, contours, morphology, pattern and intensity enhancement through venous contrast, growth pattern, invasion of adjacent organs, presence of ulceration, fistula, calcifications, infiltration of mesenteric fat, lymphadenopathy and metastasis. The mitotic index was determined through optic microscopy, counting the number of mitosis figures in 50 high power fields. Results -The tumors were located in the body (66.7%) or gastric fundus (33.3%), with dimensions varying between 4.2 and 21.2 cm (average of 10.5 cm). The growth was predominantly extraluminal (47.6%) or intra/extra luminal (28.6%). The enhancement by venous contrast was heterogeneous in 66.7%. The statistical analysis showed that irregular morphology (P = 0.027) and infiltration of mesenteric fat (P = 0.012) presented correlation with the high mitotic index. Conclusions -In the present study, most part of the tumors were located in the gastric body, with average size of 10.5 cm, presenting central hypo dense area, heterogeneous enhancement through contrast and predominantly extra luminal growth. Irregular morphology and infiltration of mesenteric fat present statistical correlation with high mitotic level. HEADINGS -Gastrointestinal stromal tumors. Spiral computed tomography. Mitotic index.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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

Pelandré

Djahjah

Gasparetto

et al. 2013

Arq. Gastroenterol.

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“…A systematic review of all pre-treatment and followup CT studies was performed in consensus by two oncoradiology fellowship-trained radiologists (ADB and SHT) with 5 and 8 years' experience. A total of 803 CTs were reviewed (mean 5; range, [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. Imaging features of the primary tumour that were recorded included the site of origin in SB, largest dimension, margin (well circumscribed or ill defined/infiltrative), outline (smooth/ undulating or irregular/lobulated), growth pattern (exophytic, intraluminal or combined), tumour heterogeneity (homogeneous or heterogeneous), presence and percentage of cystic/necrotic component (Hounsfield units # 20), presence of calcifications and complications [tumour-bowel fistula (TBF), bowel obstruction or intraperitoneal rupture].…”

Section: Imaging Analysismentioning

confidence: 99%

“…11 Imaging features of GISTs arising at different sites of the GI tract have been conventionally described in the literature as a single cohort without site-specific analysis. [12][13][14][15] In the past, our group has published the imaging features of GISTs arising at uncommon sites such as the oesophagus, duodenum and anorectal region. [16][17][18] To the best of our knowledge, there is no literature focusing dedicatedly on the imaging features of SB GISTs (excluding duodenal GISTs, which have a risk stratification different from jejunal and ileal GISTs).…”

Section: Introductionmentioning

confidence: 99%

MDCT and clinicopathological features of small bowel gastrointestinal stromal tumours in 102 patients: a single institute experience

Baheti

Shinagare

O’Neill

et al. 2015

BJR

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Objective: Small bowel (SB) is the second most common site of gastrointestinal stromal tumours (GISTs). We evaluated clinical presentation, pathology, imaging features and metastatic pattern of SB GIST. Methods: Imaging and clinicopathological data of 102 patients with jejunal/ileal GIST treated at Dana-Farber Cancer Institute and Brigham and Women's Hospital (Boston, MA) between 2002 and 2013 were evaluated. Imaging of treatment-naive primary tumour (41 patients) and follow-up imaging in all patients was reviewed. Results: 90/102 patients were symptomatic at presentation, abdominal pain and lower gastrointestinal blood loss being the most common symptoms. On pathology, 21 GISTs were low risk, 17 were intermediate and 64 were high risk. The mean tumour size was 8.5 cm. On baseline CT (n 5 41), tumours were predominantly well circumscribed, exophytic and smooth/mildly lobulated in contour. Of 41 tumours, 16 (39%) were homogeneous, whereas 25 (61%) were heterogeneous. Of the 41 tumours, cystic/necrotic areas (Hounsfield units ,20) were seen in 16 (39%) and calcifications in 9 (22%). CT demonstrated complications in 13/41 (32%) patients in the form of tumour-bowel fistula (TBF) (7/41), bowel obstruction (4/41) and intraperitoneal rupture (2/41). Amongst 102 total patients, metastases developed in 51 (50%) patients (27 at presentation), predominantly involving peritoneum (40/102) and liver (32/102). 7/8 (87%) patients having intraperitoneal rupture at presentation developed metastases. Metastases elsewhere were always associated with hepatic/peritoneal metastases. At last follow-up, 28 patients were deceased (median survival, 65 months). Conclusion: SB GISTs were predominantly large, wellcircumscribed, exophytic tumours with or without cystic/ necrotic areas. Complications such as TBF, bowel obstruction and intraperitoneal perforation were visualized at presentation, with patients with perforation demonstrating a high risk of metastatic disease. Exophytic eccentric bowel wall involvement and lack of associated adenopathy are useful indicators to help differentiate GISTs from other SB neoplasms. Advances in knowledge: SB GISTs are predominantly large, well-circumscribed, exophytic tumours, and may present with complications. They often are symptomatic at presentation, are high risk on pathology and metastasize to the peritoneum more commonly than the liver.

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“…Gastric lesions are characterized by a homogeneous enhancement, while small bowel lesions are more heterogeneous. Distal small bowel tumors and those arising from the sigmoid colon and rectum may be erroneously identified as gynecologic cancers [16][17][18][19][20]. Gross histopathologic findings typically include a fish-flesh appearance of soft consistency.…”

Section: Discussionmentioning

confidence: 99%

Gastrointestinal Stromal Tumor Mimicking as Ovarian Tumor in Gynaecologic Oncology

Ijeri

Rathod

Kundargi

et al. 2015

Indian J Surg Oncol

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To report the clinical presentation and outcomes of a series of patients who presented with abdominal/pelvic mass or pelvic pain and were diagnosed with a gastrointestinal stromal tumor (GIST). Retrospective data were collected of all patients who presented with an abdominal/pelvic mass or pelvic pain between January 2010 and July 2015 and who were ultimately diagnosed with a GIST. The patients' medical records were reviewed. A literature review was also conducted. The event free survival and overall survival was calculated for all patients using Kaplan Meier curve (SPSS19-SPSS Inc. USA). A total ten patients were identified with GIST during the study period. Eight of ten patients had a tumor in the small intestine, one in sigmoid colon and one in base of small bowel mesentry. The mean tumor size was 13.9 cm (range, 3.9 to 24 cm). A complete resection was achieved in all 10 patients. No patient had distance metastasis. There were no intraoperative complications. One patient developed postoperative intestinal fistula and was managed conservatively. All patients were treated with imatinib after surgery. The mean follow-up time was 18 months (range, 2 to 47 months). The seven of the 10 patients (70 %) with no evidence of disease, two (20 %) lost follow up and one patient developed recurrence during follow up period and was started on sunitinib and patient died during follow up period because of disease. Gastrointestinal stromal tumors should be considered in the differential diagnosis of patients presenting with an abdominal/pelvic mass or pelvic pain in Gynaecologic oncology department. In such unusual circumstances the complete resection and appropriate adjuvant treatment results in complete durable remission.

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Gastrointestinal Stromal Tumors: Clinical, Radiologic, and Pathologic Features

Cited by 116 publications

References 21 publications

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

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

MDCT and clinicopathological features of small bowel gastrointestinal stromal tumours in 102 patients: a single institute experience

Gastrointestinal Stromal Tumor Mimicking as Ovarian Tumor in Gynaecologic Oncology

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