How best to manage gastrointestinal stromal tumor

Abstract

Gastrointestinal stromal tumors (GISTs) are rare but most common nonepithelial tumor of gastrointestinal tract. They are often found incidentally on computed tomography and endoscopic investigations. Increasing knowledge of the pathogenesis of GISTs and the advent of tyrosine kinase inhibitors revolutionized the management of GISTs. The newer advanced endoscopic techniques have challenged the conventional surgery although the true efficacy and safety of endoscopic approach is not clear at this time. This review article focuses on pathogenesis, diagnosis and management of GISTs.

What’s the Mass? The Gist of Point-of-care Ultrasound in Gastrointestinal Stromal Tumors

“…These two cases illustrate the usefulness of point-of-care ultrasonography in evaluating patients with vague abdominal complaints or a clinically palpable mass in the acute setting. Although endoscopic ultrasonography has been described as a valuable tool that allows diagnosis and localization of GISTs and their characterization such as extra-mural involvement,with the possibility of performing real-time needle biopsy for confirmation, 8 , 9 such modality is often not readily available in the ED.…”

Management of hemorrhage in gastrointestinal stromal tumors: a review

“…The colon, rectum, appendix (5%), and esophagus (2%–3%) are relatively rare sites. 1 , 2 They may even occur outside the digestive tract, including in the greater omentum, mesentery, and retroperitoneal sites. 3 The size of most stromal tumors is about 5 cm at diagnosis.…”

“… 53 , 54 For stomach tumors with a diameter <5 cm, laparoscopic wedge resection is recommended. 2 Endoscopic retrieval bag is used to collect and remove the specimen, and forceps are contraindicated because of the risk of tumor rupture.…”

Clinicopathological and Prognostic Significance of Expression of B-Cell-Specific Moloney Murine Leukemia Virus Insertion Site 1 (BMI-1) Gene and Protein in Gastrointestinal Stromal Tumors

“…Gastrointestinal stromal tumor (GIST) is considered the most common mesenchymal tumor of the digestive tract [ 1 ]. GISTs are common in men and women around the world including Europe and the United States, and GISTs have a high incidence of 10 to 20 per million [ 2 ]. GIST patient symptoms include abdominal pain, gastrointestinal bleeding or palpable mass, and other symptoms [ 3 ].…”

“…GISTs are thought to originate from interstitial cells of Cajal (ICC), which are distributed around the myenteric plexus and muscularis propria, and which serve as not only coordinators of gut motility, but also as electrical pacemakers modulating the GI tract motility [ 6 ]. The independent risk factors for GISTs have been reported to include mitotic index, tumor size, site of primary tumor, and tumor rupture; at present, surgical resection is a popular treatment for primary and localized GISTs, with a goal to completely remove the tumor while avoiding tumor rupture and injury to the pseudo capsule [ 2 ]. Some previous studies have provided evidence that there is a significant association between relative B-cell-specific Moloney murine leukemia virus integration site 1 (BMI-1) levels and a variety of cancers such as gastric cancer and colon cancer [ 7 , 8 ].…”