Small gastrointestinal stromal tumours with focal areas of low attenuation on CT: pathological correlation

Kim, H.C.; Lee, J.M.; Kim, S.H.; Park, S.H.; Lee, M.; Han, Joon Koo; Choi, Byung Ihn

doi:10.1016/j.crad.2004.06.022

Cited by 23 publications

(14 citation statements)

References 14 publications

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“…CT and MR images demonstrated cystic regions in all tumors of our series, with various degrees of soft tissue elements. Conventional GISTs appear an ill-defined mass with extrinsic or extraluminal epicenter, and internal areas of hemorrhage, necrosis, and cystic change are frequent causes of density or signal changes on CT and MRI [6][7][8][9][10]. Sandrasegaran and colleagues [6] reported that central hypoattenuation due to necrosis or apoptosis was identified in 33% of conventional gastric GISTs.…”

Section: Discussionmentioning

confidence: 96%

“…The CT and MRI findings suggest that conventional GISTs are well-defined extraluminal or intramural masses, whose CT attenuation and MR signal intensity depend on tumor size. The larger tumors frequently appear heterogeneous as a result of central necrosis, cystic change, hemorrhage, and homogeneous tumors have a shorter diameter [6][7][8][9][10]. Nonspecific imaging features, however, have also been reported in various neoplasms, and one cannot rule out that a mesenchymal neoplasm other than a GIST in gastrointestinal tract constitutes a potential drawback for successful imaging of GIST [11].…”

Section: Introductionmentioning

confidence: 92%

“…Computed tomography (CT) and magnetic resonance imaging (MRI) have become a well accepted method for diagnosis and staging of GISTs [6][7][8][9][10]. The CT and MRI findings suggest that conventional GISTs are well-defined extraluminal or intramural masses, whose CT attenuation and MR signal intensity depend on tumor size.…”

Section: Introductionmentioning

confidence: 98%

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CT and MRI findings in KIT-weak or KIT-negative atypical gastrointestinal stromal tumors

et al. 2006

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The large majority of gastrointestinal stromal tumors (GIST) can be diagnosed on the basis of KIT immunoreactivity. However, some atypical tumors show weak or negative KIT expression. We studied the imaging characteristics of atypical GIST, reviewing CT and MRI findings in ten patients (eight men, two women; mean age 59 years) with atypical GIST. Radiological studies were evaluated by two radiologists by consensus and included CT and MR imaging in all patients. Pathological diagnoses were made from surgery and confirmed by the polymerase-chain reaction (PCR) to amplify both exons of the c-kit gene and PDGFRA gene. The CT and MR examinations revealed a heterogeneous mass of the stomach containing cystic regions and soft tissue elements in all cases. All lesions were extraluminal masses and had an exophytic epicenter. On T1-weighted MR images soft tissue elements of the tumors were of homogeneously low- (n=3) or iso-signal intensity (n=7) compared with the liver parenchyma. On fast spin-echo T2-weighted MR images soft tissue elements of all tumors showed cystic regions of significantly high signal intensity interspersed with septumlike structures of low signal intensity. All lesions exhibited homogeneously (n=4) or heterogeneously (n=6) mild to moderate enhancement of soft tissue elements. Despite the relatively small number of patients CT and MRI findings of atypical GIST are a submucosal mass with soft tissue elements and cystic regions.

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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 92%

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CT and MRI findings in KIT-weak or KIT-negative atypical gastrointestinal stromal tumors

et al. 2006

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“…A previous study reported heterogeneous enhancement in large GISTs on enhanced CT [7]. Focal areas of low attenuation on CT in small GISTs represent varying pathological conditions, including solid tumor, hemorrhage, hemorrhage with necrosis, cystic degeneration, fluid in ulcers, and fibrous septum [8]. Large GISTs ([6 cm) frequently show central areas of necrosis or hemorrhage, resulting in a cystic appearance [4,9].…”

Section: Discussionmentioning

confidence: 99%

Intratumoral heterogeneity of F-18 FDG uptake differentiates between gastrointestinal stromal tumors and abdominal malignant lymphomas on PET/CT

et al. 2011

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Objective Gastrointestinal stromal tumors (GISTs) and malignant lymphomas (MLs) in the abdomen are often observed as tumors of unknown origin on F-18 FDG PET/ CT. The purpose of this study was to evaluate the intratumoral metabolic heterogeneity of F-18 FDG uptake on PET to determine if it might be helpful to discriminate between these tumors. Methods The F-18 FDG PET/CT findings of 21 large abdominal tumors were retrospectively evaluated (9 GISTs and 12 MLs). Intratumoral heterogeneity was evaluated by visual scoring (visual score: 0, homogeneous; 1, slightly heterogeneous; 2, moderately heterogeneous; 3, highly heterogeneous) and by the cumulative standardized uptake value (SUV) histograms on transaxial PET images at the maximal cross-sectional tumor diameter. Percent tumor areas above a threshold from 0 to 100% of the maximum SUV were plotted and the area under curve of the cumulative SUV histograms (AUC-CSH) was used as a heterogeneity index, where lower values corresponded with increased heterogeneity. Correlation between the visual score and the AUC-CSH was investigated by the Spearman's rank test. Results GISTs exhibited heterogeneous uptake of F-18 FDG, whereas MLs showed rather homogeneous uptake on visual analysis (visual score: 2.67 ± 0.50 and 0.58 ± 0.79, respectively; p \ 0.001). The AUC-CSH was significantly lower for the GISTs than for the MLs (0.41 ± 0.14 and 0.64 ± 0.08, respectively; p \ 0.001). Significant correlations were observed between the visual score and the AUC-CSH (q = -0.866, p \ 0.001). Conclusion GISTs exhibited significantly heterogeneous intratumoral tracer uptake as compared with the MLs. Evaluation of the intratumoral heterogeneity of F-18 FDG uptake may help in the discrimination between these tumors.

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“…In cases of GIST with cystic degeneration, the larger the area of the cystic component, the lower the objectivity in determining tumor size (13). In addition, Kim et al (14) found that among cases of GIST with a diameter of <5 cm, almost half of the tumors showed internal bleeding, necrosis or cystic degeneration and the prognosis was not necessarily associated with tumor size. GIST with cystic changes may be observed in the following situations: i) primary cystic GIST, in which the main structure comprises cystic tissue with a pseudocapsule, rarely invading the surrounding organs; ii) malignant GIST with cystic degeneration, caused by rapid growth of the tumor, which due to insufficiency of the internal blood supply results in necrosis and liquefaction; iii) when the tumor metastasizes to the liver and pancreas, the metastatic lesion is always cystic in nature, often confused with liver cysts and pancreatic cysts; and iv) on treatment with imatinib, malignant GISTs show cystic degeneration (15).…”

Section: Discussionmentioning

confidence: 99%

Exophytic gastrointestinal stromal tumor with cystic changes: A case report

2014

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Gastrointestinal stromal tumor (GIST) is the most common type of mesenchymal tumor in the gastrointestinal tract. A large tumor size often means a poor prognosis. This report presents a case of a large exophytic GIST with cyst change, for which the outcome of favourable prognosis was unexpected. A 78-year-old male presented with abdominal distension and a poor appetite, and was primarily diagnosed with a pancreatic mass. Abdominal ultrasonography, computed tomography and magnetic resonance imaging revealed a tumor in the body of the pancreas, which was closely attached to the gastric wall. Surgery was performed to excise the tumor. The tumor originated from the gastric cells and was ~17×15×16 cm in size. A diagnosis of GIST was confirmed by histomorphological and immunohistochemical findings. According to the postoperative findings, the tumor was classified to be in the high-risk group, for which the suggested treatment is imatinib. However, the patient was not treated with imatinib and, three years following surgery, the patient is alive with no evidence of tumor recurrence.

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Small gastrointestinal stromal tumours with focal areas of low attenuation on CT: pathological correlation

Cited by 23 publications

References 14 publications

CT and MRI findings in KIT-weak or KIT-negative atypical gastrointestinal stromal tumors

CT and MRI findings in KIT-weak or KIT-negative atypical gastrointestinal stromal tumors

Intratumoral heterogeneity of F-18 FDG uptake differentiates between gastrointestinal stromal tumors and abdominal malignant lymphomas on PET/CT

Exophytic gastrointestinal stromal tumor with cystic changes: A case report

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