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Zhang H, Huang Z, Zhong Y, Su S. Clinical efficacy analysis of endoscopic band electrocision ligation surgical method in the treatment of small submucosal tumors of the gastric fundus. MINIM INVASIV THER 2024:1-9. [PMID: 39392255 DOI: 10.1080/13645706.2024.2413113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 09/22/2024] [Indexed: 10/12/2024]
Abstract
BACKGROUND The aim of this study was to compare and analyze the clinical effects of endoscopic submucosal dissection (ESD) and endoscopic band electrocision ligation (EEL) in the removal of gastric submucosal tumors (SMTs). METHOD We analyzed the clinical data of 130 patients with gastrointestinal SMTs (diameter ≤10 mm) who underwent endoscopic resection, including 62 cases in the EEL group and 68 in the ESD group, and compared indicators such as surgical time, intraoperative and postoperative complications, postoperative hospital stay, and surgical cost, between the EEL and ESD group. RESULTS EEL surgery time (8.9 ± 1.1 min) was significantly shorter than the ESD group (62.3 ± 2.8 min) (p < .05), EEL surgery cost (5126.8 ± 26.5 yuan) was significantly lower than the ESD group (15721.3 ± 39.6 yuan) (p < .05), and intraoperative blood loss was also markedly lower in the EEL group (5.6 ± 1.7 ml) compared to the ESD group (42.3 ± 3.5 ml) (p < .05). There was no statistically significant difference in postoperative hospitalization time or postoperative complication incidence between the two groups (p > .05). CONCLUSIONS In treating gastric muscular, mucosal, or submucosal tumors with a diameter of less than 10 mm, the EEL surgical method was superior to the ESD surgical method in terms of surgical time, intraoperative blood loss, and cost. There was no difference in hospital stay and postoperative complication rate between the two methods, which was worthy of clinical application.
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Affiliation(s)
- Hui Zhang
- Department of Gastroenterology, The Affiliated Hexian Memorial Hospital of Southern Medical University, Guangzhou, China
| | - Zhisheng Huang
- Department of Gastroenterology, The Affiliated Hexian Memorial Hospital of Southern Medical University, Guangzhou, China
| | - Yingyun Zhong
- Department of Gastroenterology, The Affiliated Hexian Memorial Hospital of Southern Medical University, Guangzhou, China
| | - Shuguang Su
- Department of Pathology, The Affiliated Hexian Memorial Hospital of Southern Medical University, Guangzhou, China
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KANTARCIOĞLU COŞKUN S. Clinicopathological features of Gastrointestinal Stromal Tumors and review of the literature. KONURALP TIP DERGISI 2022. [DOI: 10.18521/ktd.1094503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objective: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasias of the gastrointestinal system (GIS). The malignancy potential of GISTs may vary ranging from indolent tumors to progressive malignant tumors. This study aims to define clinicopathological and immunohistochemical features of GISTs diagnosed in our institute with a review of the literature.
Method: A total of 28 GIST cases were included in the study. The Hematoxylin&Eosin stained slides of surgical resection materials and cell blocks and immunohistochemistry performed slides were reviewed by a pathologist. The immunohistochemical expression with CD117, DOG-1, CD34, SMA, and S100 was scored between 0 and 3 points according to staining intensity. Descriptive statistics were used in the study. The demographic data, prognostic histopathological, and immunohistochemical findings are evaluated with the literature indications.
Result: Eleven of the cases were male and seventeen were female. The age range was 18-88. The most common site of GISTs was the stomach, followed by the small intestine, colorectal region, and, esophagus. Twenty of the tumors were resected surgically, four were endoscopic biopsy material and four were fine-needle aspiration biopsies. The tumor size in measurable materials ranged from 0,2 to 22 cm. The mitotic count in 50 HPF ranges from 0 to 10. Seven of the GISTs were high grade and the remaining 21 were low grade. The majority of the cases were composed of spindle cells, 3 were epithelioid and 3 were the mixed type with spindle and epitheloid cells.
Conclusion: A variety of criteria has been proposed to estimate the malignancy potential of GISTs and predict prognosis but definite prognostic criteria remain uncertain. Further studies with larger series of GISTs consisting of different types of biopsy materials may help define criteria to predict prognosis precisely.
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Osman A, Oze M, Afify SM, Hassan G, EL-Ghlban S, Nawara HM, Fu X, Zahra MH, Seno A, Winer I, Salomon DS, Seno M. Tumor-associated macrophages derived from cancer stem cells. Acta Histochem 2020; 122:151628. [PMID: 32992123 DOI: 10.1016/j.acthis.2020.151628] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 09/11/2020] [Accepted: 09/14/2020] [Indexed: 01/03/2023]
Abstract
Macrophages are the most abundant immune cells in the microenvironment of solid tumors. The present study displayed histological and immunohistochemical analyses of a malignant tumor model developed from cancer stem cells (CSCs) converted from human induced pluripotent stem cells (hiPSCs) in a cancer microenvironment prepared from the conditioned medium (CM) of a pancreatic cancer cell line. We focused on the localization and the origin of tumor-associated macrophages (TAMs), To the best of our knowledge this may be the first study to suggest the potential differentiation of CSCs to TAMs. hiPSCs were converted into CSCs in the presence of CM from PK8 cells. CSCs were then transplanted in vivo and formed primary tumors. Primary cultures for these tumors were serially transplanted again to obtain secondary tumors. Secondary tumors exhibited histopathological features of malignancy. Cells derived from tumors maintained the expression of endogenous stemness markers and pancreatic CSCs markers. Simultaneously, high immunoreactivity to anti-mouse CD68, anti-human CD68, CD206 and CD11b antibodies were detected revealing that the tumor tissue derived from CSCs was enriched for macrophages which can originate from both human and mouse cells. The model of CSCs highlighted the possibility of CSCs to differentiate into TAMs.
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Yi M, Xia L, Zhou Y, Wu X, Zhuang W, Chen Y, Zhao R, Wan Q, Du L, Zhou Y. Prognostic value of tumor necrosis in gastrointestinal stromal tumor: A meta-analysis. Medicine (Baltimore) 2019; 98:e15338. [PMID: 31027106 PMCID: PMC6831433 DOI: 10.1097/md.0000000000015338] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND AIMS There is currently no consensus regarding the influence of tumor necrosis on the prognosis of gastrointestinal stromal tumors (GISTs). Therefore, we conducted a meta-analysis to determine the prognostic role of tumor necrosis in patients with GIST. METHODS PubMed, Embase, and Web of Science electronic databases were searched from their inception to March 2018. Studies reporting data on the relationship between tumor necrosis and GIST prognosis were eligible. The measure of the effect of interest was the odds ratios (ORs) with 95% confidence intervals (CIs). This study has been registered in the Prospero (number CRD42018096036). RESULTS In total, 18 studies including 2320 patients were identified. The total odds of tumor necrosis were associated with a poor GIST prognosis (OR = 5.54, 95% CI = 4.39-6.99). Subgroup analysis of different observed outcomes indicated that tumor necrosis was associated with a decreased disease-free survival (OR = 7.08, 95% CI = 4.78-10.49), recurrence-free survival (OR = 3.96, 95% CI = 2.48-6.32), and overall survival (OR = 4.29, 95% CI = 2.02-9.13). In addition, any tumor site, tumor size, follow-up time, ethnicity, different outcomes of GIST, and different degrees of positive staining of immunohistochemical markers subgroups showed a significantly increased risk of a poor prognosis. CONCLUSIONS Tumor necrosis may likely predict a poorer prognosis for GIST. However, further well-designed prospective studies with large sample size are required in the future.
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Affiliation(s)
| | - Lin Xia
- Department of Gastrointestinal Surgery
| | - Yan Zhou
- Department of Pathology, West China Hospital, Sichuan University
| | | | | | - Yi Chen
- Department of Gastrointestinal Surgery
| | - Rui Zhao
- Department of Gastrointestinal Surgery
| | | | - Liang Du
- Chinese Evidence-based Medicine/Cochrane Center, Chengdu, China
| | - Yong Zhou
- Department of Gastrointestinal Surgery
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Chen T, Xu L, Ye L, Qiu H, Hu Y, Liu H, Zhou Z, Li G, Yu J. A new nomogram for recurrence-free survival prediction of gastrointestinal stromal tumors: Comparison with current risk classification methods. Eur J Surg Oncol 2018; 45:1109-1114. [PMID: 30594406 DOI: 10.1016/j.ejso.2018.12.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 12/08/2018] [Accepted: 12/19/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND This study aimed to build a new risk stratification nomogram for gastrointestinal stromal tumors (GISTs) focused on a popular factor Ki-67 to enable individualized and precise predictions of the most suitable candidates for imatinib therapy. METHODS We retrospectively collected clinicopathologic data of the patients diagnosed with GISTs from January 1998 to December 2015 at Southern Medical University Nanfang Hospital as the experiment group. And patients with GISTs at the Sun Yat-sen University Cancer Center from January 2007 to December 2012 were included as the validation group. The nomogram was built using Kaplan-Meier method and the Cox proportional hazards regression model. The receiver operating characteristic (ROC) curves were established to compare the discriminative ability of the new nomogram with other risk stratification systems, including the modified National Institute of Health (modified NIH) criteria, Armed Forces Institute of Pathology (AFIP) criteria, Memorial Sloan Kettering Cancer Center (MSKCC) prognostic nomogram, and contour maps. RESULTS In univariate analysis, the tumor size, site, mitotic count, tumor rupture and Ki-67 labeling index were significant factors (all P < 0.05) and included in the Cox model to build our nomogram. According to the ROC curve, our new nomogram showed the largest AUC value (0.778) compared with that of the other classification methods (contour maps, AUC = 0.743; AFIP, AUC = 0.719; MSKCC, AUC = 0.712; and modified NIH, AUC = 0.719). CONCLUSION Our new nomogram exhibits an excellent performance and might become a potential risk stratification to support therapeutic decision-making for GISTs.
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Affiliation(s)
- Tao Chen
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangdong Provincial Engineering Technology Research Center of Minimally Invasive Surgery, Guangzhou, 510515, Guangdong Province, China.
| | - Lili Xu
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangdong Provincial Engineering Technology Research Center of Minimally Invasive Surgery, Guangzhou, 510515, Guangdong Province, China
| | - Liangying Ye
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangdong Provincial Engineering Technology Research Center of Minimally Invasive Surgery, Guangzhou, 510515, Guangdong Province, China
| | - Haibo Qiu
- Department of Gastric Surgery, Sun Yat-sen University Cancer Center, Sun Yat-sen University, Guangzhou, 510060, Guangdong Province, China
| | - Yanfeng Hu
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangdong Provincial Engineering Technology Research Center of Minimally Invasive Surgery, Guangzhou, 510515, Guangdong Province, China
| | - Hao Liu
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangdong Provincial Engineering Technology Research Center of Minimally Invasive Surgery, Guangzhou, 510515, Guangdong Province, China
| | - Zhiwei Zhou
- Department of Gastric Surgery, Sun Yat-sen University Cancer Center, Sun Yat-sen University, Guangzhou, 510060, Guangdong Province, China
| | - Guoxin Li
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangdong Provincial Engineering Technology Research Center of Minimally Invasive Surgery, Guangzhou, 510515, Guangdong Province, China
| | - Jiang Yu
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangdong Provincial Engineering Technology Research Center of Minimally Invasive Surgery, Guangzhou, 510515, Guangdong Province, China.
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Immunohistochemical evaluation of proliferative activity (Ki-67 index) in different histological types of cutaneous basal cell carcinoma. Biologia (Bratisl) 2012. [DOI: 10.2478/s11756-012-0035-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Liang YM, Li XH, Li WM, Lu YY. Prognostic significance of PTEN, Ki-67 and CD44s expression patterns in gastrointestinal stromal tumors. World J Gastroenterol 2012; 18:1664-71. [PMID: 22529697 PMCID: PMC3325534 DOI: 10.3748/wjg.v18.i14.1664] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 01/16/2012] [Accepted: 02/08/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To develop a prognostic approach for gastrointestinal stromal tumors (GISTs) using a cluster of indicators and follow-up information.
METHODS: One hundred and four GISTs that had not been subjected to targeted therapies were collected and classified by NIH risk assessment and anatomic location. By immunohistochemistry, the expressions of PTEN, Ki-67, CD44s matrix metalloproteinase (MMP)-9 and TIMP-1 were detected on tissue microarray. Univariate and multimarker survival analyses were performed and then a COX hazard proportion model was constructed to evaluate a cluster of predictors of GIST.
RESULTS: Our data showed small intestinal GIST are more aggressive than gastric GIST. The NIH risk assessment correlated with disease-free survival for either gastric GIST or small intestinal GIST. Immunohistochemical analysis revealed that Ki-67 labeling indexes (LIs) < 5% predicted higher disease-specific survival (DSS) in gastric and small intestinal GIST. CD44s positivity and PTEN LIs ≥ 50% correlated with higher DSS in gastric GIST. MMP-9 and TIMP-1 had no correlation with survival. Multimarker analysis revealed that the expression pattern of PTEN LIs ≥ 50% combined with Ki-67 LIs < 5% and CD44s positivity reliably predicted favorable outcomes for gastric GIST (P = 0.009), as did the combination of PTEN LIs ≥ 50% and Ki-67 LIs < 5% for small intestinal GIST (P = 0.011). Authors also found that high NIH risk grade was correlated with DSS in patients with gastric GIST and disease-free survival in patients with small intestinal GIST.
CONCLUSION: PTEN LIs ≥ 50%, Ki-67 LIs < 5% and CD44s positivity provides an accurate, favorable prognosis for gastric GIST. PTEN LIs ≥ 50% and Ki-67 LIs < 5% does the same for small intestinal GIST. Ki-67 LIs enhances the NIH assessment.
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Aberrations of chromosome 13q in gastrointestinal stromal tumors: analysis of 91 cases by fluorescence in situ hybridization (FISH). ACTA ACUST UNITED AC 2009; 18:72-80. [PMID: 19430298 DOI: 10.1097/pdm.0b013e318181fa1f] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The clinical behavior of gastrointestinal stromal tumors (GISTs) ranges from benign to malignant. Recent studies suggest that loss of 13q could be correlated with GIST progression. Our objectives were: (1) to detect chromosome 13q aberrations and determine the corresponding gene status in GISTs; and (2) to assess potential roles of 13q aberrations in GIST by correlating various 13q aberrations with various histologic parameters and disease-free survival in a group of GIST patients. Ninety-one cases of primary GISTs in Chinese patients were studied by dual color fluorescence in situ hybridization (FISH), through use of a panel of bacterial artificial chromosome clones RP11-685I15, RP11-352N7, and RP11-505F3 covering the Rb, RFP2, KCNRG, and KLF5 genes, respectively. Loss of RP11-685I15 was detected in 17/91 (18.7%) cases, loss of RP11-352N7 in 11/91 (12.1%) cases, and loss of RP11-505F3 in 5/91 (5.5%) cases. Chromosome 13 polysomy was observed in 22/91 (24.2%) cases. The frequency of RP11-685I15 deletion was positively correlated with tumor risk (P=0.0460). The frequency of RP11-352N7 deletion, RP11-505F3 deletion, and chromosome 13 polysomy tended to be higher in the high-risk GISTs. Shorter disease-free survival was significantly associated with RP11-352N7 deletion (P=0.0361) and high-risk grade (P=0.0003). Chromosome 13 instability of GISTs may play a role in tumor progression. Loss of 13q, especially loss of Rb, RFP2, KCNRG, and KLF5 genes are frequent events in high-risk GISTs. Loss of 13q may be associated with tumor progression.
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Seya T, Tanaka N, Yokoi K, Shinji S, Oaki Y, Tajiri T. Life-threatening bleeding from gastrointestinal stromal tumor of the stomach. J NIPPON MED SCH 2009; 75:306-11. [PMID: 19023173 DOI: 10.1272/jnms.75.306] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Here, we report on two patients with hemorrhagic shock due to hematemesis from a gastrointestinal stromal tumor (GIST) of the stomach. Patient 1 was a 64-year-old woman who was admitted to our hospital because of syncope due to hemorrhagic shock resulting from massive hematemesis. Emergent upper gastrointestinal (GI) endoscopy revealed a 5-cm-diameter submucosal tumor on the lesser curvature of the lower gastric body. In addition to the central ulceration of the tumor, a Dieulafoy-like lesion was present. Neither lesions showed active bleeding at the time of observation. Because the patient collapsed twice with fluminant hematemesis after admission, she underwent distal gastrectomy with Billroth-I reconstruction. Histological examination revealed a gastric GIST with no nodal metastasis and the mitotic count was less than 5 per 50 HPFs. Dilated vessels were prominent in the peritumoral submucosa, and a thrombus was seen in these vessels, which seemed to be a bleeding point. The patient had an uneventful postoperative course and has been alive without recurrence for 5 and a half years. Patient 2 was a 60-year-old man who presented with syncope due to hemorrhagic shock resulting from massive hematemesis. Because the source of the bleeding was not elucidated with an initial upper GI endoscopy, he was treated for a gastric ulcer. One week after admission, he suffered from hemorrhagic shock again, and a submucosal tumor 6 cm in size was revealed on the greater curvature of the upper stomach with upper GI endoscopy. The patient subsequently underwent wedge resection of the tumor. Histopathological findings were consistent with a GIST and the mitotic count was less than 5 per 50 high-power fields. The tumor showed no necrosis or intratumoral hemorrhage. A peritumoral submucosal artery, which was responsible for the massive hematemesis, was located at some distance away from the central ulceration. Postoperative recovery was without complications. After 4 years, the patient remains healthy and disease-free. Although hematemesis associated with gastric GIST has been said to originated from the central ulceration of the GIST, life-threatening, massive hematemesis is rare. The exact bleeding points of the gastric GISTs in these cases were submucosal vessels adjacent to the GIST, not the central ulceration. There have been no reports of peritumoral, submucosal vessels causing massive hematemesis from gastric GISTs. Because the origins and manner of bleeding varies in gastric GISTs, we must decide the methods of hemostasis immediately including the tumor excision.
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Affiliation(s)
- Tomoko Seya
- Surgery for Organ Function and Biological Regulation, Graduate School of Medicine, Nippon Medical School, Bunkyo-ku, Tokyo, Japan.
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El Demellawy D, Shokry P, Ing A, Khalifa M. Polypoid gastrointestinal stromal tumor of small bowel metastasizing to mesenteric lymph nodes: a case report. Pathol Res Pract 2007; 204:197-201. [PMID: 18096326 DOI: 10.1016/j.prp.2007.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2007] [Revised: 10/17/2007] [Accepted: 10/22/2007] [Indexed: 02/06/2023]
Abstract
Gastrointestinal stromal tumor (GIST) is the commonest gastrointestinal mesenchymal tumor, which rarely metastasizes to lymph nodes. Therefore, unlike cases of adenocarcinoma, lymphadenectomy is seldom warranted. We describe an unusual case of a polypoid GIST of the small bowel which metastasized to the regional mesenteric lymph nodes at the time of primary surgery. The patient was a 79-year-old female who presented with partial bowel obstruction and anemia. The presented case has three unusual features, as the tumor was grossly pedunculated, microscopically pleomorphic, and featured mesenteric lymph node metastasis at the time of diagnosis.
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Affiliation(s)
- Dina El Demellawy
- Department of Pathology, Sunnybrook Health Sciences Center, University of Toronto, 2075 Bayview Avenue, Room E 416, Toronto, ON, Canada M4N 3M5
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An enhanced risk-group stratification system for more practical prognostication of clinically malignant gastrointestinal stromal tumors. Int J Clin Oncol 2007; 12:369-74. [PMID: 17929119 DOI: 10.1007/s10147-007-0705-7] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2006] [Accepted: 07/07/2007] [Indexed: 02/07/2023]
Abstract
BACKGROUND Recent breakthroughs regarding the oncogenesis of gastrointestinal stromal tumors (GISTs) have led to the wider use of imatinib mesylate in the treatment of advanced GISTs. However, the role of imatinib in an adjuvant setting has yet to be established, mainly owing to the lack of an accurate system to prognosticate recurrences and/or metastases. The aims of this study were to identify factors prognostic for an unfavorable postoperative outcome, and to enhance the current NIH-consensus risk-group stratification system (Fletcher's system). METHODS A retrospective review was conducted in 303 consecutive patients who had undergone surgical resection of primary GISTs during the study period (1987-2003). In addition to Fletcher's system, which is based on morphologic variables (tumor size and mitotic count), with four risk groups: very low risk, low risk, intermediate risk, and high risk, the predictive potential of any major preoperative, intraoperative, or postoperative clinical factor was statistically evaluated. RESULTS In addition to tumor size and mitosis, four operative variables were found to affect disease-free survival: peritoneal dissemination, metastasis, invasion, and tumor rupture. Patients presenting with at least one of these "clinically malignant factors" had an unfavorable outcome (i.e., they were potential candidates for adjuvant therapy). We therefore modified Fletcher's system by adding a new patient group, termed the "clinically malignant group," (patients having at least one of the "clinically malignant factors"). With this modification, the outcomes of patients in the "new" very-low-risk and low-risk groups remained favorable, but the outcomes of patients in the "clinically malignant group" and the "new" high-risk group bceame unfavorable. CONCLUSION This modified Fletcher's system, enhanced by the addition of "clinically malignant factors," can distinguish patients with a possible unfavorable outcome from those who require no therapy other than surgery. Patients in the "clinically malignant group" could be potential candidates for adjuvant therapy using imatinib.
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Abstract
This review is part two of three, which will present an update on the classification of gastrointestinal submucosal tumors. Part one treats of the diagnosis and part three of the therapeutic methods regarding gastrointestinal submucosal tumors. In the past there has been some confusion as to the classification of gastrointestinal submucosal tumors. Changes in classifications have emerged due to recent advances in mainly immunohistochemistry and electron microscopy. The aim of this paper is to update the reader on the current classification. Literature searches were performed to find information related to classification of gastrointestinal submucosal tumors. Based on these searches the twelve most frequent submucosal tumor types were chosen for description of their classification. The factors that indicate whether tumors are benign or malignant are mainly size and number of mitotic counts. Gastrointestinal stromal tumors are defined mainly by their CD117 positivity. In the future, there should be no more confusion between gastrointestinal stromal tumors and other types of submucosal tumors.
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Affiliation(s)
- Laura-Graves Ponsaing
- Department of Surgical Gastroenterology K, Bispebjerg University Hospital of Copenhagen, Bispebjerg Bakke 23, 2400 NV Copenhagen, Denmark.
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Abstract
This review is part three of three and will present an update on the therapeutic options and procedures concerning gastrointestinal (GI) submucosal tumors (SMTs). The aim of this paper is to investigate the treatments of GI SMTs and to present a case of a gastrointestinal stromal tumor (GIST). Literature searches were performed to find information on therapy for GI SMTs. Based on these searches, the optimal therapeutic procedures could be outlined. The choice of treatment of localized tumors is endoscopic resection if possible or, alternatively, laparoscopic resection or surgical resection by an open procedure. However, benign SMTs should only be excised if symptoms are present, and GISTs should be treated with particular precautions. Irresectable or recurrent GISTs may be successfully treated with the tyrosine kinase inhibitor, imatinib.
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Affiliation(s)
- Laura-Graves Ponsaing
- Department of Surgical Gastroenterology K, Bispebjerg University Hospital of Copenhagen, Bispebjerg Bakke 23, 2400 NV Copenhagen, Denmark.
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Ponsaing LG, Kiss K, Loft A, Jensen LI, Hansen MB. Diagnostic procedures for submucosal tumors in the gastrointestinal tract. World J Gastroenterol 2007; 13:3301-10. [PMID: 17659668 PMCID: PMC4172709 DOI: 10.3748/wjg.v13.i24.3301] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
This review is part one of three, which will present an update on diagnostic procedures for gastrointestinal (GI) submucosal tumors (SMTs). Part two identifies the classification and part three the therapeutic methods regarding GI SMTs. Submucosal tumors are typically asymptomatic and therefore encountered incidentally. Advances in diagnostic tools for gastrointestinal submucosal tumors have emerged over the past decade. The aim of this paper is to provide the readers with guidelines for the use of diagnostic procedures, when a submucosal tumor is suspected. Literature searches were performed to find information on diagnostics for gastrointestinal submucosal tumors. Based on the searches, the optimal diagnostic procedures and specific features of the submucosal tumors could be outlined. Standard endoscppy, capsule endoscopy and push-and-pull enteroscopy (PPE) together with barium contrast X-ray do not alone provide sufficient information, when examining submucosal tumors. Endoscopic ultrasound (EUS), computed tomography (CT), magnetic resonance imaging (MRI) and fluorodeoxyglucose-labeled positron emission tomography (FDG-PET) are recommended as supplementary tools.
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Affiliation(s)
- Laura-Graves Ponsaing
- Department of Surgical Gastroenterology K, Bispebjerg University Hospital of Copenhagen, Bispebjerg Bakke 23, 2400 NV Copenhagen, Denmark.
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Zhu X, Zhang XQ, Li BM, Xu P, Zhang KH, Chen J. Esophageal mesenchymal tumors: Endoscopy, pathology and immunohistochemistry. World J Gastroenterol 2007; 13:768-73. [PMID: 17278201 PMCID: PMC4066011 DOI: 10.3748/wjg.v13.i5.768] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To study the endoscopic, pathological and immuno-histochemical features of esophageal mesenchymal tumors.
METHODS: Twenty-nine patients diagnosed as esophageal mysenchymal tumors by electronic endoscopy and endoscopic ultrasound (EUS) were observed under light microscopes, and all tissues were stained by the immunohistochemical method. The expression of CD117, CD34, SMA and desmin were measured by staining intensity of cells and positive cell ratios.
RESULTS: Endoscopically, esophageal gastrointestinal stromal tumors (GISTs) and leiomyomas (LMs) had similar appearances, showing submucosal protuberant lesions. They all showed low echo images originated from the muscularis propria or muscularis mucosa on EUS. Endoscopy and EUS could not exactly differentiate esophageal GISTs from LMs. Microscopically, there were two kinds of cells: spindle cell type and epitheloid cell type in esophageal GISTs. Leiomyomas and leiomyosarcomas were only of spindle cell type. One malignancy was found in five cases of esophageal GISTs, and one malignancy in 24 cases of leiomyomas and leiomyosarcomas. Using Fisher’s exact method, the differences of malignant lesion proportion were not significant between esophageal LMs and GISTs, 1/5 vs 1/24 (P > 0.05). All cases of esophageal GISTs were positive for CD117, and 3 cases were also positive for CD34. The 24 cases of leiomyomas and leiomyosarcomas were all negative for CD117 and CD34. The differences of positive rates of CD117 and CD34 were significant between esophageal GISTs and LMs, 5/5 vs 0/24, 3/5 vs 0/24 (P < 0.005). All leiomyomas and leiomyosarcomas were positive for SMA, and desmin. Among 5 cases of esophageal GISTs, 2 cases were SMA positive, and 1 case was desmin positive. The differences in positive rates and expression intensity of SMA and desmin were significant between esophageal LMs and GISTs, 24/24 vs 2/5, 24/24 vs 1/5 (P < 0.005).
CONCLUSION: The most common esophageal mesenchymal tumors are leiomyomas, and esophageal GISTs are less common. Most of esophageal LMs and GISTs are benign. Endoscopy and EUS are the effective methods to diagnose esophageal mesenchymal tumors and they can provide useful information for the treatment of these tumors. However, they cannot exactly differentiate esophageal GISTs from LMs. Pathological, especially immunohistochemical features are useful to differentiate GISTs from leiomyomas.
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Affiliation(s)
- Xuan Zhu
- Department of Gastroenterology, First Affiliated Hospital, Nanchang University, Nanchang 330006, Jiangxi Province, China.
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Derici H, Nazli O, Tansug T, Bozdag AD, Ekinci N. Synchronous Primary Gastric Adenocarcinoma and Gastrointestinal Stromal Tumor. Visc Med 2007. [DOI: 10.1159/000099610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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