A gist of gastrointestinal stromal tumors: A review

Abstract

enchymal tumors. Both traditional and minimally invasive surgery are used to remove these tumors with minimal morbidity and excellent perioperative outcomes. The revolutionary use of specific, molecularlytargeted therapies, such as imatinib mesylate, reduces the frequency of disease recurrence when used as an adjuvant following complete resection. Neoadjuvant treatment with these agents appears to stabilize disease in the majority of patients and may reduce the extent of surgical resection required for subsequent complete tumor removal. The important interplay between the molecular genetics of GIST and responses to targeted therapeutics serves as a model for the study of targeted therapies in other solid tumors. This review summarizes our current knowledge and recent advances regarding the histogenesis, pathology, molecular biology, the basis for the novel targeted cancer therapy and current evidence based management of these unique tumors. AbstractGastrointestinal stromal tumors (GISTs)

Rapidly progressive dyspnea in gastrointestinal stromal tumor (GIST) with imatinib cardiac toxicity

“…Only 1% of cases suffered arrhythmias, congestive heart failure, or acute coronary syndrome. However, as noted, 8.2% of imatinib-treated GIST patients may experience edema and effusions [1]. …”

“…Congestive heart failure symptoms are seen in about 8.2% of the patients treated with imatinib for GISTs. However, few patients exhibit objective left ventricular dysfunction by echocardiography [1]. …”

Laparoscopy-assisted resection of CD117 and CD34 negative gastrointestinal tumor of stomach following tyrosine kinase inhibitor therapy

“…2 c-kit, a transmembrane tyrosine kinase receptor for steel factor/stem cell factor, which is responsible for proliferation and decreased apotosis, is mutated in most GISTs (85-95%). 2,3 Mutations are most common in exons 11 (70%), 9 (30%), 13 (10%), and 17 (<1%). Gastric GISTs have most commonly exon 11 mutation -either in-frame codon deletion or missense point mutation.…”

“…5-15% of GISTs do not have either of the above two mutations and are labeled as wild GISTs. [1][2][3] They are known to be less responsive or unresponsive to Imatinib therapy.…”

“…CT is also used to assess response to TKI therapy, by Choi criteria, where decrease in tumor size by 10% and tumor density by 15% denote response. 3 Positron-emission tomogram coupled with CT (PET CT) is sensitive in detection of metastasis and in objective assessment of tumor response to TKI therapy by fall in Standard Uptake Value (SUV) value by 15-25% after 1 cycle. 3 Imaging forms sufficient basis to proceed with surgery.…”