Association of endoscopic ultrasonographic parameters and gastrointestinal stromal tumors (GISTs): can endoscopic ultrasonography be used to screen gastric GISTs for potential malignancy?

Chen, Tsung‐Hsing; Hsu, Cheng–Lung; Chu, Yin-Yi; Wu, Chi-Huan; Chen, Tse–Ching; Hsu, Jun‐Te; Yeh, Ta‐Sen; Lin, Chan‐Yu; Chiu, Cheng-Tang

doi:10.3109/00365521.2015.1095350

Cited by 36 publications

(22 citation statements)

References 7 publications

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“…However, a study by Kim et al[33] found no CT features, other than size, to be correlated with biological behavior and prognosis of GIST. This finding was confirmed very recently by Chen et al[34]; specifically, that retrospective analysis of 110 patients who underwent endoscopic ultrasonography identified tumor size as an independent risk factor for malignancy ( P ≤ 0.0001) but not for calcification ( P = 0.667).…”

Section: Discussionsupporting

confidence: 72%

Heavily calcified gastrointestinal stromal tumors: Pathophysiology and implications of a rare clinicopathologic entity

Salati¹,

Orsi²,

Bonetti³

et al. 2017

WJGO

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Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract, and are characterized by a broad spectrum of clinical, histological and molecular features at presentation. Although focal and scattered calcifications are not uncommon within the primary tumor mass, heavy calcification within a GIST is rarely described in the literature and the clinical-biological meaning of this feature remains unclear. Cases with such an atypical presentation are challenging and may be associated with diagnostic pitfalls. Herein, we report a gastric GIST with the unusual presentation of prominent calcifications that was identified incidentally on imaging during a post-trauma diagnostic work-up. The patient underwent laparoscopic surgery with a radical resection of the mass, which was subsequently characterized by histological analysis as spindle-shaped tumor cells, positive for CD117/c-KIT, CD34 and DOG1, and with calcified areas. Given the intermediate risk of recurrence, no adjuvant therapy was recommended and the patient underwent regular follow-up for 22 mo, with no evidence of relapse. Our case can be considered of interest because of the rarity of clinical presentation and the uniquely large size of the GIST at diagnosis (longest diameter exceeding 9 cm). In closing, we discuss the pathophysiology and clinical implications of calcifications in GISTs by reviewing the most up-to-date relevant literature.

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Section: Discussionsupporting

confidence: 72%

Heavily calcified gastrointestinal stromal tumors: Pathophysiology and implications of a rare clinicopathologic entity

Salati¹,

Orsi²,

Bonetti³

et al. 2017

WJGO

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show abstract

“…Endoscopic ultrasonography (EUS) is recommended to narrow the differential diagnosis of SETs as it can help ascertain key pathologic characteristics such as depth, size, and the layer of origin within the gastrointestinal wall. Tumor size, echo patterns, extraluminal margins, and cystic spaces on EUS have been suggested to aid in distinguishing between benign and malignant lesions [5,6]. However, the diagnostic efficacy of EUS is limited, as it does not provide histopathologic diagnosis.…”

mentioning

confidence: 99%

Diagnostic yield of endoscopic ultrasonography-guided single-incision needle knife biopsy for gastric subepithelial tumors: comparison with resected specimens

Kim

et al. 2016

Surg Endosc

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“…Size larger than 20 mm, presence of cystic spaces, surface ulceration, irregular borders, and echogenic foci are unique features predictive of the malignant potential of GISTs and, therefore, worse outcomes [6, 38]. Among them, tumor size is the most important factor.…”

Section: Discussionmentioning

confidence: 99%

Subepithelial rectal gastrointestinal stromal tumor – the use of endoscopic ultrasound-guided fine needle aspiration to establish a definitive cytological diagnosis: a case report

et al. 2017

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BackgroundGastrointestinal stromal tumors are the most common mesenchymal neoplasms affecting the gastrointestinal tract. The stomach is the most common location to be affected, and the rectum one of the rarest, but the whole gastrointestinal tract remains susceptible. Gastrointestinal stromal tumors account for only 0.1% of rectal tumors. Currently, endoscopic ultrasound plays an essential role in the diagnostic process of gastrointestinal stromal tumors, especially when the affected sites have a worse outcome and higher morbidity rates.Case presentationWe describe the case of a 68-year-old white Japanese man with a history of long-term mild rectal pain and tenesmus. A digital rectal examination revealed a right palpable solid mass ranging from 3 to 7 cm from his anal verge. A colonoscopy was performed and showed a 5 cm elevated lesion covered by normal mucosa, located 4 cm above the pectineal line. Endoscopic ultrasound confirmed the diagnosis of a homogeneous hypoechoic mass with areas of necrosis as a rectal subepithelial lesion originating at the fourth layer (muscularis propria). He then underwent endoscopic ultrasound-guided fine needle aspiration of the lesion, followed by cytological and immunohistochemistry evaluation. The evaluation showed spindle and epithelioid cells of variable sizes, in fascicles separated by stroma, which reacted firmly and consistently to CD117/c-kit and CD34, and negative to desmin and S-100 protein. There was weak staining for nuclear Ki-67 in the tumor cells. A diagnosis of rectal gastrointestinal stromal tumor was confirmed. After a multidisciplinary meeting, an abdominoperineal resection of his rectum was performed. The pathology of the specimen confirmed the diagnosis of rectal gastrointestinal stromal tumor. He is now asymptomatic after 3 months’ follow-up and is on adjuvant therapy with a tyrosine-kinase inhibitor.ConclusionsGastrointestinal stromal tumors are rare tumors, and among the variety of primary location sites, the rectum is one of the rarest. The localization of this type of tumor has worse outcomes and higher morbidity rates. We report this rare case to emphasize the need for precise diagnosis and the important role of endoscopic ultrasound-guided fine needle aspiration in such situations.

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Association of endoscopic ultrasonographic parameters and gastrointestinal stromal tumors (GISTs): can endoscopic ultrasonography be used to screen gastric GISTs for potential malignancy?

Abstract: The preliminary results show that large gastric GISTs with cystic change and surface ulceration may associate with a risk of malignancy, warranting more aggressive management. Nevertheless, the tumor size is more important than other factors.

Cited by 36 publications

References 7 publications

Heavily calcified gastrointestinal stromal tumors: Pathophysiology and implications of a rare clinicopathologic entity

Heavily calcified gastrointestinal stromal tumors: Pathophysiology and implications of a rare clinicopathologic entity

Diagnostic yield of endoscopic ultrasonography-guided single-incision needle knife biopsy for gastric subepithelial tumors: comparison with resected specimens

Subepithelial rectal gastrointestinal stromal tumor – the use of endoscopic ultrasound-guided fine needle aspiration to establish a definitive cytological diagnosis: a case report

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