Gastrointestinal Stromal Tumors: A Clinicopathologic and Risk Stratification Study of 255 Cases from Pakistan and Review of Literature

Abstract

Purpose: To describe the clinicopathological features of gastrointestinal stromal tumors (GIST) diagnosed in our section and to perform risk stratification of our cases by assigning them to specific risk categories and groups for disease progression based on proposals by Fletcher et al and Miettinen and Lasota. Materials and Results: We retrieved 255 cases of GIST diagnosed between 2003 and 2014. Over 59% were male. The age range was 16 to 83 years with a mean of 51 years. Over 70% occurred between 40 and 70 years of age. Average diameter of tumors was 10 cms. The stomach was the most common site accounting for about 40%. EGISTs constituted about 16%. On histologic examination, spindle cell morphology was seen in almost of 85% cases. CD117 was the most useful immunohistochemical antibody, positive in 98%. Risk stratification was possible for 220 cases. Based on Fletcher's consensus proposal, 62.3 gastric, 81.8% duodenal, 68% small intestinal, 72% colorectal and 89% EGISTs were assigned to the high risk category; while based on Miettinen and Lasota's algorithm, about 48% gastric, 100% duodenal, 76% small intestinal, 100% colorectal and 100% EGISTs in our study were associated with high risk for disease progression, tumor metastasis and tumor related death. Follow up was available in 95 patients; 26 were dead and 69 alive at follow up. Most of the patients who died had high risk disease and on average death occurred just a few months to a maximum of one to two years after initial surgical resection. Conclusions: Epidemiological and morphologic findings in our study were similar to international published data. The majority of cases in our study belonged to the high risk category.

Gastrointestinal stromal tumor: clinicopathological characteristics and pathologic prognostic analysis

“…This observation was in agreement with that of Ahmed et al [9], Klieser et al [10], Lopes et al [11] Alqusous et al [12], Vij et al [13], Yacob et al [14], Din et al [16], Li et al [17], Cao et al [18], Sui et al [19], Tazawa et al [20], Kang et al [21], and Kkrishnappa et al [22]. These are in contrast with the two studies of Antonescu et al [7] and Bhalgami et al [15] which found slightly more in the small intestine than stomach.…”

“…GIST is most occurring in old age group. In our study, the mean age of the patients was 61.18 ± 14.13 years which was supported by the observations of Antonescu et al [7], Alqusous et al [12], Din et al [16], and Kkrishnappa et al [22]. The minimum age was 15 years which is similar to the study of Antonescu et al (12 years old).…”

“…Males (50%) were found equally with females (50%) as in the studies of Lopes et al [11]. On the contrary, most of the other studies showed males were slightly affected than females including Antonescu et al [7], Alqusous et al [12], Din et al [16], and Tazawa et al [20]. However, two other series had reported a higher incidence in females compared to males [Eckhard Klieser et al [10] and Yu Na Kang et al [21]].…”

“…One of the studies conducted in Pakistan, Din et al [16], one from China, Sun et al [19], and one from Korea, Kang et al [21], also found that majority were spindle type (84.7%, 83%, 88.2%), followed by epithelioid cell type (12.5%, 10%, 9.3%), and the minority were mixed spindled-epithelioid cell type (2.7%, 8%, 2.5%). However, the study of Klieser et al [10] in Europe found that the majority were spindle type (61.2%), while the epithelioid cell type (19.4%) was equally found with the mixed spindled-epithelioid cell type (19.4%).…”

Untitled

“…Gastrointestinal stromal tumors (GISTs) are the most common primary mesenchymal tumors of the gastrointestinal tract with varying malignancy potential 1) . To evaluate their biological behavior is significant for the decision making before the surgery 2) .…”