Gastrointestinal Stromal Tumors—A Mini Review

Gheorghe, Gina; Bacalbaşa, Nicolae; Ceobanu, Gabriela; Ilie, Mădălina; Enache, Valentin; Constantinescu, Gabriel; Bungău, Simona; Diaconu, Camelia Cristina

doi:10.3390/jpm11080694

Cited by 50 publications

(56 citation statements)

References 65 publications

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“…Expression of CD34 was negative in epithelioid GISTs. This data is very similar to data given by WHO in last classification of digestive system tumors [1,7,19]. The CD34 expression in spindled GISTs was seen in 68.1 % of spindled GISTs in our study that not contradicted to different scientific data where this marker expressed approximately in 70 % of GISTs [12,13].…”

Section: Discussionsupporting

confidence: 92%

“…However, at the same time, there are too less histological criteria, that allow to predict progression of GISTs. Criteria that were used in last histological classification of digestive system tumors include mitotic rate, tumor size and tumor site of location and only 1 st criterion in this list is histological [1,2,7]. The IHC marker, such as widely used in different type of malignancies for analysis of their aggressiveness can be also used in GISTs as additional markers for prognosis of tumor behavior.…”

Section: Introductionmentioning

confidence: 99%

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Immunohistochemical features of gastrointestinal stromal tumors and their role for differential diagnosis and prognosis

Miroshnichenko¹

2021

Eureka: HS

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The aim. To clarify all most important immunohistochemical features of gastrointestinal stromal tumors with different histological patterns and analyze the role of expression of Ki-67, MMP-9, VEGF and p16ink4A as a predictive markers of tumor progression. Materials and methods. The study is based on analysis of 100 primary GISTs for description of their morphological features and 36 GISTs taken from this 100 for study of prognostic markers. Results. All spindle cell GISTs have shown diffuse expression of CD117 in tumor cells. The levels of CD117 expression varied from strong expression (3+) until mild expression (1+). Strong expression were seen in 75,8 % of spindle cell GISTs. Epithelioid GISTs demonstrated heterognous moderate or mild expression of CD117. All primary epithelioid GISTs from patients that had relapse of tumor in period from 1 till 3 years demonstrated focal mild expression of CD 117 in tumor cells. Expression of DOG-1 were seen in all 100 cases of GISTs, that were included in our study. The strong expression of DOG-1 (3+) were seen in all 45 GISTs that had low mitotic rate (≤5 mitoses per 50HPF) and not associated with their histological pattern. GISTs with high mitotic rate demonstrated heterogeneous expression of DOG-1 in tumors: moderate expression (2+) with patchy areas of strong expression (3+). Expression of CD56 was not found in spindle cell GISTs, but single tumor cells of epithelioid GISTs that had high mitotic rate demonstrated expression of this marker. The average expression of p16ink4A were higher in tumors that gave relapses compared with tumors without relapses (50,3 % versus 5,7 % respectively, U-test=16.5; p≤0,01).The average expression of MMP-9 also were significantly higher in GISTs that gave relapses: 63,2 % compared with 13,4 % in GISTs without relapse (U-test=16; p≤0 ,01).The strong VEGF expression was found in 66,7 % of GISTs that had relapses and only in 8,3 % of GISTs without relapses. 50 % of GISTs without relapses was negative for VEGF. Finally, the average expression of Ki-67 were 13,4 % in GISTs with relapses and 8,7 % in GISTs without them (U-test=16; p≤0,01). Conclusion. We highly recommend using DOG-1 for epithelioid GISTs. Additionally in epithelioid GISTs can be used CD56 that can give focal positive reaction in some tumour cells. The following minimal panel of markers for differential diagnosis of spindled GISTs from other mesenchymal tumors of gastrointestinal tract is proposed: CD117, DOG-1 and SMA, where the first too markers will demonstrated the moderate or strong diffuse expression and SMA can be occasionally positive in some tumor cells. p16ink4A, ki-67, VEGF and MMP-9 can be used as additional prognostic markers in GISTs.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Immunohistochemical features of gastrointestinal stromal tumors and their role for differential diagnosis and prognosis

Miroshnichenko¹

2021

Eureka: HS

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“…Patients with locally advanced GISTs and metastatic GISTs have a 5-year survival rate of 80% and 55%, respectively [34]. For the diagnosis of GISTs of ≥20 mm in size, it is recommended to obtain histological specimens by EUS-FNA or surgery.…”

Section: Indicationsmentioning

confidence: 99%

The Diagnosis of Small Gastrointestinal Subepithelial Lesions by Endoscopic Ultrasound-Guided Fine Needle Aspiration and Biopsy

2022

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Endoscopic ultrasonography (EUS) has been widely accepted in the diagnosis of all types of tumors, especially pancreatic tumors, lymph nodes, and subepithelial lesions (SELs). One reason is that the examination can provide a detailed observation, with tissue samples being immediately obtained by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). Many SELs are detected incidentally during endoscopic examinations without symptoms. Most SELs are mesenchymal tumors originating from the fourth layer, such as gastrointestinal stromal tumors (GISTs), leiomyomas, and schwannomas. GISTs are potentially malignant. Surgical treatment is recommended for localized GISTs of ≥20 mm. However, the indications for the diagnosis and follow-up of GISTs of <20 mm in size are controversial. There are several reports on the rapid progression or metastasis of small GISTs. Therefore, it is important to determine whether a SEL is a GIST or not. The main diagnostic method is EUS-FNA. Recently, endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) using a new biopsy needle has been reported to obtain larger tissue samples. Additionally, various biopsy methods have been reported to have a high diagnostic rate for small GISTs. In local gastric SELs, regardless of the tumor size, EUS can be performed first; then, EUS-FNA/B or various biopsy methods can be used to obtain tissue samples for decision-making in relation to therapy and the follow-up period.

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“…The goal of surgery is to remove the primary tumor and its pseudo-capsule to achieve a negative microscopic margin. 14 Since gastrointestinal stromal tumors are inherently low invasive and rarely undergo lymph node metastasis, surgery does not require large margins and lymph node removal. 15 For GISTs with distant metastasis, it is not a contraindication to tumor resection.…”

Section: Discussionmentioning

confidence: 99%

Radical Versus Non-Radical Resection for Small intestinal Gastrointestinal Stromal Tumors: A Propensity Score-Matched Analysis

Yin¹,

Yan²,

Lin³

et al. 2021

Preprint

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Surgical resection is the first choice for the treatment of small intestinal gastrointestinal stromal tumors (GISTs), but the best surgical method for small intestinal stromal tumors remains undefined. It is not clear whether there is a difference in the long-term survival of small intestinal GISTs between radical surgery and non-radical surgery. We included 877 patients with small intestinal stromal tumors who underwent surgery between 2010 and 2015 from the SEER database. They were divided into the radical resection group and the non-radical resection group. To minimized the selection bias and mixed bias in the comparison, propensity score matching (PSM) and multivariate regression analysis were carried out. In the entire cohort, 120 patients underwent radical surgery and 757 patients received non-radical resection. The 1, 3, and 5-year OS rates were 95.7%, 80.2%, and 69.6% in the radical resection group versus 94.3%, 86.8%, and 77.2% in the non-radical resection group, respectively. (p=0.069) Meanwhile, radical resection had the similar CSS rates of 1, 3 and 5-year compared with non-radical surgery. (1-year CSS rate: 97.4% vs. 98.0%, 3-year CSS rate: 86.1% vs. 93.2%, 5-year CSS rate: 81.6% vs. 88.3%; p =0.056) Besides, after adjusting for other clinical factors and PSM, the long-term OS and CSS did not significantly differ between radical surgery and non-radical surgery. Our study preliminarily found that for small intestinal GISTs, there was no significant difference in long-term survival between radical surgery and non-radical surgery.

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Gastrointestinal Stromal Tumors—A Mini Review

Cited by 50 publications

References 65 publications

Immunohistochemical features of gastrointestinal stromal tumors and their role for differential diagnosis and prognosis

Immunohistochemical features of gastrointestinal stromal tumors and their role for differential diagnosis and prognosis

The Diagnosis of Small Gastrointestinal Subepithelial Lesions by Endoscopic Ultrasound-Guided Fine Needle Aspiration and Biopsy

Radical Versus Non-Radical Resection for Small intestinal Gastrointestinal Stromal Tumors: A Propensity Score-Matched Analysis

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