Gastrointestinale Stromatumoren (GIST) – Probleme in Diagnostik und Therapie

Abstract

Gastrointestinal stromal tumors (GIST), which form a rare group of neoplasias of the gastrointestinal tract, have not yet been fully investigated. Although good progress has been made in their diagnosis, classification of these lesions with regard to their histogenesis and biological behavior remains problematic. Between 1994 and 1998, 18 GIST patients underwere operation in the Department of Surgery. Twelve of these patients (67%) had stromal tumors in the stomach, and six (33%) had intestinal stromal tumors. The primary tumor could be removed in all patients with R0 resection. Six patients developed hematogenous liver metastasis, with the size of their primary tumor exceeding 10 cm. Extrahepatic distant metastases were not found in any case. Lymphadenectomy showed that lymph node metastases did not occur. Histological evaluation was made according to the guidelines of Lewin, Weinstein and Riddell. Currently established therapy is limited to complete surgical resection of the primary tumor and its metastases. Adjuvant or neoadjuvant chemotherapy approaches have failed.

A systematic review on the clinical diagnosis of gastrointestinal stromal tumors

“…The diagnostic value of endoluminal diagnostic studies, such as endoscopy þ mucosal biopsy or contrast radiography appeared to be limited [26,29,30,43,47,[49][50][51][52][53][54]63,68,70]. As expected their pooled diagnostic yield was similarly low 33.8% and 35.1%, respectively.…”

“…The pooled diagnostic yield of simple EUS Table IV). The diagnostic yield of CT scan was reported in 10 studies [26,29,30,33,36,47,49,52,54,70] and that of MRI in 5 [29,30,47,54]. The pooled diagnostic yield of these two exams was similar: 73.6% (range 34.8-100%) and 91.7% (range 75-100%) respectively (P ¼ 0.07).…”

“…Our most surprising result was that in the 37 studies including clear descriptions of the clinical presentation its most common featureobserved in 30%-was gastrointestinal bleeding [25][26][27][28][29][30][31][32][33]35 result certainly included chronic occult bleeding (presented as separate symptom in only 15 papers) it is nonetheless, an impressive, unexpected finding. As GISTs are submucosal neoplasms, they should not theoretically bleed in the gut lumen.…”

“…Twenty studies included clear descriptions of the diagnostic procedures and provided adequate information about their diagnostic yields [26,29,30,33,35,36,[42][43][44]47,49,51] calculated for each one and then pooled. The diagnostic yield of a simple endoscopy was described in 11 studies [26,29,30,43,47,49,53,63,68,70] and that of intestinal contrast radiology in 5 [30,49,51,54,70].…”

“…The diagnostic yield of a simple endoscopy was described in 11 studies [26,29,30,43,47,49,53,63,68,70] and that of intestinal contrast radiology in 5 [30,49,51,54,70]. The pooled diagnostic yield of endoscopy þ mucosal biopsy and of intestinal contrast radiography was similar being respectively 33.8% (range 0-100%) and 35.1% (range 11-100%) (P ¼ 0.98).…”