Large gastrointestinal stromal tumor size does not imply early recurrence

Abstract

A 28-year-old female presented with a huge intra-abdominal mass. Initially a mesenteric mass was diagnosed, but her tumor was found to be a gastrointestinal stromal tumor (GIST). Laparotomy was performed. The mass was resected en bloc with clear surgical margins in January 2007. It was found to be 20 × 18 × 16 cm. In order to remove the tumor, the left half of transverse colon with its mesocolon, spleen, body and tail of pancreas, and a part of the small intestine had to be removed. The mass was tightly attached to these viscera. The tumor was surgically removed three years ago. The pathology report of the case presented places the tumor in the high-risk category. The tumor had a relatively high mitotic index. It was positive for CD117 and CD34 stains and also positive for smooth muscle actin. Although the patient did not receive adjuvant chemotherapy, no signs of local recurrence or distant metastasis could be recognized on follow up. Surgery remains the standard initial management for all localized GISTs. The tumor should be removed en bloc, with clear surgical margin. The case presented indicates no association of tumor size with early local recurrence of the tumor or early distant metastasis.

A cohort study of prognostic factors associated with recurrence or metastasis of gastrointestinal stromal tumor (GIST) of stomach

“…1.802–24.653, p-value 0.004). The correlation between tumor size and mitotic index shows a statistical significance (p-value 0.036) in mitotic count more than 6 HPF by independent to size of tumor which like some report has shown the size not correlated with the risk of recurrence [ 8 ]. Finally, these data were interpreted that only mitotic index more than 6 HPF affected recurrence or metastasis and does not depend on tumor size.…”

“…Because GIST are heterogeneous of clinical and morphology which are difficult to predict the prognosis of the disease [ 7 ]. Few studies have focused on the specific risks of solely gastric GIST and some reports have shown the size not correlated the risk of recurrence [ 8 ]. Therefore, the primary aim of this study was to evaluate the risk of recurrence and metastasis of solely gastric GIST receiving curative resection.…”

Treatment options for giant gastrointestinal stromal tumours and related prognosis: a single‐centre retrospective study

“…Because giant GISTs often invade adjacent organs, tumour rupture and bleeding are likely during surgery. Therefore, complete removal of the tumour may require excision of multiple organs . In the present study, there were some patients with severe anaemia in whom emergency surgery was not indicated.…”

Treatment and Prognoses in Patients With Primary Gastrointestinal Stromal Tumors ≥10 cm

“…However, approximately 30% to 50% of GIST patients who underwent complete resection may experience tumor progression within 2 years postoperatively, particularly those with GISTs >10 cm, 4 , 5 thereby affecting long-term outcomes. Combined resection may be adopted for GISTs ≥10 cm because of invasion into adjacent organs, 6 , 7 and the proportion of tumor rupture and extensive intraoperative hemorrhage may also increase at surgery. As a consequence, treating giant GISTs is often a challenge for the attending clinicians.…”

“…Numerous patients with GISTs ≥10 cm have been described, but most reports present case reports. 6 , 13 – 15 In a retrospective study by Wada et al 7 , they reported the prognoses of this subset of patients, but no patient underwent neoadjuvant or adjuvant treatment until recurrence. Hence, clinical management and prognostic predictors remain unknown.…”