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BACKGROUND: Small bowel tumors (SBT) are infrequent and represent a small proportion of digestive neoplasms. There is scarce information about SBT in Latin America. AIM: To describe the epidemiology, clinical characteristics, diagnostic methods, and survival of malignant SBTs. METHODS: Retrospective observational study of adult patients with histopathological diagnosis of SBT between 2007 and 2021 in a university hospital in Chile. RESULTS: A total of 104 patients [51.9% men; mean age 57 years] with SBT. Histological type: neuroendocrine tumor (NET) (43.7%, n=38), gastrointestinal stromal tumors (GIST) (21.8%, n=19), lymphoma (17.2%, n=15) and adenocarcinoma (AC) (11.5%, n=10). GIST was more frequent in duodenum (50%; n=12) and NET in the ileum (65.8%; n=25). Metastasis was observed in 17 cases, most commonly from colon and melanoma. Nausea and vomiting were significantly more often observed in AC (p=0.035), as well as gastrointestinal bleeding in GIST (p=0.007). The most common diagnostic tools were CT and CT enteroclysis with an elevated diagnostic yield (86% and 94% respectively). The 5-year survival of GIST, NET, lymphoma and AC were 94.7% (95%CI: 68.1-99.2), 82.2% (95%CI: 57.6-93.3), 40.0% (95%CI: 16.5-82.8) and 25.9% (95%CI: 4.5-55.7%), respectively. NET (HR 6.1; 95%CI: 2.1-17.2) and GIST (HR 24.4; 95%CI: 3.0-19.8) were independently associated with higher survival compared to AC, adjusted for age and sex. CONCLUSIONS: Malignant SBT are rare conditions and NETs are the most common histological subtype. Clinical presentation at diagnosis, location or complications may suggest a more probable diagnosis. GIST and NET are associated with better survival compared to other malignant subtypes.
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Hospitales Universitarios , Neoplasias Intestinales , Intestino Delgado , Humanos , Persona de Mediana Edad , Masculino , Femenino , Estudios Retrospectivos , Chile/epidemiología , Hospitales Universitarios/estadística & datos numéricos , Pronóstico , Anciano , Neoplasias Intestinales/epidemiología , Neoplasias Intestinales/patología , Neoplasias Intestinales/diagnóstico , Intestino Delgado/patología , Adulto , Tumores del Estroma Gastrointestinal/epidemiología , Tumores del Estroma Gastrointestinal/patología , Tumores del Estroma Gastrointestinal/diagnóstico , Anciano de 80 o más Años , Tasa de Supervivencia , Tumores Neuroendocrinos/epidemiología , Tumores Neuroendocrinos/diagnóstico , Tumores Neuroendocrinos/patología , Adenocarcinoma/epidemiología , Adenocarcinoma/diagnóstico , Adenocarcinoma/patología , Adulto Joven , Linfoma/epidemiología , Linfoma/diagnóstico , Linfoma/patologíaRESUMEN
INTRODUCTION: The critical role of microRNA-128 (miR-128) in gastrointestinal-related diseases has been documented. In the current study, we tried to clarify the specific role miR-128 in gastrointestinal stromal tumor (GIST) and the underlying mechanism. METHODS: Differentially expressed genes in GIST were identified following bioinformatics analysis. Then, expression patterns of miR-128 and B-lymphoma Mo-MLV insertion region 1 (BMI-1) in clinical tissue samples and cell lines were characterized, followed by validation of their correlation. GIST-T1 cells were selected and transfected with different mimic, inhibitor, or siRNA plasmids, after which the biological functions were assayed. RESULTS: We identified low miR-128 and high BMI-1 expression in GIST tissues of 78 patients and 4 GIST cell lines. Ectopic expression of miR-128 or silencing of BMI-1 suppressed the malignant potentials of GIST-T1 cells. As a target of miR-128, BMI-1 re-expression could partly counteract the suppressive effect of miR-128 on the malignancy of GIST-T1 cells. CONCLUSION: Our study provided evidence that miR-128-mediated silencing of BMI-1 could prevent malignant progression of GIST, highlighting a promising anti-tumor target for combating GIST.
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Tumores del Estroma Gastrointestinal , Linfoma , MicroARNs , Humanos , MicroARNs/genética , MicroARNs/metabolismo , Tumores del Estroma Gastrointestinal/genética , Tumores del Estroma Gastrointestinal/patología , Proliferación Celular , ARN Interferente Pequeño/farmacología , Línea Celular Tumoral , ApoptosisRESUMEN
RESUMEN El tumor estromal gastrointestinal representa el 3% de las neoplasias gastrointestinales; es el tumor mesenquimático más frecuente. Afecta a hombres mayores de 50 años. El 80% son benignos, la mayoría afectan el estómago e intestino delgado. La incidencia de localización extragastrointestinal es desconocida. Paciente masculino de 56 años, tabaquista, obeso, con hipertensión arterial (HTA) y diabético (DBT), anticoagulado, consulta por dolor en fosa ilíaca derecha, posterior a esfuerzo físico. Se realiza tomografía computarizada (TC) donde se visualiza lesión de aspecto expansivo intraperitoneal que muestra realce periférico. Se decide conducta quirúrgica. Se halla un tumor mesentérico. En su presentación, estos tumores hasta en un 60% suelen ser asintomáticos por lo que resultan solo un hallazgo imagenológico; es indispensable, pues, su sospecha clínica y fundamentalmente el aporte de la inmunohistoquímica para la definición de la patología. El CD 117 es el principal marcador. Su tratamiento de preferencia es siempre quirúrgico, acompañado de tratamientos quimioterápicos.
ABSTRACT Gastrointestinal stromal tumors (GISTs) account for < 3% of gastrointestinal neoplasms and are the most common mesenchymal tumors. They are more common in men > 50 years. They are benign in 80% of the cases and usually occur in the stomach and small intestine. The incidence of extragastrointestinal GISTs is unknown. A 56-year-old male patient sought medical care for abdominal pain in the right iliac fossa that appeared after exercising. The patient was a current smoker, obese, had a history of hypertension (HTN) and diabetes (DBT) and was receiving anticoagulants. A computed tomography (CT) scan showed an expansive mass within the peritoneum with peripheral enhancement. Surgical management was decided. During the procedure, a tumor was found in the mesentery. Up to 60% of these tumors are usually asymptomatic and are incidentally found in imaging tests; therefore, clinical suspicion and, most importantly immunohistochemistry, are essential for the diagnosis. CD117 is the main marker. Surgery is the treatment of choice for GISTs and chemotherapy is also indicated.
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Humanos , Masculino , Persona de Mediana Edad , Tumores del Estroma Gastrointestinal/cirugía , Neoplasias Gastrointestinales/cirugía , Ileostomía , Tumores del Estroma Gastrointestinal/patología , Tumores del Estroma Gastrointestinal/diagnóstico por imagen , LaparotomíaRESUMEN
RESUMEN Los tumores GIST son un motivo de consulta cada vez más frecuente en las entrevistas de cirugía gastroenterológica. Suelen ser derivados como hallazgos incidentales o por presentar síntomas derivados de su crecimiento. Se presenta el caso clínico de una paciente que requirió internación de urgencia por síndrome anémico agudo. Se comenta su algoritmo diagnóstico y su resolución quirúrgica. Asimismo se comentan los estándares de diagnóstico y tratamiento actuales con especial foco en la estrategia quirúrgica, la cual debe ser individualizada según cada caso.
ABSTRACT Gastrointestinal stromal tumors (GISTs) are becoming an increasingly common reason for consultation in gastroenterology surgery interviews. Patients are usually referred for surgery due to an incidental finding or symptoms associated with tumor growth. We report the case of a female patient who required urgent hospitalization due to acute anemic syndrome. The diagnostic algorithm and surgical approach are described. The current standards of diagnosis and treatment are also discussed, with special focus on the surgical strategy, which must be tailored to each case.
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Humanos , Femenino , Persona de Mediana Edad , Tumores del Estroma Gastrointestinal/cirugía , Neoplasias Gastrointestinales/cirugía , Endoscopía del Sistema Digestivo , Tumores del Estroma Gastrointestinal/patología , Tumores del Estroma Gastrointestinal/diagnóstico por imagen , Neoplasias Gastrointestinales/diagnóstico por imagen , LaparotomíaRESUMEN
Resumen Introducción Los tumores del estroma gastrointestinal (GIST) corresponden al 1% de todas las neoplasias gastrointestinales, sin embargo, sólo el 3-5% de estos se desarrollan en el duodeno. Objetivo Reportar el caso de un paciente masculino con localización atípica de un tumor de estroma gastrointestinal y su manejo. Caso clínico paciente masculino de 50 años con antecedente de traumatismo encefalo craneano (TEC) con daño orgánico cerebral secundario, tabaquismo, consumidor de alcohol ocasional y sometido a quistectomía branquial en la infancia, que consulta en el servicio de urgencias por cuadro de hemorragia digestiva alta con compromiso hemodinámico. Tras realizar endoscopia digestiva alta (EDA), resonancia nuclear magnética (RNM) y tomografía computada (TC) de abdomen, se pesquisa masa tumoral en segunda porción de duodenal. Discusión A pesar de que la presentación clínica de los GIST es variable, lo más frecuente es que sean pacientes asintomáticos. En algunas ocasiones, al igual que en este reporte, pueden presentarse con dolor abdominal y/o hemorragia digestiva alta. El diagnóstico preoperatorio fue difícil ya que el estudio con imágenes (TC, RNM, EDA) sólo permite establecer la sospecha; el diagnóstico definitivo se realizó con biopsia (no contamos con endosonografía en nuestro centro). Debido a los sitios de reparo anatómico, no existe una cirugía estandarizada; en este caso, debido a la localización, infiltración y características, se decidió realizar una pancreatoduodenectomía.
Introduction Gastrointestinal stromal tumors (GIST), corresponds to 1%, of all gastrointestinal neoplasms, however, only 3%-5% developed in duodenum. Aim To report a case of a male patient with atypical location of gastrointestinal stroma tumor and the treatment proposed. Case report 50-year-old male patient, with medical history of organic brain damage secondary a traumatic brain injury, smoker, occasional alcohol consumer and branquial cystomy during childhood. Consulted in the emergency department for a high digestive hemorrhage case with hemodynamic compromise. Upper digestive endoscopy, computed tomography and nuclear magnetic resonance were performed, which impresses tumor-like lesion in the second duodenal portion. Discussion Although the GIST clinical presentation is variable, most often they are asymptomatic patients. In some times, as in this report, they may present with abdominal pain and/or upper gastrointestinal bleeding. The preoperative diagnosis was difficult, because the imaging study (CT, RNM, EDA) only stablished the suspicion and the final diagnosis was made by biopsy (we don't have endosonography in our center). Due to the anatomic repair, there is not a standardized surgery, in this case, due tumor location, infiltration and characteristics, it was decided to perform a pancreatoduodenectomy.
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Humanos , Masculino , Persona de Mediana Edad , Tumores del Estroma Gastrointestinal/diagnóstico , Neoplasias Gastrointestinales/patología , Hemorragia Gastrointestinal/etiología , Tomografía Computarizada por Rayos X , Tumores del Estroma Gastrointestinal/complicaciones , Tumores del Estroma Gastrointestinal/patología , Hemorragia Gastrointestinal/complicacionesAsunto(s)
Tumores del Estroma Gastrointestinal/genética , Proteínas de Fusión Oncogénica/genética , Receptor trkA/genética , Neoplasias del Recto/genética , Prolapso Rectal/etiología , Biopsia , Colonoscopía , Tumores del Estroma Gastrointestinal/diagnóstico , Tumores del Estroma Gastrointestinal/patología , Tumores del Estroma Gastrointestinal/cirugía , Humanos , Lamina Tipo A/genética , Masculino , Proctectomía , Neoplasias del Recto/diagnóstico , Neoplasias del Recto/patología , Neoplasias del Recto/cirugía , Recto/diagnóstico por imagen , Recto/patología , Recto/cirugía , Adulto JovenRESUMEN
Background: Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastrointestinal tract. It is exposed a clinical case of jejunal GIST from a second-level hospital in Mexico. Clinical case: Female patient of 76 years, with history of tobacco use (two cigarettes per day for 25 years), that is referred to General Surgery due to a four month evolution of symptoms, characterized by abdominal pain, hyporexia and urinary symptomatology. Physical examination revealed a non-pulsatile, solid, non-mobile, non-painful mass in the hypogastrium and right iliac fossa of approximately 15 cm in length. Ovarian tumor was ruled out, since CEA and CA-125 tumor markers were negative. Abdominopelvic ultrasound was performed and reported a solid tumor with cystic spaces inside. CT reported a solid tumor of 9.5 x 2.5 x 8.3 cm, with defined edges, multilobed, presence of some calcifications in its wall that did not show enhancement with the use of contrast media. Patient underwent exploratory laparotomy and it was found a jejunal tumor, 210 cm from the ligament of Treitz. Immunohistochemistry reported positivity to KIT and DOG1, confirming the diagnosis of GIST. Conclusion: GISTs are uncommon entities. Their clinical presentation is insidious and the preoperative diagnosis is complex due to the need for biopsy. The treatment is surgery, but tyrosine kinase inhibitors should be administered. Even in patients with response to treatment, follow-up is mandatory due to the risk of recurrence.
Introducción: los tumores del estroma gastrointestinal (GIST) son los tumores mesenquimatosos más comunes del tracto gastrointestinal. Se expone un caso clínico de GIST en yeyuno que se presentó en un hospital de segundo nivel en México. Caso clínico: femenino de 76 años, con antecedente de tabaquismo (dos cigarros diarios durante 25 años), referida a Cirugía General por cuadro de cuatro meses de evolución (dolor abdominal tipo cólico en hipogastrio, hiporexia y sintomatología urinaria). A la exploración física, se le detectó tumor no pulsátil, sólido, no móvil, no doloroso, adherido a planos profundos en hipogastrio y fosa ilíaca derecha de aprox. 15 cm de longitud. Se descartó tumor ovárico al resultar negativos los marcadores tumorales ACE y CA-125. Se realizó ultrasonido abdominopélvico que reportó imagen de tumoración sólida con zonas quísticas en su interior. La TC reportó tumoración sólida, de bordes definidos, multilobulada con algunas calcificaciones milimétricas en su pared de 9.5 x 2.5 x 8.3 cm y sin realce al administrar medio de contraste. La paciente se sometió a laparotomía exploradora y se encontró tumoración adherida a yeyuno a 210 cm del ligamento de Treitz. El tumor fue positivo a KIT y DOG1, lo que confirmó el diagnóstico de GIST de patrón fusiforme. Conclusión: los GIST son poco frecuentes. Su presentación clínica es insidiosa y el diagnóstico preoperatorio es complejo debido a la toma de biopsia. El tratamiento continúa siendo la cirugía, pero se deben administrar inhibidores de la tirosina cinasa. Incluso en pacientes con respuesta favorable al tratamiento, se recomienda seguimiento por riesgo de recidiva.
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Tumores del Estroma Gastrointestinal , Anciano , Antineoplásicos/uso terapéutico , Femenino , Tumores del Estroma Gastrointestinal/diagnóstico , Tumores del Estroma Gastrointestinal/patología , Tumores del Estroma Gastrointestinal/cirugía , Humanos , Inmunohistoquímica , México , Recurrencia Local de Neoplasia , Proto-Oncogenes MasRESUMEN
Abstract Background This study defines the disease profile in south Indian population and determine the clinic-pathological aspects of Gastro-Intestinal Stromal Tumors. Method In this prospective study patients diagnosed of gastrointestinal stromal tumors were taken thorough clinical examination and a database of Anthropometric details and clinical details were analyzed. Pathological data included tumor size, presence or absence necrosis, mitotic counts, immunohistochemistry for CD-117, CD-34. Results There were 44 patients with confirmed diagnosis of gastro-intestinal stromal tumor. The highest incidence was found in the 6th decade. The most common symptoms were abdominal pain and gastrointestinal bleed. Stomach was most frequent site for gastro-intestinal stromal tumors. Immunochemistry for CD-117 was positive in 93.18% cases. Majority of tumors (79.5%) had pure spindle cell morphology and mitotic activity showed that 34% of the GISTs were of the high risk group. Forty two patients were suggestive of surgery as the primary treatment after presentation. Conclusion Abdominal pain was the most common presenting complaint. Majority of the tumors aroused from the stomach. The majority of the tumors had pure spindle cell morphology and 93% of the tumors were CD-117 positive. A significant relationship between tumor size, tumor necrosis and mitotic activity with large tumors having necrosis and high mitotic rate having high risk of malignancy, was observed. Surgical resection is considered mainstay of treatment of gastro-intestinal stromal tumor. Imatinib therapy should be given to patients in moderate to severe risk categories.
Resumo Justificativa Este estudo define o perfil da doença na população do sul da Índia e determina os aspectos clínicos e patológicos dos tumores estromais gastrointestinais. Método Neste estudo prospectivo, os pacientes diagnosticados com tumor estromal gastrointestinl foram submetidos a um exame clínico completo, e uma série de dados dos pacientes, incluindo detalhes antropométricos e clínicos, foram analisados. Os dados patológicos incluíram tamanho do tumor, presença ou ausência de necrose, contagem mitótica e imuno-histoquímica para CD-117, CD-34. Resultados Havia 44 pacientes com diagnóstico confirmado de tumor estromal gastrointestinal. A maior incidência foi encontrada na 6ª década de vida. Os sintomas mais comuns foram dor abdominal e sangramento gastrointestinal. O estômago foi o local mais frequente para tumores estromais gastrointestinais. A imuno-histoquímica para CD-117 foi positiva em 93,18% dos casos. A maioria dos tumores (79,5%) apresentava morfologia pura de células fusiformes e a atividade mitótica mostrou que 34% dos GISTs pertenciam ao grupo de alto risco. Quarenta e dois pacientes receberam indicação para cirurgia como tratamento primário após a apresentação. Conclusão A dor abdominal foi a queixa mais comum. A maioria dos tumores afetava o estômago, apresentava morfologia pura de células fusiformes e 93% eram CD-117 positivos. Foi observada uma relação significativa entre o tamanho do tumor, a necrose tumoral e a atividade mitótica, com os tumores grandes apresentando necrose e alta taxa mitótica com alto risco de malignidade. A ressecção cirúrgica é considerada o principal tratamento do tumor estromal gastrointestinal. A terapia com imatinibe deve ser administrada a pacientes em categoria de risco de moderadas a grave.
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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Adulto Joven , Tumores del Estroma Gastrointestinal/patología , Neoplasias Gastrointestinales , Proteínas Proto-Oncogénicas c-kit/inmunología , Antígenos CD34/inmunología , Mesilato de Imatinib/uso terapéutico , India , Antineoplásicos/uso terapéuticoRESUMEN
Background: Gastrointestinal stromal tumor (GIST) is a malignant mesenchymal neoplasm rarely described in the veterinary routine. The aim of this study was to report a case of GIST accompanied by a periosteal reaction, suggestive ofhypertrophic osteopathy, in a dog.Case: An 11-year-old male dog had a history of progressive weight loss, difficulty in locomotion, and dyspnea. During clinical care, increased bone volume was observed. Blood samples were collected for a complete blood count and biochemicalanalysis. The dog also underwent thoracic radiography and abdominal ultrasonography. The test results revealed anemia,leukocytosis, hypocalcemia, hypoalbuminemia, and hypocholesterolemia. The radiographic images of the limbs showeda generalized periosteal reaction, and thoracic radiography indicated changes compatible with mild chronic lung disease.Ultrasonographic findings indicated a neoformation in the intestinal loop of the right mesogastric region and increasedvolume in the left testicle, both of which were indicative of neoplasia. Therefore, the dog was referred for surgery, whereinthe intestinal mass and both testes were removed; the intestinal mass and left testicle were subjected to histopathologicaldiagnosis. The results of the biopsies confirmed that the testicular neoplasm was a seminoma, whereas the intestinal nodulewas compatible with GIST, and immunohistochemical analysis was necessary to confirm the diagnosis. On the basis ofpositive labeling for the antibodies vimentin, desmin, S100, and c-kit, the diagnosis of GIST was confirmed. Therefore,the animal underwent metronomic chemotherapy with 12 mg/m2 cyclophosphamide every 24 h for 3 months, and thereafter every 48 h for 6 months. Moreover, the dog was periodically monitored via imaging (radiography of the anteriorand posterior limbs, abdominal ultrasonography, and computed tomography)...(AU)
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Animales , Perros , Tumores del Estroma Gastrointestinal/patología , Tumores del Estroma Gastrointestinal/veterinaria , Hiperostosis/patología , Hiperostosis/veterinaria , Inmunohistoquímica/veterinariaRESUMEN
PURPOSE OF REVIEW: The purpose of this review is to review the past year's literature to provide comprehensive information to researchers, physicians, and the general public regarding the epidemiology, diagnosis, and treatment of gastrointestinal stromal tumors (GISTs). Common ground as well as divergent viewpoints will be highlighted and discussed. RECENT FINDINGS: The diagnosis of GISTs may involve imaging tests such as computed tomorgraphy scan and MRI, endoscopy with or without endoscopic ultrasound, and biopsy. Only biopsy, however, can yield a positive diagnosis. As most GISTs express KIT protein, immunostaining for KIT and/or molecular genetic testing for mutations in KIT can diagnose 95% of GISTs. Regorafenib, a drug that inhibits various protein genes that lead to GIST development is a relatively new treatment modality. SUMMARY: The current review should enable clinicians to best select the diagnostic and treatment approaches to GIST.
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Neoplasias Gastrointestinales/patología , Neoplasias Gastrointestinales/terapia , Tumores del Estroma Gastrointestinal/patología , Tumores del Estroma Gastrointestinal/terapia , Compuestos de Fenilurea/administración & dosificación , Piridinas/administración & dosificación , Biopsia con Aguja , Terapia Combinada , Supervivencia sin Enfermedad , Detección Precoz del Cáncer , Femenino , Neoplasias Gastrointestinales/diagnóstico , Neoplasias Gastrointestinales/epidemiología , Tumores del Estroma Gastrointestinal/diagnóstico , Tumores del Estroma Gastrointestinal/epidemiología , Humanos , Inmunohistoquímica , Masculino , Invasividad Neoplásica/patología , Estadificación de Neoplasias , Medición de Riesgo , Análisis de SupervivenciaRESUMEN
PURPOSE: This SEER-based study aimed to explore and analyze the relationship of metastasis of liver, lung and bone of GIST patients and their prognosis. METHODS: The data of GIST patients were from Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2015 and all the statistical analyses were conducted by statistical software package SPSS (Version 22.0). RESULTS: A total of 4224 GIST patients were identified, of which 388 (9.19%) patients with liver metastasis, 20 (0.47%) patients with bone metastasis and 32 (0.76%) patients with lung metastasis. There was no significant difference of risk of bone or lung metastasis between patients with and without liver metastasis (P = 0.935). The median overall survival of patients with liver, bone, or lung metastasis was, respectively, 49 months, 18 months, and 20 months, which were all shorter than that of patients without metastasis. The overall survival of patients with both liver and bone metastasis and those with metastasis of all three sites was not significantly different from that of patients with only liver metastasis. The multivariate analysis showed age of less than 65 years, female patients, married status and receiving surgery were all the beneficial factors for prognosis of GIST patients with liver metastasis. CONCLUSIONS: Patients with metastasis had a poorer prognosis than those without. Liver metastasis might have no relationship with bone or lung metastasis and liver might play a more dominant role than the other two sites in the prognosis of GIST patients with metastasis. So, more attention should be paid to liver status in diagnosis and treatment of GIST patients.
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Neoplasias Óseas/secundario , Tumores del Estroma Gastrointestinal/patología , Neoplasias Hepáticas/secundario , Neoplasias Pulmonares/secundario , Anciano , Neoplasias Óseas/mortalidad , Femenino , Tumores del Estroma Gastrointestinal/mortalidad , Humanos , Neoplasias Hepáticas/mortalidad , Neoplasias Pulmonares/mortalidad , Masculino , Persona de Mediana Edad , Análisis Multivariante , Pronóstico , Factores de Riesgo , Programa de VERF , Factores de TiempoRESUMEN
RESUMEN El tumor estromal gastrointestinal es el tumor mesenquimático más frecuente y se caracteriza por la expresión de un receptor de factor de crecimiento tirosina kinasa, CD117 c-KIT/CD 117. Se diferencia del resto de los tumores mesenquimáticos en que no expresa esta proteína. Alrededor del 70 - 80 por ciento de estos tumores son benignos, la mayoría se localizan en estómago e intestino delgado (> 90 por ciento). Los tumores estromal gastrointestinal malignos son generalmente de gran tamaño (> 5 cm), con índice mitótico alto y pueden dar metástasis a hígado y peritoneo. El tratamiento es la resección quirúrgica. Presentamos una paciente con 65 años de edad que acudió al cuerpo de guardia por sufrir caída de sus pies y quejarse de dolor abdominal. Como datos positivos al examen físico se constató palidez cutáneo mucosa y los complementarios de urgencia. El ultrasonido y la tomografía axial computarizada informaron líquido libre en cavidad con cifras de hemoglobina en 6,4 g/L. La punción abdominal constató sangre roja que no coagulaba. Se realizó laparotomía exploratoria encontrando hemoperitoneo y gran tumoración en cara anterior del antro gástrico, con otra pequeña en la porción alta del cuerpo; se realizó resección local con bordes libres de tumor y se suturaron los bordes gástricos. El resultado de la biopsia informó tumor del estroma gastrointestinal de células fusiformes con bajo índice mitótico, que midió 13 x 8 x 8 cm, con marcada angiogénesis y zonas de calcificación(AU)
ABSTRACT Gastrointestinal stromal tumor is the most frequent mesenchymal tumor and is characterized by expression of a tyrosine kinase growth factor receptor, CD117 c-KIT/CD 117. It is different to the rest of mesenchymal tumors in that it does not express this protein. About 70-80 percent of these tumors are benign. The majority are located in the stomach and small intestine (more than 90 percent). Malignant gastrointestinal stromal tumors are usually large (over 5 cm in size), with a high mitotic index, and can metastasize to the liver and peritoneum. The treatment is surgical resection. We present a 65-year-old patient who came to the emergency room due to having fallen on her own feet and complaining of abdominal pain. As positive data to the physical examination, mucous and skin whitening and the emergency complement tests were analyzed. Ultrasound and CT scan reported free fluid in cavity with hemoglobin values at 6.4 g/L. The abdominal puncture showed red blood that did not clot. The exploratory laparotomy showed a hemoperitoneum and a large tumor in the anterior face of the gastric antrum, with a small one in the upper portion of the body; local resection with tumor-free borders was performed and the gastric borders were sutured. The result of the biopsy reported a spindle cell gastrointestinal stromal tumor with a low mitotic index, measuring 13x8x8 cm, with marked angiogenesis and areas of calcification(AU)
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Humanos , Masculino , Anciano , Tumores del Estroma Gastrointestinal/patología , Márgenes de Escisión , Hemoperitoneo/diagnóstico por imagen , Laparotomía/métodosAsunto(s)
Hemorragia Gastrointestinal/etiología , Tumores del Estroma Gastrointestinal/complicaciones , Neoplasias del Yeyuno/complicaciones , Anciano , Femenino , Hemorragia Gastrointestinal/patología , Tumores del Estroma Gastrointestinal/patología , Infecciones por Helicobacter/complicaciones , Helicobacter pylori , Humanos , Neoplasias del Yeyuno/patologíaRESUMEN
PURPOSE: Gastrointestinal stromal tumors (GIST) have the potential to recur and metastasize. Several prognostic schemes have been developed, mostly based on the mitotic count, diameter, and tumor site. However, these systems are not precise enough. The research question was whether the tumor size determined by volumetry allows a better risk stratification than the traditional system, and our aim was to determine the value of tumor volumetry, a feasible and simple parameter, in the recurrence of GIST. METHODS: Seventy-four cases of GIST were studied. The cases presented with non-metastatic disease, which were resected and did not receive imatinib. We compared the clinico-pathologic features of the cases with recurrence against those with non-recurrence and compared the tumor volumetry against the classification system based on tumor size and mitosis. RESULTS: The median age was 58 years (range: 25 to 91 years). Half of the cases were presented in the stomach. The tumor size had a median of 8 cm (range of 1-30 cm). The median mitosis count for 50 HPF was 4 (range 0-92). During the period of study, 16 (21.6%) patients suffered recurrence. The significant differences were that patients with recurrence accounted for more deaths and the follow-up period was larger. The area under the curve (AUC) of the volumetry classification was superior to the AUC of the classification system based on tumor size and mitosis (NIH-criteria) (p = .05). CONCLUSION: Tumor volumetry calculated in the surgical specimen and/or pre-operative tomography was superior to the NIH consensus in stratifying the risk of recurrence in GIST.
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Neoplasias Gastrointestinales/patología , Tumores del Estroma Gastrointestinal/patología , Mitosis , Recurrencia Local de Neoplasia/patología , Medición de Riesgo/métodos , Carga Tumoral , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Neoplasias Gastrointestinales/cirugía , Tumores del Estroma Gastrointestinal/cirugía , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/cirugía , Pronóstico , Curva ROCRESUMEN
Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of the gastrointestinal tract. However, the development of molecular markers, especially circulating biomarkers, remains largely undone for the prognosis of GIST. We discussed the clinical-pathological characteristics of GIST and identified potential biomarkers for guidance of therapy and prognosis of GIST. Around 90% of GISTs contain mutations in KIT or PDGFRA and the remaining 10% of GISTs are wild-type. Recent studies have indicated that various DNAs and miRNAs could serve as potential biomarkers for prognosis of GIST, including KIT, PDGFRA, other DNAs (such as BRAF, SDH, SETD2 and ROR2), and microRNAs (miRNAs). The pressing need and challenges in the development of circulating prognostic biomarkers for GIST are also discussed. Although challenges remain, DNAs and miRNAs are promising circulating biomarkers for surveillance and prognosis of GIST. Advances in clarification of aberrant molecular alterations may open new avenues for exploration of reliable and robust biomarkers to improve the management of GIST.
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Biomarcadores de Tumor/genética , Tumores del Estroma Gastrointestinal/genética , Tumores del Estroma Gastrointestinal/mortalidad , Tumores del Estroma Gastrointestinal/patología , Humanos , PronósticoRESUMEN
Background: Gastrointestinal stromal tumor (GIST) is a malignant mesenchymal neoplasm rarely described in the veterinary routine. The aim of this study was to report a case of GIST accompanied by a periosteal reaction, suggestive ofhypertrophic osteopathy, in a dog.Case: An 11-year-old male dog had a history of progressive weight loss, difficulty in locomotion, and dyspnea. During clinical care, increased bone volume was observed. Blood samples were collected for a complete blood count and biochemicalanalysis. The dog also underwent thoracic radiography and abdominal ultrasonography. The test results revealed anemia,leukocytosis, hypocalcemia, hypoalbuminemia, and hypocholesterolemia. The radiographic images of the limbs showeda generalized periosteal reaction, and thoracic radiography indicated changes compatible with mild chronic lung disease.Ultrasonographic findings indicated a neoformation in the intestinal loop of the right mesogastric region and increasedvolume in the left testicle, both of which were indicative of neoplasia. Therefore, the dog was referred for surgery, whereinthe intestinal mass and both testes were removed; the intestinal mass and left testicle were subjected to histopathologicaldiagnosis. The results of the biopsies confirmed that the testicular neoplasm was a seminoma, whereas the intestinal nodulewas compatible with GIST, and immunohistochemical analysis was necessary to confirm the diagnosis. On the basis ofpositive labeling for the antibodies vimentin, desmin, S100, and c-kit, the diagnosis of GIST was confirmed. Therefore,the animal underwent metronomic chemotherapy with 12 mg/m2 cyclophosphamide every 24 h for 3 months, and thereafter every 48 h for 6 months. Moreover, the dog was periodically monitored via imaging (radiography of the anteriorand posterior limbs, abdominal ultrasonography, and computed tomography)...
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Animales , Perros , Hiperostosis/patología , Hiperostosis/veterinaria , Tumores del Estroma Gastrointestinal/patología , Tumores del Estroma Gastrointestinal/veterinaria , Inmunohistoquímica/veterinariaRESUMEN
OBJECTIVES: To evaluate the diagnostic yield of the cell block (CB) technique with immunohistochemistry in patients with mesenchymal neoplasms of the gastrointestinal tract collected by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). METHODS: Tissue samples from consecutive patients with subepithelial lesions collected by EUS-FNA, without analysis by on-site cytopathology, were evaluated by the same pathologist only using CBs in AAF fixative. Sections were stained with haematoxylin-eosin and underwent complementary immunohistochemical staining for SMA, CD117, DOG-1 and S100 in the presence of mesenchymal neoplasms. Specimens were defined as diagnostic when sufficient tissue was present for histopathological evaluation and immunohistochemistry analysis. If they were insufficient for complete evaluation, the specimens were considered nondiagnostic. RESULTS: Between September 2012 and December 2016, a total of 158 patients (median age: 57 years, 64.5% women) underwent EUS-FNA with an average of three needle passes for every lesion. The median lesion size was 17 mm. There were 113 mesenchymal neoplasms confirmed by immunohistochemistry (66 leiomyomas, 44 GISTs, two schwannomas, one leiomyosarcoma). The overall diagnostic yield of CBs was 84.17%. However, diagnosis was obtained in 98.5% (133/135) of the cases after exclusion of 23 cases in which EUS-FNA sampling was insufficient or without tumoural tissue. Only two mesenchymal neoplasms were not confirmed by CBs even after immunohistochemistry. CONCLUSIONS: CBs collected by EUS-FNA and analysed by immunohistochemistry showed a high diagnostic yield in patients with mesenchymal neoplasms, even without on-site cytopathology.
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Tumores del Estroma Gastrointestinal/diagnóstico , Tumores del Estroma Gastrointestinal/patología , Tracto Gastrointestinal/patología , Mesodermo/patología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Diagnóstico Diferencial , Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico/métodos , Femenino , Humanos , Inmunohistoquímica/métodos , Masculino , Persona de Mediana Edad , Agujas , Adulto JovenRESUMEN
PURPOSE: Gastrointestinal stromal tumors (GIST) have the potential to recur and metastasize. Several prognostic schemes have been developed but none are precise enough and most times the pathologist faces a small biopsy where it is not possible to evaluate the mitotic count. Our aim was to determine the influence of ki67 index and other clinicopathologic characteristics in the recurrence of GIST. METHODS: Forty-three consecutive cases of GIST were studied. The cases presented with non-metastatic disease. We compared the clinicopathologic features of cases with recurrence against those with non-recurrence. The ki67 index was determined by square-millimeters. RESULTS: The median age was 55 years (IQR 45-63), the most frequent site of involvement was the stomach with 21 (48.8%) cases, and the median of tumor diameter was 10 cm (IQR 5.5-17.5). Twenty-six (60.5%) cases were spindle cell, 13 (30.2%) were mixed, and 4 (9.3%) were epithelioid. The median mitosis count for 50 high power fields was 4 (IQR 0-16), while per square millimeter it was 1 (IQR 0-5, range 0-32). The median of the ki67 proliferation index was 5% (IQR 1-20). During the period of study, 11 (25.6%) patients recurred. The only significant differences between patients with GIST with recurrence and without recurrence were the sex and tumor size. CONCLUSION: We did not find an association of the ki67 index with recurrence. The factors associated with recurrence were a high tumor size (> 10 cm) and male sex.
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Tumores del Estroma Gastrointestinal/patología , Antígeno Ki-67/análisis , Recurrencia Local de Neoplasia/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Biopsia , Estudios Transversales , Femenino , Tumores del Estroma Gastrointestinal/cirugía , Humanos , Inmunohistoquímica , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/patología , Recurrencia Local de Neoplasia/prevención & control , Pronóstico , Factores Sexuales , Estómago/patología , Estómago/cirugíaAsunto(s)
Humanos , Femenino , Adulto , Diafragma/patología , Tumores del Estroma Gastrointestinal/patología , Neoplasias Duodenales/patología , Neoplasias Hepáticas/secundario , Diafragma/cirugía , Diafragma/diagnóstico por imagen , Hepatectomía , Neoplasias Hepáticas/cirugía , Neoplasias Hepáticas/diagnóstico por imagenRESUMEN
Primary omental gastrointestinal stromal tumours (GISTs) are classified as extra-GISTs with a reported incidence of <1% of all GISTs. There are only a few cases in the English literature reporting omental GIST with none reporting acute intra-abdominal haemorrhage as a presenting feature. We report a case of a 67-year-old man who presented with haemorrhage from a primary omental GIST requiring emergency laparotomy.